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Stutvoet MD, Levelt L, Hrehovcsik MM, Van't Veer J, Visch VT, Bramer WM, Hillegers MHJ, Veltkamp RC, Nijhof SL, Estévez-López F. Gamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review. Games Health J 2024. [PMID: 38900649 DOI: 10.1089/g4h.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.
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Affiliation(s)
- Maartje D Stutvoet
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisa Levelt
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Job Van't Veer
- Department of Healthcare, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
| | - Valentijn T Visch
- Department of Human Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Remco C Veltkamp
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fernando Estévez-López
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024); and CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, Almería, Spain
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Viola AS, Levonyan-Radloff K, Masterson M, Manne SL, Hudson SV, Devine KA. Development of a Self-management and Peer-Mentoring Intervention to Improve Transition Readiness Among Young Adult Survivors of Pediatric Cancer: Formative Qualitative Research Study. JMIR Form Res 2022; 6:e36323. [PMID: 35921137 PMCID: PMC9386586 DOI: 10.2196/36323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood cancer survivors require lifelong risk-based follow-up care. It should be noted that less than one-third of adult survivors of childhood cancer report any survivor-focused care, and fewer than 1 in 5 obtain risk-based follow-up care. It is thought that this may be due to inadequate transition readiness, including low levels of knowledge, skills, motivation, and resources to make the transition to independent self-management of follow-up care. Interventions that focus specifically on improving the transition from parent-managed to self-managed care are needed. Theory and prior research suggest that targeting self-management skills and using peer mentoring may be innovative strategies to improve transition readiness. OBJECTIVE This study aims to identify the content of a self-management intervention to improve transition readiness among adolescent and young adult (AYA) survivors. METHODS Intervention development occurred in 3 stages: formative research with AYA survivors to identify barriers and facilitators to obtaining risk-based survivorship care, content development using feedback from multiple stakeholders (AYA survivors, parents, and providers), and content refinement (usability testing) of the initial proposed educational modules for the program. Content analysis, guided by the social-ecological model of AYA readiness for transition, was used to identify themes and develop and refine the content for the intervention. RESULTS A total of 19 AYA survivors participated in the formative research stage, and 10 AYA survivors, parents, and health care providers participated in the content development and refinement stages. The major barrier and facilitator themes identified included knowledge of cancer history and risks; relationships with health care providers; relationships with family members involved in care; emotions about health, follow-up care, and transfer of care; and lifestyle behaviors and life transitions. These themes were translated into 5 self-management modules: understanding treatment history and the survivorship care plan, managing health care logistics and insurance, communicating with health care providers and family members involved in care, dealing with emotions, and staying healthy in the context of life transitions. Feedback from the key stakeholders indicated that the content was relevant but should include participative elements (videos and tailored feedback) to make the intervention more engaging. The AYA survivors were receptive to the idea of working with a peer mentor and expressed a preference for using SMS text messaging, telephone calls, or videoconference to communicate with their mentor. CONCLUSIONS Incorporating AYA survivors, parents, and providers in the design was essential to developing the content of a self-management and peer-mentoring intervention. AYA survivors confirmed the important targets for the intervention and facilitated design decisions in line with our target users' preferences. The next step will be to conduct a single-arm trial to determine the feasibility and acceptability of the proposed intervention among AYA survivors of childhood cancer.
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Affiliation(s)
- Adrienne S Viola
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | | | - Margaret Masterson
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Sharon L Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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3
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Mobley EM, Moke DJ, Milam J, Ochoa CY, Stal J, Osazuwa N, Kemp J, Bolshakova M, Dinalo J, Motala A, Hempel S. Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review. J Cancer Surviv 2022; 16:667-676. [PMID: 34132984 PMCID: PMC8674368 DOI: 10.1007/s11764-021-01060-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Many childhood cancer survivors experience disparities due to barriers to recommended survivorship care. With an aim to demonstrate evidence-based approaches to alleviate barriers and decrease disparities, we conducted a scoping review of (1) proposed strategies and (2) evaluated interventions for improving pediatric cancer survivorship care. METHODS We searched research databases (PubMed, CINAHL, and PsycINFO), research registries, and grey literature (websites of professional organizations and guideline clearing houses) for guidelines and published studies available through October 2020 (scoping review registration: https://doi.org/10.17605/OSF.IO/D8Q7Y ). RESULTS We identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including clinical practice guidelines (N=9), policy statements (N=4), and recommendations (N=3). Twenty-seven published studies evaluated an intervention to alleviate disparities or barriers to survivorship care; however, these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Most commonly, interventions evaluated survivorship care plans (N=11) or models of care (N=11) followed by individual survivorship care services (N=9). Interventions predominantly targeted patients rather than providers or systems and used technology, education, shared care, collaboration, and location-based interventions. CONCLUSIONS Published studies aimed at overcoming disparities and barriers to survivorship care for childhood cancer survivors revealed that gaps remain between published recommendations and empirical evaluations of interventions aiming to reduce barriers and disparities. IMPLICATIONS FOR CANCER SURVIVORS Additional research is needed to identify evidence-based interventions to improve survivorship care for childhood cancer survivors.
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Affiliation(s)
- Erin M Mobley
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL, USA.
| | - Diana J Moke
- Department of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, University of California, CA, Irvine, Irvine, USA
| | - Carol Y Ochoa
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Julia Stal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Nosa Osazuwa
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Jai Kemp
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
| | - Susanne Hempel
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA
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Prussien KV, Barakat LP, Darabos K, Psihogios AM, King-Dowling S, O'Hagan B, Tucker C, Li Y, Hobbie W, Ginsberg J, Szalda D, Hill-Kayser C, Schwartz LA. Sociodemographics, Health Competence, and Transition Readiness Among Adolescent/Young Adult Cancer Survivors. J Pediatr Psychol 2022; 47:1096-1106. [PMID: 35482609 DOI: 10.1093/jpepsy/jsac039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Fewer than one-third of childhood cancer survivors receive follow-up from an adult provider, and adolescent and young adults (AYAs) from structurally minoritized sociodemographic groups often face health disparities that can impact transition to adult-oriented care. The primary aim of this study was to determine the relation among sociodemographic factors, cumulative effects, and transition beliefs/expectations and goals, and the moderating role of health competence beliefs in AYA survivors of childhood cancer. METHODS A total of 195 AYAs (aged 15-29) reported sociodemographic information, completed the Transition Readiness Inventory assessing positive beliefs/expectations and goals related to transition, and completed the Health Competence Beliefs Inventory assessing health perceptions, healthcare satisfaction, cognitive competence, and autonomy. A cumulative sociodemographic factor variable was computed to investigate the potential additive effects of multiple sociodemographic factors associated with disparities. T-tests, Pearson correlations, and multivariate linear regressions were used. RESULTS Cumulative sociodemographic factors were not related to transition readiness, and insurance type was the only factor associated with health competence beliefs and transition readiness, such that AYAs with public insurance reported lower healthcare satisfaction, cognitive competence, and transition goals relative to those with private insurance. There were no interaction effects; however, health competence beliefs were significantly associated with transition beliefs/expectations and goals. CONCLUSION Public insurance is a barrier to holding positive beliefs/expectations and goals about transition, yet other sociodemographic factors associated with risks for poor transfer were not related to transition readiness. Multi-level interventions to reduce disparities and improve transition readiness should target health competence beliefs and barriers created by insurance.
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Affiliation(s)
- Kemar V Prussien
- Division of Oncology, The Children's Hospital of Philadelphia, USA
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
| | - Katie Darabos
- Division of Oncology, The Children's Hospital of Philadelphia, USA
| | - Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
| | | | - Bridget O'Hagan
- Division of Oncology, The Children's Hospital of Philadelphia, USA
| | - Carole Tucker
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, USA
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
| | - Wendy Hobbie
- Division of Oncology, The Children's Hospital of Philadelphia, USA
| | - Jill Ginsberg
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
| | - Dava Szalda
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
| | - Christine Hill-Kayser
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, USA.,Perelman School of Medicine at the University of Pennsylvania, USA
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5
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Darabos K, Barakat LP, Schapira M, Hill-Kayser C, Schwartz LA. Association of Demographic and Cancer-Specific Factors on Health Behavior Recommendations Specific to Cancer Prevention and Control Among Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2021; 10:619-628. [PMID: 33211609 PMCID: PMC8819508 DOI: 10.1089/jayao.2020.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for long-term health problems that are exacerbated by not meeting health behavior recommendations (e.g., exercise). To identify AYA at risk for not meeting health behavior recommendations, we explored demographic (e.g., age) and cancer-specific (e.g., intensity of treatment) factors associated with not meeting specific health behavior recommendations that have implications for cancer prevention and control. Methods: Regression (linear/binary) was used to examine demographic and cancer-specific associates regarding fruit/vegetable intake, binge drinking, sleep duration, sunscreen use, tobacco use, and physical activity among 307 AYA (Mage = 20.33, range = 15-34) across three combined studies, treated at a pediatric cancer center. Health behavior measures were adapted from The Health Behaviors Survey and the Youth Risk Behavior Surveillance System questionnaire. Results: AYA in general did not meet health behavior recommendations. Compared with AYA with public insurance, AYA with private insurance (β = -0.19, p < 0.01) were more likely to meet multiple health behavior recommendations. AYA at greatest risk for not meeting specific health behaviors were more likely to be diagnosed in middle childhood (11.35years) compared with early childhood (8.38years), be closer to diagnosis (8.77years vs. 11.76years) and closer to treatment completion (6.97years vs. 9.91years), and have a solid tumor (32.7%) compared with a brain tumor (10.6%). Conclusion: Not meeting health behavior recommendations is common among AYA survivors of childhood cancer. Early education in the context of survivorship care is critical to provide teachable moments to AYA; such interventions might impact future long-term health and reduce risk for secondary cancers.
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Affiliation(s)
- Katie Darabos
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lamia P. Barakat
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn Schapira
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Hill-Kayser
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa A. Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Psihogios AM, King-Dowling S, O’Hagan B, Darabos K, Maurer L, Young J, Fleisher L, Barakat LP, Szalda D, Hill-Kayser CE, Schwartz LA. Contextual Predictors of Engagement in a Tailored mHealth Intervention for Adolescent and Young Adult Cancer Survivors. Ann Behav Med 2021; 55:1220-1230. [PMID: 33674863 PMCID: PMC8825221 DOI: 10.1093/abm/kaab008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite the promise of mobile health (mHealth), engagement is often too low for durable health behavior change, and little is known regarding why certain individuals abandon mHealth tools. PURPOSE Guided by a mHealth engagement framework, we evaluated contextual predictors of objective engagement with an app for adolescents and young adults (AYA) who survived cancer. METHODS One hundred and ten AYA survivors (M age = 20.5, 43% female, 30% racial/ethnic minority) were randomized to receive a disease self-management app that delivered 1-2 tailored messages/day for 16 weeks, and contained a survivorship care plan (SCP). Demographic, disease, psychosocial, and setting characteristics were examined as predictors of three objective engagement outcomes: (a) % of active app days, (b) % of messages read, and (c) viewed SCP in the app versus not. A subsample (n = 10) completed qualitative interviews to further assess engagement barriers. RESULTS Self-reported uninterrupted app access (β = -0.56, p < .001), iPhone (vs. Android) ownership (β = 0.30, p < .001), and receiving the intervention in the summer (β = -0.20, p = .01) predicted more active days. Lower depressed mood (β = -0.30, p = .047) and uninterrupted app access (β = -0.50, p < .001) predicted more messages read. Qualitatively, technical glitches and competing priorities were described as engagement barriers, whereas certain types of messages (e.g., health goal messages) were perceived as engaging. Among participants who had uninterrupted app access (n = 76), higher baseline motivation to change, better health perceptions, using the app during the summer, and iPhone ownership predicted higher engagement. CONCLUSIONS Findings demonstrate the importance of comprehensively assessing and planning for multi-level ecological determinants of mHealth engagement in future trials. CLINICALTRIALS.GOV IDENTIFIER NCT03363711.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sara King-Dowling
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bridget O’Hagan
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katie Darabos
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jordyn Young
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Lamia P Barakat
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dava Szalda
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine E Hill-Kayser
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lisa A Schwartz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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7
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Ahmad ZN, Benedict C, Hotchkiss M, Ford JS. Psychological symptoms and patterns of mobile application use for young adult cancer survivors. Psychooncology 2021; 30:1178-1182. [PMID: 33646607 DOI: 10.1002/pon.5662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Zeba N Ahmad
- Doctoral Program in Psychology, The Graduate Center, City University of New York, New York City, New York, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Maiya Hotchkiss
- Department of Psychology, Hunter College, City University of New York, New York City, New York, USA
| | - Jennifer S Ford
- Doctoral Program in Psychology, The Graduate Center, City University of New York, New York City, New York, USA.,Department of Psychology, Hunter College, City University of New York, New York City, New York, USA
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8
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King-Dowling S, Psihogios AM, Hill-Kayser C, Szalda D, O’Hagan B, Darabos K, Daniel LC, Barakat LP, Fleisher L, Maurer LA, Velázquez-Martin B, Jacobs LA, Hobbie W, Ginsberg JP, Vachani CC, Metz JM, Schwartz LA. Acceptability and feasibility of survivorship care plans and an accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer 2021; 68:e28884. [PMID: 33416214 PMCID: PMC9639403 DOI: 10.1002/pbc.28884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-management interventions for adolescent and young adult (AYA) survivors of childhood cancer are needed. The present study reports on the acceptability and feasibility of delivering survivorship care plans (SCPs) and an accompanying app to AYA. PROCEDURE AYA (n = 224) ages 15-29 who completed treatment for cancer were randomized and received a digital SCP only or an SCP plus a mobile app intended to enhance self-management. For 16 weeks, the app delivered one to two daily messages complementing information in their SCP and tailored based on age, treatment, and health goal. Data are presented on feasibility, self-reported acceptability (including satisfaction and perceived benefits) and its relationship to app engagement (for those in app group), and feedback from qualitative interviews conducted with 10 AYA. RESULTS The SCP and app proved feasible as evidenced by high recruitment and retention, access to technology, time analysis, moderate app engagement, and minimal technical issues. However, 12% reported never reading the SCP and 8% never used the app. The app and SCP were acceptable to AYA, and SCP acceptability ratings did not differ between groups. For those with the app, acceptability was positively related to message engagement. AYA recommended enhanced individualization and design features of the SCP and app. CONCLUSIONS Results support the use of tailored SCPs and mobile health interventions for most AYA, as well as the need for further refinement and research. Delivery of SCPs and digital interventions are acceptable and feasible to AYA survivors, and may help promote health-related knowledge and survivorship self-management.
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Affiliation(s)
- Sara King-Dowling
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Alexandra M. Psihogios
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine Hill-Kayser
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Dava Szalda
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Bridget O’Hagan
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Katie Darabos
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | | | - Lamia P. Barakat
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Laurie A. Maurer
- Tennessee Department of Health, HIV/STD/Viral Hepatitis Section, Nashville, TN, USA
| | | | - Linda A. Jacobs
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Wendy Hobbie
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Jill P. Ginsberg
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Carolyn C Vachani
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - James M. Metz
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
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9
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Psihogios AM, Li Y, Ahmed A, Huang J, Kersun LS, Schwartz LA, Barakat LP. Daily text message assessments of 6-mercaptopurine adherence and its proximal contexts in adolescents and young adults with leukemia: A pilot study. Pediatr Blood Cancer 2021; 68:e28767. [PMID: 33073479 PMCID: PMC10313157 DOI: 10.1002/pbc.28767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND This pilot study explored the feasibility and acceptability of implementing text-based assessments of oral chemotherapy adherence in adolescents and young adults (AYA) with leukemia. METHODS AYA prescribed maintenance 6-mercaptopurine (6MP) received daily text message surveys and utilized an electronic pill bottle for 28 days. Text surveys assessed 6MP adherence and contextual associates (eg, mood). Feasibility was defined by recruitment/retention rates, survey completion rates, cost, and technical issues. After the 28-day period, AYA completed an acceptability survey. Secondary analyses compared text survey and electronic pill bottle adherence rates, and explored the daily associations between contextual factors and 6MP nonadherence. RESULTS Eighteen AYA enrolled (M age = 18, range 15-22) and completed study procedures (100% recruitment and retention rates). Adherence survey completion rates were high (M = 88.9%), the technology cost was $204.00, and there were few technical issues. AYA reported high satisfaction with the surveys and perceived them as a helpful medication reminder. While not significantly correlated, survey and electronic pill bottle adherence data converged on the majority of days (>90%). Exploratory analyses showed that AYA were more likely to miss a dose of 6MP on weekends (OR = 2.33, P = .048) and on days when their adherence motivation (OR = 0.28, P = .047) and negative affect (OR = 3.92, P = .02) worsened from their own typical functioning. CONCLUSIONS For AYA with leukemia, daily text-based surveys are a feasible and acceptable method for delivering medication adherence assessments, and may operate as a short-term intervention. To develop personalized mobile health interventions, findings also highlighted the need to study time-varying predictors of 6MP nonadherence.
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Affiliation(s)
- Alexandra M. Psihogios
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yimei Li
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Annisa Ahmed
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Leslie S. Kersun
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lamia P. Barakat
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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The Use and Effect of the Health Storylines mHealth App on Female Childhood Cancer Survivors' Self-efficacy, Health-Related Quality of Life and Perceived Illness. Cancer Nurs 2020; 45:61-69. [PMID: 33337669 DOI: 10.1097/ncc.0000000000000917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND mHealth apps have been not been well tested among childhood cancer survivors (CCSs) to track physical and psychosocial functioning for improved self-management of post-treatment needs. OBJECTIVES This pilot study had 3 aims: (1) assess the usage of the Health Storylines mHealth app; (2) examine its effect in improving self-efficacy in managing survivorship healthcare needs, health-related quality of life, and perceived illness; and (3) determine if app usage moderated the effects on the above patient-reported outcome measures among female CCSs. METHODS Study participants accessed the Health Storylines mHealth app on their own personal device. This single-group, pilot study included 3 measurement points: baseline and 3 and 6 months after initiation of using the app. RESULTS Use of the mHealth app ranged from 0 times to 902 times. Every study participant who used the app (n = 26) also used the mental health app component of the Health Storylines app. Generalized estimating equations were fit to examine the effect of the mHealth app use on self-efficacy, perceived illness, and health-related quality of life, between baseline, 3-month follow-up, and 6-month follow-up. No statistically significant changes were evident, on average, from baseline to 3- or 6-month follow-up on any outcome. Subsequent testing of effect moderation showed differential trends for high versus low users. CONCLUSIONS Studies are needed among this clinical population to determine who will benefit and who will perceive the app as a useful aspect of their survivorship care. IMPLICATIONS FOR PRACTICE Sharing mental health functioning tracked on mhealth apps with healthcare providers may inform needed interventions for young adult female CCSs.
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Schmidt M, Fisher AP, Sensenbaugh J, Ling B, Rietta C, Babcock L, Kurowski BG, Wade SL. User experience (re)design and evaluation of a self-guided, mobile health app for adolescents with mild Traumatic Brain Injury. JOURNAL OF FORMATIVE DESIGN IN LEARNING 2020; 4:51-64. [PMID: 33860150 PMCID: PMC8046025 DOI: 10.1007/s41686-019-00038-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Mild Traumatic Brain Injury (mTBI) is a significant cause of morbidity for adolescents. Currently, there is a lack of evidence-based interventions to address common sequelae of mTBI. To address this gap, we designed a program to promote recovery for adolescents following mTBI. Preliminary testing of the Self-Monitoring Activity Regulation and Relaxation Treatment (SMART) program demonstrated good usability but indicated a need for modifications to the program. The SMART application was redesigned with the addition of more interactive and gamified components. Content was also reframed to specifically target and engage adolescents with mTBI. We describe the usability evaluation of the updated SMART application. Children aged 11-18 years diagnosed with mTBI who were 1 to 6 months post mTBI were recruited to participate in a 1-2-hour usability session in which they thought aloud and responded to targeted usability-related questions during their interaction with the SMART program. After completing the session, participants rated their usability experience using the System Usability Scale (SUS) and rated the overall user-friendliness of the program. Participants' responses during the session were qualitatively coded and analyzed. Six adolescents participated in a usability session (average age = 13.7 years). On the SUS, participants rated the program as highly usable (M = 85.6, SD = 3.24). They also had overwhelmingly positive feedback regarding the content, design and structure of the program. Overall, findings suggest that the redesigned SMART program was usable, acceptable, and relevant to adolescents with mTBI. Based on adolescents' feedback, additional modifications were made before the program undergoes efficacy testing.
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12
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Perspective-taking influences attentional deployment towards facial expressions of pain: an eye-tracking study. Pain 2020; 161:1286-1296. [PMID: 32040077 DOI: 10.1097/j.pain.0000000000001827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Empathetic perspective-taking (PT) may be critical in modulating attention and associated responses to another's pain. However, the differential effects of imagining oneself to be in the pain sufferer's situation ("Self-perspective") or imagining the negative impacts on the pain sufferer's experience ("Other-perspective") on attention have not been studied. The effects of observer PT (Self vs Other) and level of facial pain expressiveness (FPE) upon attention to another person's pain was investigated. Fifty-two adults were assigned to 1 of 3 PT conditions; they were instructed to view pairs of pain expressions and neutral faces and either (1) consider their own feelings (Self-perspective), (2) consider the feelings of the person in the picture (Other-perspective), or (3) received no further instructions (Control). Eye movements provided indices of early (probability and duration of first fixation) and later (total gaze duration) attentional deployment. Pain faces were more likely to be fixated upon first. A significant first fixation duration bias towards pain was observed, which increased with increasing levels of FPE, and was higher in the Self-PT than the Control condition. The proportion of total gaze duration on pain faces was higher in both experimental conditions than the Control condition. This effect was moderated by FPE in the Self-PT condition; there was a significant increase from low to high FPE. When observers attend to another's facial display of pain, top-down influences (such as PT) and bottom-up influences (such as sufferer's FPE) interact to control deployment and maintenance of attention.
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Abstract
PURPOSE OF REVIEW This article reviews the current literature on psychosocial care of children with cancer with particular focus on evidence-based standards of care, including developments in systematic distress screening, utilization of patient-reported outcomes, evidence-based interventions, survivorship, palliative care and bereavement. RECENT FINDINGS Although attention to the psychosocial needs of the child and family is increasingly recognized as an essential element of care for children with cancer, implementing evidence-based care remains suboptimal. Recent efforts have focused on utilizing technology to improve the reach of these interventions and to enhance engagement with special populations, such as adolescents and young adults. Increasing data elucidate the long-term psychological and physical late effects of childhood cancer survivorship and the impact of cancer on siblings and the family. Gaps in clinical care and important directions for future research include the needs of infants and toddlers, overlooked minorities, and patients with hereditary tumor predisposition syndromes, and attention to the psychosocial impact of exciting new treatments, such as autologous chimeric antigen receptor (CAR) T-cell therapy. SUMMARY The evidence base for the psychosocial standards of care for children with cancer and their families continues to grow, but more work is needed to successfully implement these standards across pediatric cancer centers.
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Affiliation(s)
- Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, 10 Center Drive, Room 1C247B-4, Bethesda, MD 20892
| | - Katie A Devine
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Amanda L Thompson
- Center for Cancer and Blood Disorders, Children’s National Health System, Washington, DC
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Schwartz LA, Daniel LC, Henry‐Moss D, Bonafide CP, Li Y, Psihogios AM, Butler ES, Szalda D, Ver Hoeve ES, Hobbie WL, Dowshen NL, Pierce L, Kersun LS, Barakat LP. Feasibility and acceptability of a pilot tailored text messaging intervention for adolescents and young adults completing cancer treatment. Psychooncology 2019; 29:164-172. [DOI: 10.1002/pon.5287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Lisa A. Schwartz
- Philadelphia Pennsylvania
- University of Pennsylvania Philadelphia Pennsylvania
| | | | | | | | - Yimei Li
- Philadelphia Pennsylvania
- University of Pennsylvania Philadelphia Pennsylvania
| | | | | | - Dava Szalda
- Philadelphia Pennsylvania
- University of Pennsylvania Philadelphia Pennsylvania
| | | | | | - Nadia L. Dowshen
- Philadelphia Pennsylvania
- University of Pennsylvania Philadelphia Pennsylvania
| | - Lisa Pierce
- University of Pennsylvania Philadelphia Pennsylvania
| | - Leslie S. Kersun
- Philadelphia Pennsylvania
- University of Pennsylvania Philadelphia Pennsylvania
| | - Lamia P. Barakat
- Philadelphia Pennsylvania
- University of Pennsylvania Philadelphia Pennsylvania
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15
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Preferences for cancer survivorship care among adolescents and young adults who experienced healthcare transitions and their parents. J Cancer Surviv 2019; 13:620-631. [DOI: 10.1007/s11764-019-00781-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/26/2019] [Indexed: 11/26/2022]
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16
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Psihogios AM, Li Y, Butler E, Hamilton J, Daniel LC, Barakat LP, Bonafide CP, Schwartz LA. Text Message Responsivity in a 2-Way Short Message Service Pilot Intervention With Adolescent and Young Adult Survivors of Cancer. JMIR Mhealth Uhealth 2019; 7:e12547. [PMID: 30998225 PMCID: PMC6495290 DOI: 10.2196/12547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Within a 2-way text messaging study in AYAs who recently completed treatment for cancer, we sought to evaluate text message responsivity across different types of text messages. METHODS AYAs who recently completed treatment for cancer (n=26; mean age=16 years; 62% female, 16/26 participants) received 2-way text messages about survivorship health topics over a 16-week period. Using participants' text message log data, we coded responsivity to text messages and evaluated trends in responsivity to unprompted text messages and prompted text messages of varying content (eg, medication reminders, appointment reminders, and texts about personal experiences as a cancer survivor). RESULTS Across prompted and unprompted text messages, responsivity rapidly decreased (P ≤.001 and =.01, respectively) and plateaued by the third week of the intervention. However, participants were more responsive to prompted text messages (mean responsivity=46% by week 16) than unprompted messages (mean responsivity=10% by week 16). They also demonstrated stable responsivity to certain prompted content: medication reminders, appointment reminders, goal motivation, goal progress, and patient experience texts. CONCLUSIONS Our methodology of evaluating text message responsivity revealed important patterns of engagement in a 2-way text message intervention for AYA cancer survivors.
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Affiliation(s)
| | - Yimei Li
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Eliana Butler
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Lauren C Daniel
- Rutgers University Camden, The Children's Hospital of Philadelphia, Camden, NJ, United States
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher P Bonafide
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
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