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Magwood O, Saad A, Ranger D, Volpini K, Rukikamirera F, Haridas R, Sayfi S, Alexander J, Tan Y, Pottie K. Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta-analysis: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1398. [PMID: 38680950 PMCID: PMC11047135 DOI: 10.1002/cl2.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
Background Among youth, symptoms of depression, anxiety, and alcohol use are associated with considerable illness and disability. Youth face many personal and health system barriers in accessing mental health care. Mobile applications (apps) offer youth potentially accessible, scalable, and anonymous therapy and other support. Recent systematic reviews on apps to reduce mental health symptoms among youth have reported uncertain effectiveness, but analyses based on the type of app-delivered therapy are limited. Objectives We conducted this systematic review with youth co-researchers to ensure that this review addressed the questions that were most important to them. The objective of this review is to synthesize the best available evidence on the effectiveness of mobile apps for the reduction of depressive symptoms (depression, generalized anxiety, psychological distress) and alcohol use among youth. Search Methods We conducted electronic searches of the following bibliographic databases for studies published between January 1, 2008, and July 1, 2022: MEDLINE (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCOHost), and CENTRAL (via the Cochrane Library). The search used a combination of indexed terms, free text words, and MeSH headings. We manually screened the references of relevant systematic reviews and included randomized controlled trials (RCTs) for additional eligible studies, and contacted authors for full reports of identified trial registries or protocols. Selection Criteria We included RCTs conducted among youth aged 15-24 years from any setting. We did not exclude populations on the basis of gender, socioeconomic status, geographic location or other personal characteristics. We included studies which assessed the effectiveness of app-delivered mental health support or therapy interventions that targeted the management of depressive disorders and/or alcohol use disorders. We excluded apps that targeted general wellness, apps which focused on prevention of psychological disorders and apps that targeted bipolar disorder, psychosis, post-traumatic stress disorder, attention-deficit hyperactivity disorder, substance use disorders (aside from alcohol), and sleep disorders. Eligible comparisons included usual care, no intervention, wait-list control, alternative or controlled mobile applications. We included studies which reported outcomes on depressive symptoms, anxiety symptoms, alcohol use and psychological distress over any follow-up period. Data Collection and Analysis We standardized the PICO definitions (population, intervention, comparison, and outcome) of each included study and grouped studies by the type of therapy or support offered by the app. Whenever app design and clinical homogeneity allowed, we meta-analyzed outcomes using a random-effects model. Outcome data measured using categorical scales were synthesized using odds ratios. Outcome data measured using continuous scales were synthesized as the standardized mean difference. We assessed the methodological quality of each included study using the Cochrane Risk of Bias 2.0 tool and we assessed certainty of the evidence using the GRADE approach. Main Results From 5280 unique citations, we included 36 RCTs published in 37 reports and conducted in 15 different countries (7984 participants). Among the 36 included trials, we assessed two with an overall low risk of bias, 8 trials with some concern regarding risk of bias, and 26 trials with a high risk of bias. Interventions varied in the type of therapy or supports offered. The most common intervention designs employed mindfulness training, cognitive behavioral therapy (CBT), or a combination of the two (mindfulness + CBT). However, other interventions also included self-monitoring, medication reminders, cognitive bias modification or positive stimulation, dialectical behavioral therapy, gamified health promotion, or social skill building. Mindfulness apps led to short term improvements in depressive symptoms when compared to a withheld control (SMD = -0.36; 95% CI [-0.63, -0.10]; p = 0.007, n = 3 RCTs, GRADE: very low certainty) and when compared to an active control (SMD = -0.27; 95% CI [-0.53, -0.01]; p = 0.04, n = 2 RCTs, GRADE: very low). Apps delivering this type of support also significantly improved symptoms of anxiety when compared to a withheld control (SMD = -0.35; 95% CI [-0.60, -0.09]; p = 0.008, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.24; 95% CI [-0.50, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low). Mindfulness apps showed improvements in psychological stress that approached statistical significance among participants receiving the mindfulness mobile apps compared to those in the withheld control (SMD = -0.27; 95% CI [-0.56, 0.03]; p = .07, n = 4 RCTs, GRADE: very low). CBT apps also led to short-term improvements in depressive symptoms when compared to a withheld control (SMD = -0.40; 95% CI [-0.80, 0.01]; p = 0.05, n = 2 RCTs, GRADE: very low) and when compared to an active control (SMD = -0.59; 95% CI [-0.98, -0.19]; p = 0.003, n = 2 RCTs, GRADE: very low). CBT-based apps also improved symptoms of anxiety compared to a withheld control (SMD = -0.51; 95% CI [-0.94, -0.09]; p = 0.02, n = 3 RCTs, GRADE: very low) but not when compared to an active control (SMD = -0.26; 95% CI [-1.11, 0.59]; p = 0.55, n = 3 RCTs, GRADE: very low). Apps which combined mindfulness and CBT did not significantly improve symptoms of depression (SMD = -0.20; 95% CI [-0.42, 0.02]; p = 0.07, n = 2 RCTs, GRADE: very low) or anxiety (SMD = -0.21; 95% CI [-0.49, 0.07]; p = 0.14, n = 2 RCTs, GRADE: very low). However, these apps did improve psychological distress (SMD = -0.43; 95% CI [-0.74, -0.12]; p = 0.006, n = 2 RCTs, GRADE: very low). The results of trials on apps to reduce alcohol use were inconsistent. We did not identify any harms associated with the use of apps to manage mental health concerns. All effectiveness results had a very low certainty of evidence rating using the GRADE approach, meaning that apps which deliver therapy or other mental health support may reduce symptoms of depression, anxiety and psychological distress but the evidence is very uncertain. Authors' Conclusions We reviewed evidence from 36 trials conducted among youth. According to our meta-analyses, the evidence is very uncertain about the effect of apps on depression, anxiety, psychological distress, and alcohol use. Very few effects were interpreted to be of clinical importance. Most of the RCTs were small studies focusing on efficacy for youth at risk for depressive symptoms. Larger trials are needed to evaluate effectiveness and allow for further analysis of subgroup differences. Longer trials are also needed to better estimate the clinical importance of these apps over the long term.
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Affiliation(s)
- Olivia Magwood
- Bruyère Research InstituteOttawaOntarioCanada
- Interdisciplinary School of Health Sciences, Faculty of Health SciencesUniversity of OttawaOttawaOntarioCanada
| | - Ammar Saad
- Bruyère Research InstituteOttawaOntarioCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada
| | | | - Kate Volpini
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | | | - Rinila Haridas
- Bruyère Research InstituteOttawaOntarioCanada
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- School of NursingUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Shahab Sayfi
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Biology, Faculty of ScienceUniversity of OttawaOttawaOntarioCanada
| | - Jeremie Alexander
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Biochemistry and Biomedical ScienceMcMaster UniversityHamiltonOntarioCanada
| | - Yvonne Tan
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Biomedical and Molecular Sciences, Faculty of Arts and ScienceQueen's UniversityKingstonOntarioCanada
| | - Kevin Pottie
- Bruyère Research InstituteOttawaOntarioCanada
- Departments of Family Medicine and Epidemiology and BiostatisticsWestern UniversityLondonOntarioCanada
- Department of Family MedicineDalhousie UniversityHalifaxNova ScotiaCanada
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Lv H, Zhang T, Li B, Wang R. The influence of control beliefs on the cardiovascular fitness of college students: the chain mediating effect of subjective exercise experience and exercise adherence. BMC Public Health 2024; 24:2. [PMID: 38166937 PMCID: PMC10759651 DOI: 10.1186/s12889-023-17509-3] [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] [Received: 07/20/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE Lack of adequate physical exercise is the main reason for the frequent occurrence of health problems among Chinese college students. The purpose of this study is to explore the effects of control beliefs on cardiovascular fitness among college students and the mediating role of subjective exercise experience and exercise adherence in it. METHODS The Control Belief Scale, the Subjective Exercise Experience Scale (SEES), and the Exercise Adherence Scale were used to investigate 1854 freshmen and sophomores in Nantong and Suzhou, China. Cardiovascular fitness data for college students from the National Student Physical Health Standard and SPSS 23.0 statistical analysis software were used to carry out statistics and analyses on the questionnaires. Correlation analysis, regression analysis, and mediation models were used to assess control beliefs, subjective exercise experiences, exercise adherence, and cardiovascular fitness. RESULTS The control belief of college students was directly related to cardiovascular fitness (effect value: 0.121), the mediating effect through subjective exercise experience was not significant, indirectly related through the mediating effect of exercise adherence (effect value: 0.101), and indirectly related through the mediating effect of subjective exercise experience and exercise adherence (effect value: 0. 019). The positive prediction effect of control belief on cardiovascular fitness of college students was significant (β = 0.267, P < 0.001), and the positive prediction effect of control belief on cardiovascular fitness of college students was still significant (β = 0.121, P < 0.01) after adding the intermediary variables (subjective exercise experience and exercise adherence). CONCLUSIONS The cardiovascular fitness of college students was not only directly affected by control beliefs but also affected by the chain mediating effect of subjective exercise experience and exercise adherence. Therefore, it is necessary to improve the control beliefs, subjective exercise experiences, and exercise adherence of college students to improve their cardiovascular fitness level and enhance their physical health.
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Affiliation(s)
- Hewu Lv
- College of Sports Science, Nantong University, Nantong, 226019, China
| | - Ting Zhang
- School of Physical Education, Central China Normal University, Wuhan, 430079, China
| | - Bo Li
- College of Sports Science, Nantong University, Nantong, 226019, China
| | - Rui Wang
- Student Affairs Office, Nantong University, Nantong, 226019, China.
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Kandola A, Edwards K, Muller MAE, Dührkoop B, Hein B, Straatman J, Hayes JF. Digitally managing depression: A fully remote randomised attention-placebo controlled trial. Digit Health 2024; 10:20552076241260409. [PMID: 38854919 PMCID: PMC11162123 DOI: 10.1177/20552076241260409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Background Depression is a common and disabling condition. Digital apps may augment or facilitate care, particularly in under-served populations. We tested the efficacy of juli, a digital self-management app for depression in a fully remote randomised controlled trial. Methods A pragmatic randomised controlled trial that included participants aged > 18 who self-identified as having depression and scored > 5 on the Patient Health Questionnaire-8. Participants were randomly assigned (1:1) to receive juli for 8 weeks or a limited attention-placebo control app. Our primary outcome was the difference in Patient Health Questionnaire-8 scores at 8 weeks. Secondary outcomes were remission, minimal clinically important difference, worsening of depression, and health-related quality of life. Analyses were per-protocol (primary), and modified and full intention-to-treat (secondary). The trial was registered at ISRCTN (ISRCTN12329547). Results Between May 2021 and January 2023, we randomised 908 participants. 662 completed the week 2 outcome assessment and were included in the modified intention-to-treat analysis, and 456 completed the week 8 outcome assessments (per-protocol). In the per-protocol analysis, the juli group had a greater reduction in Patient Health Questionnaire-8 score (10.78, standard deviation 6.26) than the control group (11.88, standard deviation 5.73) by week 8 (baseline adjusted β-coefficient -0.94, 95% CI: -1.87 to -0.22, p = 0.045). Achieving remission and a minimal clinically important difference was more likely in the juli group at 8 weeks (adjusted odds ratios 2.22, 95% CI: 1.45-3.39, p < 0.001 and 1.56, 95% CI: 1.08-2.27, p = 0.018, respectively). There were no between-group differences in health-related quality of life or worsening of depression. Modified and full intention-to-treat analyses found similar results, but the primary outcome was non-significant. Conclusion The use of juli for 8 weeks resulted in a small reduction in symptoms of depression compared with an attention-placebo control. The juli app is a digital self-management tool that could increase the accessibility of evidence-based depression treatments.
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Affiliation(s)
- Aaron Kandola
- MRC Unit of Lifelong Health and Aging, University College London - UCL, UK
- juli Health, Hull, MA, USA
| | - Kyra Edwards
- Division of Psychiatry, University College London - UCL, UK
| | | | | | | | | | - Joseph F Hayes
- juli Health, Hull, MA, USA
- Division of Psychiatry, University College London - UCL, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Liquori G, Pio Posa V, De Leo A, Giannetta N, Di Simone E, Di Muzio M, Dionisi S. The Use of mHealth in Promoting Therapeutic Adherence: A Scoping Review. Comput Inform Nurs 2024; 42:71-79. [PMID: 37769234 DOI: 10.1097/cin.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Nonadherence to therapy negatively impacts mortality and quality of life and results in suboptimal efficacy of treatment regimens, threats to patient safety, and increased healthcare costs for disease management. Mobile health solutions can offer users instruments that can promote therapeutic adherence. The objective of this review is to investigate the impact mobile health systems have on therapeutic adherence. Specifically, we want to map the main systems used, the functions implemented, and the different methods of adherence detection used. For this purpose, a scoping review was conducted. The following databases were consulted: PubMed, Cochrane Library, EBSCO (including APA PsycINFO, CINAHL Plus with Full Text, ERIC), including English-language studies published in the last 10 years (2012-2022). The main mobile health systems used are as follows: applications, automated messaging, interactive voice response, and mobile video games. The main features implemented to support medication management were as follows: reminders, self-monitoring instruments, educational support, and caregiver involvement. In conclusion, the use of interactive mobile health instruments intended for use by the patient and/or caregiver can improve objectively and subjectively detected therapeutic adherence. The use of these systems in the therapeutic pathway of users, with a special focus on people with comorbidities and in polypharmacy treatment, represents a challenge to improve caregiver health.
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Affiliation(s)
- Gloria Liquori
- Author Affiliations: Department of Biomedicine and Prevention, University of Rome Tor Vergata (Drs Liquori and De Leo); Department of Clinical and Molecular Medicine, Sapienza University of Rome (Mr Pio Posa, Dr Di Muzio and Di Simone); Nursing, Technical, Rehabilitation, Assistance and Research Department, IRCCS Istituti Fisioterapici Ospitalieri (Drs De Leo); UniCamillus-Saint Camillus International University of Health and Medical Sciences (Dr Giannetta), Rome; and Nursing, Technical and Rehabilitation, Department, DaTeR Azienda Unità Sanitaria Locale di Bologna (Dr Dionisi)
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Hamlin M, Holmén J, Wentz E, Aiff H, Ali L, Steingrimsson S. Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis. JMIR Ment Health 2023; 10:e48843. [PMID: 37819697 PMCID: PMC10600645 DOI: 10.2196/48843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. OBJECTIVE The aim of this study was to determine patients' experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. METHODS This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. RESULTS In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app's ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app's content and requested tailored content. CONCLUSIONS The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results.
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Affiliation(s)
- Matilda Hamlin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Joacim Holmén
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Elisabet Wentz
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Harald Aiff
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lilas Ali
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Amonoo HL, Deary EC, Wang A, Newcomb RA, Daskalakis E, Weber D, Holmbeck KE, Choe JJ, Nabily A, Cutler C, Traeger LN, El-Jawahri A. Medication Adherence in Patients with Hematologic Malignancies Who Are Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study. Transplant Cell Ther 2023; 29:620.e1-620.e11. [PMID: 37516379 PMCID: PMC10592303 DOI: 10.1016/j.jtct.2023.07.019] [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] [Received: 05/26/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Medication adherence is critical for optimal health outcomes in patients with hematologic malignancies who have undergone allogeneic hematopoietic stem cell transplants (HSCT). However, this population struggles with medication nonadherence. Research that comprehensively describes the complex patient- and medication-related factors which impact medication adherence in this population is lacking. Hence, we used semistructured qualitative interviews to explore the diverse and complex factors contributing to medication adherence in HSCT recipients. We conducted 30 in-depth interviews with patients who were more than 180 days post-allogeneic HSCT at the Dana-Farber Cancer Institute. The interviews explored the physical, social, psychological, and sociodemographic factors that facilitate or discourage adherence to the post-transplantation medication regimen. Interviews were audio-recorded, transcribed, and coded using NVivo software. Two themes emerged that characterized the barriers patients face with their medication regimen. Patients reported factors outside of their control, such as managing multiple pharmacies, health insurance difficulties, and dosage timing, as significant barriers to medication adherence. Patients also reported barriers within their control, such as familial responsibilities. Important facilitators for medication adherence included caregiver and clinician support, previous experience managing a medication regimen, and tools that aid pill organization and timing. Furthermore, patients reported that although medication side effects and quantity of pills did not directly impact medication adherence, it increased their psychological distress. Facilitators and barriers to medication adherence can be physical, psychological, organizational, and social. There are many aspects of medication regimens that significantly increase patient distress. Hence, supportive interventions to improve medication adherence in patients undergoing HSCT may need to incorporate strategies to manage medication side effects and skills to improve psychological well-being and social support.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Annie Wang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine E Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychology, University of Miami, Coral Gables, Florida
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Oh WO, Park IT, Han J, Lee E, Lee A. Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease. J Pediatr Nurs 2023; 72:63-72. [PMID: 37086628 DOI: 10.1016/j.pedn.2023.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD. DESIGN AND METHODS The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app. RESULTS Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use. CONCLUSION We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app. PRACTICE IMPLICATIONS The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.
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Affiliation(s)
- Won-Oak Oh
- Korea University, College of Nursing, Seoul, Republic of Korea.
| | - Il Tae Park
- Woosong University, College of Health and Welfare, Daejeon, Republic of Korea
| | - Jihee Han
- Korea University, College of Nursing, Seoul, Republic of Korea
| | - Eunji Lee
- Korea University, College of Nursing, Seoul, Republic of Korea.
| | - Anna Lee
- Yonsei University, College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
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Bennett BL, Pokhrel P, Latner JD. Delivering a media literacy intervention for body dissatisfaction using an app-based intervention: A feasibility and pilot trial. Eat Behav 2023; 50:101770. [PMID: 37329770 DOI: 10.1016/j.eatbeh.2023.101770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/19/2023]
Abstract
Body dissatisfaction rates continue to remain high, and the consequences remain dire, especially among young women. Traditional media literacy interventions have found success in addressing body image-related constructs, though they are limited in their reach and are often quickly outdated. This study was designed to examine the feasibility and acceptability of delivering a media literacy intervention via ecological momentary intervention. This pilot study tested a media literacy intervention delivered via a smartphone app designed to disrupt the connection between media use and body dissatisfaction. Thirty-seven undergraduate women (Mage = 21.17; SD = 2.20) received a 15-day media literacy intervention through a smartphone application. The primary outcomes were completion rates, retention rates, percentage of data points lost to technological errors, and participant feedback. The secondary outcome was change in body dissatisfaction. The retention and percentage of data points lost to technological errors, alongside participants' ratings, indicated that this intervention is feasible and acceptable. Several targets were identified to increase participant acceptance and potential efficacy of the intervention. Trait body dissatisfaction decreased, though not significantly, following the intervention. State body image satisfaction improved significantly from the first day to the last day of engagement with the app. Overall, the intervention was deemed feasible and acceptable, opening the door for future research in which the intervention and its delivery system are improved, and its efficacy is reexamined. Future digital media literacy interventions should focus on building a user-centered app, further reducing participant burden, and testing efficacy in large and diverse samples.
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Affiliation(s)
- Brooke L Bennett
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT, USA; Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI 96822-2294, USA.
| | - Pallav Pokhrel
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI 96822-2294, USA
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Vathy R, Rosenthal M, Ballou JM. College student behaviors and preferences in community pharmacies. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-5. [PMID: 37289988 DOI: 10.1080/07448481.2023.2217725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/01/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
Objective: The primary goal of conducting this research was to gain insight into what characteristics of a community pharmacy college students may find appealing and how community pharmacies can tailor their services toward college students. Participants: The survey was distributed to 3,000 college students at The University of Mississippi from various schools and majors across campus. A total of 188 students participated by completing questions from the survey. Methods: The research was performed by using a cross-sectional online survey, and basic descriptive statistics, including frequency counts were used to characterize the findings. Statistical analyses, including crosstabs and chi-square analyses, were used to determine if there were any significant (p < 0.05) associations between characteristics such as pharmacy preferences and other variables. Results: Results of this survey indicated that the majority of respondents have used a community pharmacy in the past six months, and a small number of participants are interested in using a pharmacy for more than the sole reason of filling a prescription. Results also showed that insurance and convenience were the two most influential factors in choosing a community pharmacy. Conclusion: The findings presented in this study show a number of opportunities for community pharmacies to improve the health of college students and their communities.
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Affiliation(s)
- Ryan Vathy
- University of Mississippi School of Pharmacy, University, Mississippi, USA
| | - Meagen Rosenthal
- University of Mississippi School of Pharmacy Department of Pharmacy Administration, University, Mississippi, USA
| | - Jordan Marie Ballou
- University of South Carolina College of Pharmacy, Clinical Pharmacy and Outcomes Sciences, Columbia, South Carolina, USA
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Leiz M, Pfeuffer N, Rehner L, Stentzel U, van den Berg N. Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review. Patient Prefer Adherence 2022; 16:3441-3463. [PMID: 36605330 PMCID: PMC9809413 DOI: 10.2147/ppa.s388106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022] Open
Abstract
Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.
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Affiliation(s)
- Maren Leiz
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Nils Pfeuffer
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Laura Rehner
- Institute for Nursing Science and Interprofessional Learning, University Medicine, Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine, Greifswald, Germany
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11
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Spetz K, Hult M, Olbers T, Bonn S, Svedjeholm S, Lagerros YT, Andersson E. A smartphone application to improve adherence to vitamin and mineral supplementation after bariatric surgery. Obesity (Silver Spring) 2022; 30:1973-1982. [PMID: 36050801 PMCID: PMC9805084 DOI: 10.1002/oby.23536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This trial evaluated a smartphone application's effectiveness in improving adherence to vitamin and mineral supplementation postoperatively. METHODS This study was a randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 to the 12-week intervention, using the smartphone application PromMera, or to standard care. The primary end point was adherence to vitamin and mineral supplementation. RESULTS Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before the intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B12 (-9.6% [SD = 27%] vs. -9.3% [SD = 30%]; p = 0.48) or calcium/vitamin D (-12.3% [SD = 29%] vs. -11.5% [SD = 32%]; p = 0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5) was seen immediately after the intervention (intervention group 0.00 [SD = 1.3] vs. control group -1.2 [SD = 3.5]; p = 0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies. CONCLUSIONS The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation 1 year post bariatric surgery.
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Affiliation(s)
- Kristina Spetz
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
| | - Mari Hult
- Division of Upper Abdominal Diseases, Karolinska University Hospital, and Unit of Gastroenterology, Department of Medicine (Huddinge)Karolinska InstitutetStockholmSweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
| | - Stephanie Bonn
- Clinical Epidemiology Division, Department of Medicine (Solna)Karolinska InstitutetStockholmSweden
| | - Sanna Svedjeholm
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, and Center for ObesityAcademic Specialist Center, Stockholm Health ServicesStockholmSweden
| | - Ellen Andersson
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
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12
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Aguiar M, Trujillo M, Chaves D, Álvarez R, Epelde G. mHealth Apps Using Behavior Change Techniques to Self-report Data: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33247. [PMID: 36083606 PMCID: PMC9508675 DOI: 10.2196/33247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/15/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management. Objective This review aimed to identify behavior change techniques (BCTs) commonly used in mHealth, assess their effectiveness based on the evidence reported in interventions and reviews to highlight the most appropriate techniques to design an optimal strategy to improve adherence to data reporting, and provide recommendations for future interventions and research. Methods We performed a systematic review of studies published between 2010 and 2021 in relevant scientific databases to identify and analyze mHealth interventions using BCTs that evaluated their effectiveness in terms of user adherence. Search terms included a mix of general (eg, data, information, and adherence), computer science (eg, mHealth and BCTs), and medicine (eg, personalized medicine) terms. Results This systematic review included 24 studies and revealed that the most frequently used BCTs in the studies were feedback and monitoring (n=20), goals and planning (n=14), associations (n=14), shaping knowledge (n=12), and personalization (n=7). However, we found mixed effectiveness of the techniques in mHealth outcomes, having more effective than ineffective outcomes in the evaluation of apps implementing techniques from the feedback and monitoring, goals and planning, associations, and personalization categories, but we could not infer causality with the results and suggest that there is still a need to improve the use of these and many common BCTs for better outcomes. Conclusions Personalization, associations, and goals and planning techniques were the most used BCTs in effective trials regarding adherence to mHealth apps. However, they are not necessarily the most effective since there are studies that use these techniques and do not report significant results in the proposed objectives; there is a notable overlap of BCTs within implemented app components, suggesting a need to better understand best practices for applying (a combination of) such techniques and to obtain details on the specific BCTs used in mHealth interventions. Future research should focus on studies with longer follow-up periods to determine the effectiveness of mHealth interventions on behavior change to overcome the limited evidence in the current literature, which has mostly small-sized and single-arm experiments with a short follow-up period.
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Affiliation(s)
- Maria Aguiar
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
- Multimedia and Computer Vision Group, Universidad del Valle, Cali, Colombia
| | - Maria Trujillo
- Multimedia and Computer Vision Group, Universidad del Valle, Cali, Colombia
| | - Deisy Chaves
- Multimedia and Computer Vision Group, Universidad del Valle, Cali, Colombia
- Department of Electrical, Systems and Automation, Universidad de León, León, Spain
| | - Roberto Álvarez
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
- Biodonostia Health Research Institute, eHealth Group, Donostia-San Sebastián, Spain
| | - Gorka Epelde
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
- Biodonostia Health Research Institute, eHealth Group, Donostia-San Sebastián, Spain
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13
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González de León B, del Pino-Sedeño T, Serrano-Pérez P, Rodríguez Álvarez C, Bejarano-Quisoboni D, Trujillo-Martín MM. Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis. BMC Psychiatry 2022; 22:487. [PMID: 35858887 PMCID: PMC9301839 DOI: 10.1186/s12888-022-04120-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. METHODS We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. RESULTS Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). CONCLUSIONS Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts. TRIAL REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723 .
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Affiliation(s)
- Beatriz González de León
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria “La Laguna ‑ Tenerife Norte”, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain ,grid.467039.f0000 0000 8569 2202Servicio de Evaluación y Planificación del Servicio Canario de La Salud, Santa Cruz de Tenerife, Spain
| | - Pedro Serrano-Pérez
- grid.411083.f0000 0001 0675 8654Servicio de Psiquiatría, Hospital Universitario Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Departamento de Psiquiatría Y Medicina Legal, Universidad Autónoma de Barcelona, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Grupo de Investigación en Psiquiatría, Salud Mental Y Adicciones, Vall d’Hebron Instituto de Investigación (VHIR), Barcelona, Spain
| | - Cristobalina Rodríguez Álvarez
- grid.10041.340000000121060879Campus Ciencias de La Salud. Área de Medicina Preventiva y Salud Pública. Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Daniel Bejarano-Quisoboni
- Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Valencia, Spain ,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - María M. Trujillo-Martín
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Spain ,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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14
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Davis JL, Carpenter S, Irwin AN. Characteristics of unclaimed prescriptions in a college-aged population. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:34-38. [PMID: 32343202 DOI: 10.1080/07448481.2020.1748040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
Objective: Describe the frequency and characteristics of unclaimed prescriptions from a pharmacy embedded within a student health services clinic. Methods: Cross-sectional study of prescriptions received by an on-campus pharmacy between September 1-December 31, 2017 and September 1-December 31, 2018. Prescription data were extracted from the pharmacy administrative database and then categorized into medication classes and claimed versus unclaimed. Results: The pharmacy received 18,337 prescriptions during the study periods. Medications classified as central nervous system (n = 5101, 27.8%), hormones (n = 3976; 21.7%), and anti-infective (n = 3262, 17.8%) medications were most common. A total of 2,609 prescriptions (14.2%) were left unclaimed by patients. The frequency of unclaimed prescriptions varied across medication classes, ranging from 9.0% (anti-infective) to 34.1% (genitourinary). Conclusions: Approximately one in seven prescriptions went unclaimed at this on-campus pharmacy. Future research is needed to identify predictors for unclaimed prescriptions to develop effective interventions that improve medication adherence.
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Affiliation(s)
- Jennifer L Davis
- Student Health Services, Oregon State University, Corvallis, Oregon, USA
- College of Pharmacy, Oregon State University, Corvallis, Oregon, USA
| | - Sierra Carpenter
- Student Health Services, Oregon State University, Corvallis, Oregon, USA
- College of Pharmacy, Oregon State University, Corvallis, Oregon, USA
| | - Adriane N Irwin
- College of Pharmacy, Oregon State University, Corvallis, Oregon, USA
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15
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Ng R, Carter SR, El-Den S. The impact of mobile applications on medication adherence: a systematic review. Transl Behav Med 2021; 10:1419-1435. [PMID: 31384950 DOI: 10.1093/tbm/ibz125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In 2008, Apple and Android launched their Application or "App" stores. Since then, there has been a growing interest in using mobile apps for improving medication adherence. However, research on the efficacy of apps, in terms of improved medication adherence and clinical outcome and/or patient-related outcome measures (PROMs) is scarce. The objective of this research was to systematically review the impact of apps on consumers' medication adherence and to determine the effect on clinical outcome and/or PROM(s). A systematic literature search was conducted to identify publications aimed at improving medication adherence published from January 2008 to April 2018. All studies were assessed for risk of bias using either the Risk Of Bias In Non-randomized Studies-of Interventions or the revised tool for Risk of Bias in randomized trials tool, depending on study design. Eleven randomized controlled trials (RCTs) and 10 non-RCTs were included. All 11 RCTs showed improvements in adherence; however, only seven reported statistically significant improvements in at least one adherence measure. Nine RCTs also demonstrated improvements in clinical outcome/PROM(s), of which five were statistically significant, whereas two RCTs did not report on clinical outcome/PROM(s). Only two studies using non-RCT study designs showed statistically significant improvements in all measures of adherence and clinical outcome/PROM(s). The risk of bias was moderate or serious for all included studies. Even though the use of an app may improve adherence, it is difficult to draw conclusions regarding the impact of apps on medication adherence due to the high degree of heterogeneity across studies, from the methodological design to the features of the app and the measure of adherence.
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Affiliation(s)
- Ricki Ng
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Stephen R Carter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Sarira El-Den
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
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16
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Cazeau N. Mobile Health Interventions: Examining Medication Adherence Outcomes Among Patients With Cancer. Clin J Oncol Nurs 2021; 25:431-438. [PMID: 34269338 DOI: 10.1188/21.cjon.431-438] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment for cancer is trending toward oral therapies, which patients can self-manage from home. Proper adherence to oral therapy is vital to safe and optimal care in this setting. Mobile health interventions (i.e., text message reminders, mobile applications, and automated calls) are an evolving strategy aimed at improving medication adherence for patients on long-term oral therapies. OBJECTIVES This review aims to provide an overview of research outcomes for the use of mobile health interventions among patients with cancer. METHODS A comprehensive review of CINAHL®, MEDLINE®, and PubMed® was completed. Eleven articles were eligible for inclusion in this review. FINDINGS Mobile health interventions are an acceptable approach among patients with cancer and may improve adherence outcomes for those at highest risk for suboptimal adherence.
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17
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Habib B, Buckeridge D, Bustillo M, Marquez SN, Thakur M, Tran T, Weir DL, Tamblyn R. Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge. JAMIA Open 2021; 4:ooab050. [PMID: 34345805 PMCID: PMC8325487 DOI: 10.1093/jamiaopen/ooab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events. Materials and Methods We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up. Results Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%). Conclusion The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial. Trial registration Clinicaltrials.gov, registration number NCT04676165.
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Affiliation(s)
- Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - David Buckeridge
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | | | - Manish Thakur
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University Health Center, Montreal, Canada
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18
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Verma S, Agrawal R. Psychotropic Medication Adherence in Children and Adolescents. South Med J 2021; 114:388-394. [PMID: 34215889 DOI: 10.14423/smj.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Researchers believe that almost 20% of children and adolescents struggle with chronic and persistent mental health concerns. Mental health is the leading cause of disability in the United States. Youth can struggle with several impairing mental health disorders, such as attention-deficit/hyperactivity disorder, mood disorders, psychotic disorders, and autism spectrum disorder. Inadequately treated chronic mental illnesses can adversely affect the growing brain profoundly, including academic decline, early school dropout, cognitive deficits, interpersonal relationship concerns, aggression, suicide attempts or completion, substance use disorders, frequent hospital admissions, and inability to maintain employment. Even if diagnosed early in their course of illness, many of these individuals struggle to continue medications as prescribed. The factors predicting adherence to medications are underresearched in children and adolescents. Psychotropic medication compliance is a complicated issue that is tied to various aspects of caring for a minor individual. Hence, it is relevant to discuss factors that are predicted to contribute to noncompliance in this age group. The purpose of this review is to carefully consider the gaps in knowledge, suggesting interventions by using established instruments and clinical strategies to resolve the identified barriers for improving medication adherence. Compliance should be targeted at various levels, including the entire family tree and the treatment team.
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Affiliation(s)
- Shikha Verma
- From Evolve Treatment Center-PC, Danville, California, and Centerstone of Kentucky, Louisville
| | - Ruchita Agrawal
- From Evolve Treatment Center-PC, Danville, California, and Centerstone of Kentucky, Louisville
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19
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Pitel L, Ballová Mikušková E. The Irrational Health Beliefs Scale and Health Behaviors in a Non-Clinical Population. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2021. [DOI: 10.1027/2512-8442/a000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. To date, there has been inconclusive evidence on the predictive ability of health-related cognitive distortion, as measured by the Irrational Health Belief Scale (IHBS), regarding health behaviors (HBs). The aims of our study were to provide a validation of the Slovak translation of the IHBS and to assess the relationship of the IHBS with a wide range of HBs, as well as the predictive ability of the IHBS regarding HBs over and above other health-related psychological constructs. A total of 448 students attending mostly Slovak universities completed the IHBS, the Multidimensional Health Locus of Control Scale, the Big Five Inventory – 2, the Positive and Negative Affect Scale, and the Bratislava Health Behaviors Questionnaire. The internal consistency and temporal stability of the Slovak version of the IHBS were confirmed. The IHBS correlated moderately with medical adherence but was unrelated to substance use and an unhealthy diet. The association of cognitive distortion with the sum score of HBs was only weak, albeit statistically significant. The IHBS had weak but significant incremental power. However, two health locus of control dimensions as well as negative emotionality were more strongly related to HBs than cognitive distortion in that multivariate model.
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Affiliation(s)
- Lukáš Pitel
- Hull York Medical School, University of Hull, United Kingdom
- Institute of Experimental Psychology, Centre of Social and Psychological Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Eva Ballová Mikušková
- Institute of Experimental Psychology, Centre of Social and Psychological Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
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20
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Solmi M, Miola A, Croatto G, Pigato G, Favaro A, Fornaro M, Berk M, Smith L, Quevedo J, Maes M, Correll CU, Carvalho AF. How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:189-202. [PMID: 32491040 PMCID: PMC8023158 DOI: 10.1590/1516-4446-2020-0935] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).
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Affiliation(s)
- Marco Solmi
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
- Azienda Ospedale Università di Padova, Padova, Italy
| | - Alessandro Miola
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
| | - Giovanni Croatto
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
| | | | - Angela Favaro
- Dipartimento di Neuroscienze, Università di Padova, Padova, Italy
- Azienda Ospedale Università di Padova, Padova, Italy
| | - Michele Fornaro
- Dipartimento di psichiatria, Università Federico II, Napoli, Italy
- Polyedra, Teramo, Italy
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT Strategic Research Centre), School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Orygen – The Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Joao Quevedo
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Neurociências, Unidade de Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Center of Excellence on Mood Disorders, McGovern Medical School, UTHealth, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
| | - Michael Maes
- IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Christoph U. Correll
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - André F. Carvalho
- IMPACT Strategic Research Centre, Barwon Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Malik NM, Davis JL, Irwin AN. Understanding barriers to prescription retrieval and attitudes toward mental health medications at a university student health services pharmacy. J Am Pharm Assoc (2003) 2020; 61:S17-S24. [PMID: 33317972 DOI: 10.1016/j.japh.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe barriers affecting college students' ability to retrieve prescription medications for mental health conditions from a community pharmacy embedded within a student health center on a university campus and then describe beliefs and attitudes toward the use of those medications. METHODS We conducted a cross-sectional study of college students who were prescribed a medication(s) for a mental health condition(s) and left the medication(s) unclaimed at the pharmacy for at least 5 days. Eligible participants were identified through routine reminder telephone calls and then provided a link to an online survey via e-mail. The survey collected information on demographics, prescription retrieval barriers, and medication beliefs and attitudes using 2 validated questionnaires. Data were summarized using descriptive statistics and scoring methods specific to the validated questionnaires. RESULTS A total of 83 e-mails were distributed with 46 usable responses received (55.4% response rate). Participants were undergraduate students (n = 38, 82.6%) and most frequently prescribed a medication(s) for depression (n = 21, 45.7%) or anxiety (n = 16, 34.8%). Forgetting to pick up their medication was the most commonly cited reason for prescription nonretrieval (n = 32, 69.6%) followed by limited pharmacy hours (n = 21, 45.7%). Participants generally viewed the necessity of their medication(s) as outweighing their concerns about their medication(s), and they generally viewed themselves as medication adherent. CONCLUSIONS University students taking medications for mental health conditions identified forgetfulness and limited pharmacy hours as the most common reasons for not retrieving prescriptions. Students generally viewed their medication(s) as necessary and themselves as medication adherent, suggesting that attitudes and beliefs may play a smaller role in medication use behaviors in this population. Future research is needed to develop and evaluate interventions that improve medication adherence in college students, potentially focused on reminder-based interventions.
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Khalifeh AH, Hamdan-Mansour AM. Prevalence, Barriers, and Interventions Related to Medication Adherence Among Patients With Major Depressive Disorder: A Scoping Review. J Psychosoc Nurs Ment Health Serv 2020; 59:39-51. [PMID: 33095267 DOI: 10.3928/02793695-20201015-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
The current scoping review aimed to identify the prevalence, contributing factors, methods of measurement, and interventions related to medication adherence among patients with major depressive disorder (MDD). A total of 37 articles met inclusion criteria. The prevalence of medication adherence among patients with MDD ranged from 10.6% to 85.4%. Approximately 67% of studies used self-report data collection. Illness-related factors (e.g., onset of illness, duration of illness, symptoms, illness severity), medication-related factors (e.g., adverse reactions, duration of treatment, cost of treatment), and patient-related factors (e.g., beliefs, attitudes, knowledge, self-stigma) were the most reported factors associated with medication adherence. In addition, multi-faceted interventions were recommended over single-element interventions to enhance medication adherence. There is a need to integrate appropriate and effective assessment measures of medication adherence that lead to better health care outcomes, lower risk factors, and improved interventions related to medication adherence. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 39-51.].
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Werremeyer A, Skoy E, Burns W, Bach-Gorman A. Photovoice as an intervention for college students living with mental illness: A pilot study. Ment Health Clin 2020; 10:237-243. [PMID: 32685335 PMCID: PMC7337996 DOI: 10.9740/mhc.2020.07.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Photovoice is a participatory-action research method in which participants capture and collectively reflect upon photos of their lived experience. Photovoice participation may be beneficial for individuals living with mental illness, but its effects have not been quantitatively measured. METHODS In this pilot study, 20 college students living with a mental illness and prescribed at least 1 medication were randomized to a Photovoice group intervention or usual group counseling, which was an active control. Participants completed the BURNS Anxiety Inventory, Beck Depression Inventory, and Medication Adherence Rating Scale at baseline and 8 weeks. Between-groups comparisons were conducted. RESULTS Photovoice participants experienced a significantly greater reduction in the BURNS Anxiety Inventory (-8.5 vs -2.6; P = .049) compared to control participants. No difference was seen in change in the Beck Depression Inventory (6.7 in the Photovoice group vs 0.2 among controls; P = .26). Mean medication adherence scores worsened in both groups from baseline with no difference between the groups (1 vs 0.86; P = .16). DISCUSSION Photovoice may be a resource-efficient and effective intervention to reduce anxiety among college students with mental illness; however, it may be associated with poorer medication adherence. Further study is needed to evaluate these findings.
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Affiliation(s)
- Amy Werremeyer
- Associate Professor, Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota
- Director, Counseling Center, North Dakota State University, Fargo, North Dakota
- Assistant Director, Clinical and Crisis Services, Counseling Center, North Dakota State University, Fargo, North Dakota
| | - Elizabeth Skoy
- Associate Professor, Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota
| | - William Burns
- Director, Counseling Center, North Dakota State University, Fargo, North Dakota
| | - Amber Bach-Gorman
- Assistant Director, Clinical and Crisis Services, Counseling Center, North Dakota State University, Fargo, North Dakota
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Hyun C, McMenamin J, Ko O, Kim S. Efficacy of a Mobile Texting App (HepTalk) in Encouraging Patient Participation in Viral Hepatitis B Care: Development and Cohort Study. JMIR Mhealth Uhealth 2020; 8:e15098. [PMID: 32234704 PMCID: PMC7160703 DOI: 10.2196/15098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/10/2020] [Accepted: 02/29/2020] [Indexed: 01/05/2023] Open
Abstract
Background Chronic hepatitis B virus (HBV) infection is a major cause of liver-related morbidity and mortality among Asian Americans in the United States. Despite the available resources, a majority of HBV-infected individuals are not able to access adequate health care owing to numerous barriers. Objective This study aimed to assess the efficacy of a newly developed mobile texting app (HepTalk) in overcoming these barriers and improving patient engagement and health care access among HBV-infected and nonimmune individuals. Methods HepTalk was employed for two-way communication between participants and patient navigators. A total of 82 Korean American participants who were either HBV infected or nonimmune to HBV, identified from a community hepatitis B campaign in New York, were enrolled in the study. After informed consent was obtained, both the frequency and themes of the text messages were evaluated. The effects of this communication on linkage to care at the end of the 6-month intervention period were analyzed and discussed. Results On average, patient navigators sent and received 14 and 8 messages per participant, respectively, during the 6-month period. The themes of the messages were similar to the following 4 categories: finding providers, scheduling appointments with providers, health education, and financial issues. Of the 82 participants, 78 were linked to care within 6 months (a 95% linkage rate). Conclusions HepTalk may be employed as an effective and strategic tool to facilitate communicative interaction between patients and patient navigators or health care providers, thereby improving patient engagement and health care access.
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Affiliation(s)
- Chul Hyun
- The Center for Viral Hepatitis, Englewood, NJ, United States
| | | | - Okhyun Ko
- Korean Community Services Public Health and Research Center, New York, NY, United States
| | - Soonsik Kim
- Korean Community Services Public Health and Research Center, New York, NY, United States
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Armitage LC, Kassavou A, Sutton S. Do mobile device apps designed to support medication adherence demonstrate efficacy? A systematic review of randomised controlled trials, with meta-analysis. BMJ Open 2020; 10:e032045. [PMID: 32005778 PMCID: PMC7045248 DOI: 10.1136/bmjopen-2019-032045] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the efficacy of app-based interventions designed to support medication adherence and investigate which behaviour change techniques (BCTs) used by the apps are associated with efficacy. DESIGN Systematic review of randomised controlled trials (RCTs), with meta-analysis. SETTING Medline/PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase and Web of Science were searched from 1990 to November 2018 for RCTs conducted in any healthcare setting. PARTICIPANTS Studies of participants of any age taking prescribed medication for any health condition and for any duration. INTERVENTION An app-based intervention delivered through a smartphone, tablet computer or personal digital assistant to help, support or advise about medication adherence. COMPARATOR One of (1) usual care, (2) a control app which did not use any BCTs to improve medication adherence or (3) a non-app-based comparator. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the pooled effect size of changes in medication adherence. The secondary outcome was the association between BCTs used by the apps and the effect size. RESULTS The initial search identified 13 259 citations. After title and abstract screening, full-text articles of 83 studies were screened for eligibility. Nine RCTs with 1159 recruited participants were included. The mean age of participants was >50 years in all but one study. Health conditions of target populations included cardiovascular disease, depression, Parkinson's disease, psoriasis and multimorbidity. The meta-analysis indicated that patients who use mobile apps to support them in taking medications are more likely to self-report adherence to medications (OR 2.120, 95% CI 1.635 to 2.747, n=988) than those in the comparator groups. Meta-regression of the BCTs did not reveal any significant associations with effect size. CONCLUSIONS App-based medication adherence interventions may have a positive effect on patient adherence. Larger scale studies are required to further evaluate this effect, including long-term sustainability, and intervention and participant characteristics that are associated with efficacy and app usage. PROSPERO REGISTRATION NUMBER PROSPERO Protocol Registration Number: CRD42017080150.
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Affiliation(s)
- Laura Catherine Armitage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Aikaterini Kassavou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Basit SA, Mathews N, Kunik ME. Telemedicine interventions for medication adherence in mental illness: A systematic review. Gen Hosp Psychiatry 2020; 62:28-36. [PMID: 31775066 DOI: 10.1016/j.genhosppsych.2019.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/18/2019] [Accepted: 11/10/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To conduct a systematic review to assess the evidence for telemedicine interventions for pharmacologic adherence in persons with depression, bipolar disorder, or schizophrenia. METHOD We searched PubMed and PsycINFO in August 2018 without restrictions on years or language. We also searched tables of contents in 2 journals, meeting abstracts, reference lists from identified studies and review articles. The selection criteria required that articles be randomized controlled trials involving outpatient adults diagnosed with depression, bipolar disorder, or schizophrenia; that they involve telemedicine interventions; and that they include an outcome of medication adherence. Initially, 1 author identified relevant titles. Two authors independently reviewed the abstracts and titles. RESULTS Of 512 articles identified through database searching, we identified 17 articles that we categorized by intensity of intervention and rated by quality of evidence. There were 3 low-, 3 medium- and 11 high-intensity interventions. The most common type of technology used was the phone. Efficacy for adherence was demonstrated by 9 studies. CONCLUSIONS Telemedicine may improve medication adherence in patients with depression, bipolar disorder, or schizophrenia. Future studies are needed to better understand how technology can be tailored to different types of nonadherence.
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Affiliation(s)
- Saadia A Basit
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, United States.
| | - Nikhil Mathews
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, United States.
| | - Mark E Kunik
- Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030, United States; VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), United States.
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Jeminiwa RN, Hohmann NS, Fox BI. Developing a Theoretical Framework for Evaluating the Quality of mHealth Apps for Adolescent Users: A Systematic Review. J Pediatr Pharmacol Ther 2019; 24:254-269. [PMID: 31337988 DOI: 10.5863/1551-6776-24.4.254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess adolescents' preferred mobile app features and to propose a framework for evaluating health-related mobile apps for adolescents. METHODS PubMed, CINAHL, PsycINFO, ERIC, HealthIT.gov, and ClinicalTrials.gov were systematically searched in August 2017. Studies pertaining to app development, feasibility, or usability that reported preferred app features and rating criteria on mHealth (mobile health) apps intended for adolescents were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. Qualitative synthesis was performed to develop themes reflecting best practices for evaluating the quality of mHealth apps for adolescents. Using a grounded theory approach, we constructed a theoretical framework of rating criteria that can be used to inform development of an evaluation tool for mHealth apps targeted to adolescents. RESULTS Thirteen articles were included. Most commonly preferred features include ability to track test results or self-management progress, connect to social media, and gain points or prizes through app gamification. Common rating criteria include degree of app customizability, ease of use, visual appeal, and interactivity. Five emerging dimensions were used in the theoretical framework: Technical Quality; Engagement; Support System; Autonomy; and Safety, Privacy, and Trust. CONCLUSIONS We found that adolescents prefer mHealth apps that are customizable, offer peer support through social media, sustain engagement via gamification, and support the ability to visualize health trends via simplified graphs. Findings may help in the development of mHealth apps that are preferred by adolescents, as well as the development of a quality evaluation tool for mHealth apps targeted to this population.
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Schwitzer AM, St. John D, Moss C, Burnett D, Foss J, Thompson L. Psychotropic Medication and Academic Success: Supportive Evidence. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1607644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alan M. Schwitzer
- Department of Counseling and Human Services, Old Dominion University, Norfolk, VA, USA
| | - Dan St. John
- Director of Academic Development, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Catherine Moss
- Student Assistance Center, Old Dominion University, Norfolk, VA, USA
| | - Dana Burnett
- Department of Educational Foundations and Leadership, Old Dominion University, Norfolk, VA, USA
| | - Jennifer Foss
- Student Health Center, Old Dominion University, Norfolk, VA, USA
| | - Lenora Thompson
- Student Counseling Center, Old Dominion University, Norfolk, VA, USA
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Del Pino-Sedeño T, Peñate W, de Las Cuevas C, Valcarcel-Nazco C, Fumero A, Serrano-Pérez PG, Acosta Artiles FJ, Ramos García V, León Salas B, Bejarano-Quisoboni D, Trujillo-Martín MM. Effectiveness and cost-effectiveness of a multicomponent intervention to improve medication adherence in people with depressive disorders - MAPDep: a study protocol for a cluster randomized controlled trial. Patient Prefer Adherence 2019; 13:309-319. [PMID: 30863020 PMCID: PMC6391125 DOI: 10.2147/ppa.s172963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Depression is a widespread mental disorder which can be treated effectively. However, low adherence to antidepressants is very common. The study of medication adherence in depression (MAPDep study) assesses the effectiveness and cost-effectiveness of a multicomponent strategy to enhance adherence toward medications in patients with depression. INTERVENTION The intervention is a multicomponent one consisting of an educational program for psychiatrists and/or a collaborative care program for patients and relatives, plus a reminder system that works through the use of an already available high-quality medication reminder application. STUDY DESIGN MAPDep study is an open, multicenter, four-arm cluster randomized controlled trial. The clusters are mental health units where psychiatrists are invited to participate. The clusters are randomly allocated to one of the three interventions or to usual care (control arm). Patients (18-65 years of age) diagnosed with depressive disorder, those taking antidepressant medication for an existing diagnosis of depression, and mobile phone users are selected. In group 1, only patients and relatives receive intervention; in group 2, only psychiatrists receive intervention; and in group 3, patients/relatives and psychiatrists receive intervention. The primary outcome is adherence to the antidepressant drug. The calculated sample size is 400 patients. To examine changes across time, generalized linear mixed model with repeated measures will be used. A cost-effectiveness analysis will be conducted. The effectiveness measure is quality-adjusted life years. Deterministic sensitivity analyses are planned. CONCLUSION MAPDep study aims to assess a multicomponent strategy to improve adherence toward medications in patients with depression, based not only on clinical effectiveness but also on cost-effectiveness. This methodology will enhance the transferability of the expected results beyond mental health services (patients and psychiatrists) to health care policy decision making. CLINICAL TRIAL IDENTIFIER NCT03668457.
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Affiliation(s)
- Tasmania Del Pino-Sedeño
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
| | - Carlos de Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain,
| | - Cristina Valcarcel-Nazco
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Canary Islands Foundation of Health Research (FUNCANIS), San Cristóbal de La Laguna, Canary Islands, Spain
| | - Ascensión Fumero
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
| | - Pedro Guillermo Serrano-Pérez
- Department of Psychiatry, Hospital Universitari Vall d' Hebron, Catalonia, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Francisco Javier Acosta Artiles
- Service of Mental Health, General Health Care Programs Direction, Canary Health Service, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Vanesa Ramos García
- Canary Islands Foundation of Health Research (FUNCANIS), San Cristóbal de La Laguna, Canary Islands, Spain
| | - Beatriz León Salas
- Canary Islands Foundation of Health Research (FUNCANIS), San Cristóbal de La Laguna, Canary Islands, Spain
| | | | - María M Trujillo-Martín
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Canary Islands Foundation of Health Research (FUNCANIS), San Cristóbal de La Laguna, Canary Islands, Spain
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Han M, Lee E. Effectiveness of Mobile Health Application Use to Improve Health Behavior Changes: A Systematic Review of Randomized Controlled Trials. Healthc Inform Res 2018; 24:207-226. [PMID: 30109154 PMCID: PMC6085201 DOI: 10.4258/hir.2018.24.3.207] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/07/2018] [Accepted: 05/30/2018] [Indexed: 01/09/2023] Open
Abstract
Objectives The purpose of this study was to examine the effectiveness of mobile health applications in changing health-related behaviors and clinical health outcomes. Methods A systematic review was conducted in this study. We conducted a comprehensive bibliographic search of articles on health behavior changes related to the use of mobile health applications in peer-reviewed journals published between January 1, 2000 and May 31, 2017. We used databases including CHINAHL, Ovid-Medline, EMBASE, and PubMed. The risk of bias assessment of the retrieved articles was examined using the Scottish Intercollegiate Guidelines Network. Results A total of 20 articles met the inclusion criteria. Sixteen among 20 studies reported that applications have a positive impact on the targeted health behaviors or clinical health outcomes. In addition, most of the studies, which examined the satisfaction of participants, showed health app users have a statistically significant higher satisfaction. Conclusions Despite the high risk of bias, such as selection, performance, and detection, this systematic review found that the use of mobile health applications has a positive impact on health-related behaviors and clinical health outcomes. Application users were more satisfied with using mobile health applications to manage their health in comparison to users of conventional care.
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Affiliation(s)
- Myeunghee Han
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Eunjoo Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
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Holender A, Sutton S, De Simoni A. Opinions on the use of technology to improve tablet taking in >65-year-old patients on cardiovascular medications. J Int Med Res 2018; 46:2754-2768. [PMID: 29730949 PMCID: PMC6124260 DOI: 10.1177/0300060518770578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective This study was performed to evaluate the perceptions of the use of technology to improve cardiovascular medicine taking among patients aged >65 years. Methods This qualitative study used focus groups with people aged >65 years taking cardiovascular medications from two East London community centres. Thematic analysis was informed by the Perceptions and Practicalities Approach framework. Results Participants welcomed technologies they considered familiar, accessible, and easy to use. They valued the opportunity to receive alerts to help with forgetting and monitoring their treatment. More advanced technologies such as ingestible sensor systems were considered helpful for elderly people with significant cognitive impairments still living in the community because of improved monitoring by caregivers and clinicians and prolonging independence. Although generally adapting to the increase in technology in everyday life, participants raised a number of concerns that included potential reduction in face-to-face communication, data security, becoming dependent on technology, and worrying about the consequences of technological failure. Conclusions Participants raised a number of concerns and practical barriers that would need to be addressed for technologies to be accepted and adopted in this patient group.
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Affiliation(s)
- Anita Holender
- 1 Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Stephen Sutton
- 1 Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anna De Simoni
- 2 Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, QMUL, London, UK
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Kao CK, Liebovitz DM. Consumer Mobile Health Apps: Current State, Barriers, and Future Directions. PM R 2018; 9:S106-S115. [PMID: 28527495 DOI: 10.1016/j.pmrj.2017.02.018] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 12/24/2022]
Abstract
This paper discusses the current state, barriers, and future directions of consumer-facing applications (apps). There are currently more than 165,000 mobile health apps publicly available in major app stores, the vast majority of which are designed for patients. The top 2 categories are wellness management and disease management apps, whereas other categories include self-diagnosis, medication reminder, and electronic patient portal apps. Apps specific to physical medicine and rehabilitation also are reviewed. These apps have the potential to provide low-cost, around-the-clock access to high-quality, evidence-based health information to end users on a global scale. However, they have not yet lived up to their potential due to multiple barriers, including lack of regulatory oversight, limited evidence-based literature, and concerns of privacy and security. The future directions may consist of improving data integration into the health care system, an interoperable app platform allowing access to electronic health record data, cloud-based personal health record across health care networks, and increasing app prescription by health care providers. For consumer mobile health apps to fully contribute value to health care delivery and chronic disease management, all stakeholders within the ecosystem must collaborate to overcome the significant barriers.
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Affiliation(s)
- Cheng-Kai Kao
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC-5000, W314, Chicago, IL 60637(∗).
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Ali EE, Teo AKS, Goh SXL, Chew L, Yap KYL. MedAd-AppQ: A quality assessment tool for medication adherence apps on iOS and android platforms. Res Social Adm Pharm 2018; 14:1125-1133. [PMID: 29402755 DOI: 10.1016/j.sapharm.2018.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the recent proliferation of smartphone medication adherence applications (apps), it is increasingly more difficult for patients and clinicians to identify the most useful app. OBJECTIVE To develop a quality assessment tool for medication adherence apps, and evaluate the quality of such apps from the major app stores. METHODS In this study, a Medication Adherence App Quality assessment tool (MedAd-AppQ) was developed and two evaluators independently assessed apps that fulfilled the following criteria: availability in English, had at least a medication reminder feature, non-specific to certain disease conditions (generic apps), free of technical malfunctions and availability on both the iPhone Operating System (iOS) and Android platforms. Descriptive statistics, Mann-Whitney U test, Pearson product moment correlation and Spearman rank-order correlation were used for statistical analysis. RESULTS MedAd-AppQ was designed to have 24 items (total 43 points) categorized under three sections: content reliability (11 points), feature usefulness (29 points) and feature convenience (3 points). The three sections of MedAd-AppQ were found to have inter-rater correlation coefficients of 0.801 (p-value < .001) or higher. Based on analysis of 52 apps (27 iOS and 25 Android), quality scores ranged between 7/43 (16.3%) and 28/43 (65.1%). There was no significant difference between the quality scores of the Android and iOS versions. None of the apps had features for self-management of side effects. Only two apps in each platform provided disease-related and/or medication information. CONCLUSIONS MedAd-AppQ can be used to reliably assess the quality of adherence apps. Clinicians can use the tool in selecting apps for use by patients. Developers of adherence apps should consider features that provide therapy-related information and help patients in medications and side-effects management.
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Affiliation(s)
- Eskinder Eshetu Ali
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore.
| | - Amanda Kai Sin Teo
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Republic of Singapore.
| | - Sherlyn Xue Lin Goh
- Department of Economics, Faculty of Arts and Social Sciences, National University of Singapore, Republic of Singapore.
| | - Lita Chew
- Department of Pharmacy, Faculty of Science, National University of Singapore, Republic of Singapore; Department of Pharmacy, National Cancer Centre Singapore, Republic of Singapore.
| | - Kevin Yi-Lwern Yap
- National Pharmacy Programme Management Office, Office of Director of Medical Services, Ministry of Health, Republic of Singapore.
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Wu F, Xiao C, Aitken D, Jones G, Winzenberg T. The optimal dosage regimen of vitamin D supplementation for correcting deficiency in adolescents: a pilot randomized controlled trial. Eur J Clin Nutr 2018; 72:534-540. [PMID: 29374249 DOI: 10.1038/s41430-018-0098-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/28/2017] [Accepted: 01/09/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Vitamin D deficiency is common in adolescents but the optimal dosage regimen for correcting deficiency is unknown. To test the safety and efficacy of two different vitamin D dosage regimens to correct vitamin D deficiency in adolescents. SUBJECTS/METHODS In this 12-month, double-blind, randomized placebo-controlled trial, 28 adolescents (serum 25 hydroxyvitamin D (25(OH)D) of 21 to 50 nmol/L) were randomly assigned to one of three groups: monthly (n = 9; vitamin D3 50,000 IU orally monthly plus three placebo tablets 3-monthly), 3-monthly (n = 9; 150,000 IU (3 × 50,000 IU tablets) 3-monthly and placebo orally monthly), or placebo (n = 10; placebo monthly and three placebo tablets 3-monthly). Serum 25(OH)D was measured at baseline, 3, 6 and 12 months. RESULTS Two participants withdrew after their baseline measurement from the 3-monthly group. At 12 months, one participant was deficient (≤50 nmol/L) in both the monthly and 3-monthly groups, whereas six out of ten in the placebo remained deficient (P = 0.055). At 12 months, the average serum 25(OH)D levels for the monthly, 3-monthly and placebo groups were 76.4, 64.7 and 49.7 nmol/L, respectively (P < 0.001 and P = 0.04 for differences between monthly and placebo groups and 3-monthly and placebo groups respectively, after adjustment for age, sex and seasonal variation). Adherence was 100% and adverse events were minor. CONCLUSIONS Both 50,000 IU monthly and 150,000 IU 3-monthly of vitamin D3 safely and effectively corrects vitamin D deficiency in adolescents. These data provide treatment options which can be used by health practitioners to tailor vitamin D dosage regiments according to patient preference and context.
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Affiliation(s)
- Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Cecilia Xiao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. .,Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
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Nguyen T, Rascati K, Temple H. Comparison of a medication adherence simulation in professional pharmacy students versus undergraduate students. CURRENTS IN PHARMACY TEACHING & LEARNING 2018; 10:102-105. [PMID: 29248066 DOI: 10.1016/j.cptl.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/01/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND PURPOSE Previous research at colleges and schools of pharmacy showed that simulation learning is an effective method to teach pharmacy students about the issues patients face when prescribed complicated medication regimens. The purpose of this analysis was to compare reported medication adherence rates, perceived barriers, and methods used to increase adherence between undergraduate students and pharmacy students based on a medication-taking simulation course activity. EDUCATIONAL ACTIVITY AND SETTING In spring semesters 2014 and 2015, students in both a pharmacy course and an undergraduate seminar course participated in a short simulation involving a complicated medication regimen. Within one week of participating in the simulation activity, the students answered survey questions about the assignment through an online course sharing platform. FINDINGS Almost all students enrolled in the courses (237/246 pharmacy students and 34/36 undergraduate students) completed the assignment (> 96% response rate). A large percentage of each group reported some non-adherence; 95% (225/237) of first-year pharmacy students and 82% (28/34) of undergraduate students. The top two barriers reported were 1) simply forgetting and 2) difficulty following the food- and/or alcohol-related restrictions associated with some of the simulated medications. The top two methods used to increase adherence were phone/electronic reminders and paper/spreadsheet reminders. DISCUSSION A limitation to this study was the small sample size of undergraduate students. Even though the response rate was over 96%, the course was a small seminar-type course. Although it might be expected that pharmacy students would be more adherent since they may have had experience with non-adherence issues while working in a pharmacy, opposite results were found. Since the students were relatively young, most had not personally dealt with a complicated medication regimen. SUMMARY Pharmacy students reported lower adherence to a complicated medication regimen than undergraduate students. The most common reasons for non-adherence and most common methods used to increase adherence were similar between the two cohorts. The use of electronic reminders was common for both groups of students, and should be included in discussions about methods to improve adherence rates.
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Affiliation(s)
- Teresa Nguyen
- College of Pharmacy, University of Texas, 2409 University Ave Stop A1900, Austin, TX 78712-1113, United States.
| | - Karen Rascati
- College of Pharmacy, University of Texas, 2409 University Ave Stop A1900, Austin, TX 78712-1113, United States.
| | - Holli Temple
- College of Pharmacy, University of Texas, 2409 University Ave Stop A1900, Austin, TX 78712-1113, United States.
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Badawy SM, Barrera L, Sinno MG, Kaviany S, O'Dwyer LC, Kuhns LM. Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review. JMIR Mhealth Uhealth 2017; 5:e66. [PMID: 28506955 PMCID: PMC5447825 DOI: 10.2196/mhealth.7798] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. OBJECTIVE The purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. METHODS PubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). RESULTS Of the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size <50 (11/15, 73%), and included adherence self-report and/or biomarkers (9/15, 60%). Only four studies were designed based on a theoretical framework. Approaches for text messaging and mobile phone app interventions varied across studies. Seven articles (7/15, 47%) reported significant improvement in adherence with moderate to large standardized mean differences. Most of the included studies were of low or moderate quality. Studies varied in sample size, methods of adherence assessment, and definition of adherence, which prohibited performing a meta-analysis. CONCLUSIONS The use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. Further evaluation of short- and long-term efficacy and cost-effectiveness of these interventions is warranted given the early and evolving state of the science.
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Affiliation(s)
- Sherif M Badawy
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Zagazig University Faculty of Medicine, Department of Pediatrics, Division of Hematology and Oncology, Zagazig, Egypt
| | - Leonardo Barrera
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Chicago, IL, United States
| | - Mohamad G Sinno
- University of Kansas School of Medicine, Department of Pediatrics, Wichita, KS, United States
| | - Saara Kaviany
- Advocate Children's Hospital, Department of Pediatrics, Oak Lawn, IL, United States
| | - Linda C O'Dwyer
- Northwestern University Feinberg School of Medicine, Galter Health Sciences Library, Chicago, IL, United States
| | - Lisa M Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Adolescent Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Zhao J, Freeman B, Li M. Can Mobile Phone Apps Influence People's Health Behavior Change? An Evidence Review. J Med Internet Res 2016; 18:e287. [PMID: 27806926 PMCID: PMC5295827 DOI: 10.2196/jmir.5692] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/07/2016] [Accepted: 10/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people's health-related behaviors. OBJECTIVE The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies. METHODS We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal's website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool. RESULTS A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the effectiveness of apps, such as less time consumption, user-friendly design, real-time feedback, individualized elements, detailed information, and health professional involvement. All studies were assessed as having some risk of bias. CONCLUSIONS Our results provide a snapshot of the current evidence of effectiveness for a range of health-related apps. Large sample, high-quality, adequately powered, randomized controlled trials are required. In light of the bias evident in the included studies, better reporting of health-related app interventions is also required. The widespread adoption of mobile phones highlights a significant opportunity to impact health behaviors globally, particularly in low- and middle-income countries.
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Affiliation(s)
- Jing Zhao
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mu Li
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Sobowale K, Torous J. Disaster psychiatry in Asia: The potential of smartphones, mobile, and connected technologies. Asian J Psychiatr 2016; 22:1-5. [PMID: 27520886 DOI: 10.1016/j.ajp.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/08/2016] [Accepted: 03/28/2016] [Indexed: 11/20/2022]
Abstract
Disaster mental health is recognized as a crucial part of disaster preparedness and response. Despite the commonality of disasters in Asia, many countries face formidable barriers to a rapid and robust mental health care response. Mobile technologies can alleviate the immediate suffering and reduce onset of chronic conditions such as post-traumatic stress disorder and depression. This article explores the role of mobile technologies to improve mental health before, during, and after disasters in Asia.
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Affiliation(s)
- Kunmi Sobowale
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John Torous
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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