The potential of cellular technology to mediate social networks for support of chronic disease self-management

Impact of a Dyadic Intervention on Family Supporter Involvement in Helping Adults Manage Type 2 Diabetes

BACKGROUND

Family support for adults' diabetes care is associated with improved self-management and outcomes, but healthcare providers lack structured ways to engage those supporters.

OBJECTIVE

Assess the impact of a patient-supporter diabetes management intervention on supporters' engagement in patients' diabetes care, support techniques, and caregiving experience.

DESIGN

Multivariate regression models examined between-group differences in support-related measures observed as part of a larger trial randomizing participants to a dyadic intervention versus usual care.

PARTICIPANTS

A total of 239 adults with type 2 diabetes and either A1c >8% or systolic blood pressure >160mmHg enrolled with a family supporter.

INTERVENTION

Health coaches provided training on positive support techniques and facilitated self-management information sharing and goal-setting.

MAIN MEASURES

Patient and supporter reports at baseline and 12 months of supporter roles in diabetes care and caregiving experience.

RESULTS

At 12 months, intervention-assigned patients had higher odds of reporting increased supporter involvement in remembering medical appointments (AOR 2.74, 95% CI 1.44, 5.21), performing home testing (AOR 2.40, 95% CI 1.29, 4.46), accessing online portals (AOR 2.34, 95% CI 1.29, 4.30), deciding when to contact healthcare providers (AOR 2.12, 95% CI 1.15, 3.91), and refilling medications (AOR 2.10, 95% CI 1.14, 3.89), but not with attending medical appointments or with healthy eating and exercise. Intervention-assigned patients reported increased supporter use of autonomy supportive communication (+0.27 points on a 7-point scale, p=0.02) and goal-setting techniques (+0.30 points on a 5-point scale, p=0.01). There were no differences at 12 months in change scores measuring supporter distress about patients' diabetes or caregiving burden. Intervention-assigned supporters had significantly larger increases in satisfaction with health system support for their role (+0.88 points on a 10-point scale, p=0.01).

CONCLUSIONS

A dyadic patient-supporter intervention led to increased family supporter involvement in diabetes self-management and increased use of positive support techniques, without increasing caregiver stress.

Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis

OBJECTIVE

To describe and assess digital health-led diabetes self-management education and support (DSMES) effectiveness in improving glycosylated hemoglobin, diabetes knowledge, and health-related quality of life (HrQoL) of Type 1 and 2 Diabetes in the past 10 years.

DESIGN

Systematic Review and Meta-Analysis. The protocol was registered on PROSPERO registration number CRD42019139884.

DATA SOURCES

PubMed, EMBASE, Cochrane library, Web of Science, and Scopus between January 2010 and August 2019. Study Selection and Appraisal: Randomized control trials of digital health-led DSMES for Type 1 (T1DM) or 2 (T2DM) diabetes compared to usual care were included. Outcomes were change in HbA1c, diabetes knowledge, and HrQoL. Cochrane Risk of Bias 2.0 tool was used to assess bias and GRADEpro for overall quality. The analysis involved narrative synthesis, subgroup and pooled meta-analyses.

RESULTS

From 4286 articles, 39 studies (6861 participants) were included. Mean age was 51.62 years, range (13-70). Meta-analysis revealed intervention effects on HbA1c for T2DM with difference in means (MD) from baseline -0.480% (-0.661, -0.299), I²75% (6 months), -0.457% (-0.761, -0.151), I² 81% (12 months), and for T1DM -0.41% (-1.022, 0.208) I² 83% (6 months), -0.03% (-0.210, 0.142) I² 0% (12 months). Few reported HrQoL with Hedges' g 0.183 (-0.039, 0.405), I² 0% (6 months), 0.153 (-0.060, 0.366), I² 0% (12 months) and diabetes knowledge with Hedges' g 1.003 (0.068, 1.938), I² 87% (3 months).

CONCLUSION

Digital health-led DSMES are effective in improving HbA1c and diabetes knowledge, notably for T2DM. Research shows non-significant changes in HrQoL. Intervention effect on HbA1c was more impressive if delivered through mobile apps or patient portals. Further research is needed on the impact of DSMES on these outcomes, especially for newly diagnosed diabetes patients.

Application of the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies in Assessing Mobile-Delivered Technologies for the Self-Management of Type 2 Diabetes Mellitus: Scoping Review

BACKGROUND

There is a growing role of digital health technologies (DHTs) in the management of chronic health conditions, specifically type 2 diabetes. It is increasingly important that health technologies meet the evidence standards for health care settings. In 2019, the National Institute for Health and Care Excellence (NICE) published the NICE Evidence Standards Framework for DHTs. This provides guidance for evaluating the effectiveness and economic value of DHTs in health care settings in the United Kingdom.

OBJECTIVE

The aim of this study is to assess whether scientific articles on DHTs for the self-management of type 2 diabetes mellitus report the evidence suggested for implementation in clinical practice, as described in the NICE Evidence Standards Framework for DHTs.

METHODS

We performed a scoping review of published articles and searched 5 databases to identify systematic reviews and primary studies of mobile device-delivered DHTs that provide self-management support for adults with type 2 diabetes mellitus. The evidence reported within articles was assessed against standards described in the NICE framework.

RESULTS

The database search yielded 715 systematic reviews, of which, 45 were relevant and together included 59 eligible primary studies. Within these, there were 39 unique technologies. Using the NICE framework, 13 technologies met best practice standards, 3 met minimum standards only, and 23 technologies did not meet minimum standards.

CONCLUSIONS

On the assessment of peer-reviewed publications, over half of the identified DHTs did not appear to meet the minimum evidence standards recommended by the NICE framework. The most common reasons for studies of DHTs not meeting these evidence standards included the absence of a comparator group, no previous justification of sample size, no measurable improvement in condition-related outcomes, and a lack of statistical data analysis. This report provides information that will enable researchers and digital health developers to address these limitations when designing, delivering, and reporting digital health technology research in the future.

Integrating family and friend support, information technology, and diabetes education in community-centric diabetes self-management

OBJECTIVE

Diabetes self-management (DSM) education, social support, and information technology interventions can improve patient engagement and health. A major challenge is animating, integrating, and accessing resources in under-resourced, rural communities. Set in an island community in Hawai'i, this study piloted a program that integrated friend-and-family support, community health services, telehealth-enabled DSM education, and mobile technologies by activating the community's social capital to support the program.

MATERIALS AND METHODS

An action research approach informed the design and implementation of a community-based DSM program that included: friends and family support, telehealth classes, personalized consultations, Bluetooth-enabled blood glucose monitors, and text messaging support. Outcomes were evaluated using biometric data, surveys, interviews, and participant observations.

RESULTS

The study spanned 9 months with 7 dyads, each with 1 individual with type 2 diabetes and a friend or family member. Six of the 7 participants with diabetes experienced reduced hemoglobin A1c percentages, with 3 reducing by more than 1%. The seventh participant maintained a hemoglobin A1c level within American Diabetes Association recommended ranges. DSM knowledge and self-care behaviors improved overall. Interviews and participant observations highlighted program strengths and social challenges associated with the interpersonal relationships between the members of the dyads.

CONCLUSIONS

A community-centric diabetes program can enhance understanding of diabetes etiology, DSM activities, and communication skills for effective disease management support in under-resourced rural communities. Social capital among community members, leveraged with health information technology, can catalyze and integrate limited health system resources for DSM and social support as a cost-effective strategy to develop community-centric chronic healthcare management initiatives.

Patients' Use of Social Media for Diabetes Self-Care: Systematic Review

BACKGROUND

Patient engagement with diabetes self-care is critical to reducing morbidity and mortality. Social media is one form of digital health that is available for diabetes self-care, although its use for peer-to-peer communication has not been systematically described, and its potential to support patient self-care is unclear.

OBJECTIVE

The primary aim of this systematic review was to describe the use of social media among patients (peer-to-peer) to manage diabetes and cardiovascular disease (CVD). The secondary aim was to assess patients' clinical outcomes, behavioral outcomes, quality of life, and self-efficacy resulting from peer-to-peer social media use.

METHODS

We conducted a literature search in the following databases: PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO (January 2008 through April 2019). The inclusion criteria were quantitative studies that included peer-to-peer use of social media for self-care of diabetes mellitus (with all subtypes) and CVD, including stroke.

RESULTS

After an initial yield of 3066 citations, we selected 91 articles for a full-text review and identified 7 papers that met our inclusion criteria. Of these, 4 studies focused on type 1 diabetes, 1 study included both type 1 and 2 diabetes, and 2 studies included multiple chronic conditions (eg, CVD, diabetes, depression, etc). Our search did not yield any individual studies on CVD alone. Among the selected papers, 2 studies used commercial platforms (Facebook and I Seek You), 3 studies used discussion forums developed specifically for each study, and 2 surveyed patients through different platforms or blogs. There was significant heterogeneity in the study designs, methodologies, and outcomes applied, but all studies showed favorable results on either primary or secondary outcomes. The quality of studies was highly variable.

CONCLUSIONS

The future landscape of social media use for patient self-care is promising. However, current use is nascent. Our extensive search yielded only 7 studies, all of which included diabetes, indicating the most interest and demand for peer-to-peer interaction on diabetes self-care. Future research is needed to establish efficacy and safety in recommending social media use among peers for diabetes self-care and other conditions.

Analyzing Online Social Support Within the Type 1 Diabetes Community

Social support has been linked with many health outcomes, ranging from heart disease to depression. Although its importance has been recognized, less is known about how individuals with chronic illnesses may use social media to provide and seek social support. This chapter's focus is on the way in which people with Type 1 diabetes (T1D) use social media to provide and solicit social support. A mixed-methods approach is utilized. First, posts from two social media platforms were qualitatively content analyzed. Second, the data were quantitatively analyzed to provide a finer-grained understanding of the messages. The results show informational support as the most prevalent on both sites, although there are some differences in content and use. This chapter's implications highlight the importance of social media as a conduit for social support among caregivers and individuals affected by T1D.

Sharing sensitive health information through social media in the Arab world

Background

Sharing daily activities on social media has become a part of our lifestyle, but little is known about sharing sensitive health information in the Arab world.

Objective

The objective of this study is to explore how social media users in the Arab world share sensitive health information through Facebook.

Design

A retrospective qualitative analysis was used in the study.

Settings and participants

A total of 110 Facebook groups, related to HIV, sickle cell and depression were screened between 5 June and 1 December 2014.

Results

Forty four Facebook groups met the inclusion criteria. 28 471 posts were extracted, of which 649 met inclusion criteria. Forty two percent of health information exchanged were related to HIV, 34% to depression and 24% to sickle cell diseases. The majority of postings were from Egypt 21.1%, Saudi Arabia 20%, Algeria 10% and Libya 9.2%. Male posts were 54.2% while 45.8% were posted by females. Individuals utilized Facebook groups to share personal experiences of their disease 31%, in addition to being used for seeking queries 13.6%, offering explicit advice 8.3%, reporting signs and symptoms of the disease 7.3% and posting their communication with the health-care provider 6.6%.

Conclusions

Users in the Arab world use social media to exchange sensitive health information, which could have serious implications regarding the privacy of the information shared with other members of the group. On the other hand, sharing health information could have positive effects for patients, such as sharing disease experiences and peer support. However, more work is needed to ensure that Facebook users in the Arab world are aware of the potential consequences of sharing sensitive health information through social media.

Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies

OBJECTIVES

To understand the experiences of patients and healthcare professionals (HCPs) using self-management digital interventions (DIs) for chronic physical health conditions.

METHODS

A systematic search was conducted in 6 electronic databases. Qualitative studies describing users' experiences of self-management DIs were included, and authors' interpretations were synthesised using meta-ethnography.

RESULTS

30 papers met the inclusion criteria, covering a range of DIs and chronic conditions, including hypertension, asthma and heart disease. The review found that patients monitoring their health felt reassured by the insight this provided, and perceived they had more meaningful consultations with the HCP. These benefits were elicited by simple tele-monitoring systems as well as multifaceted DIs. Patients appeared to feel more reliant on HCPs if they received regular feedback from the HCP. HCPs focused mainly on their improved clinical control, and some also appreciated patients' increased understanding of their condition.

CONCLUSIONS

Patients using self-management DIs tend to feel well cared for and perceive that they adopt a more active role in consultations, whilst HCPs focus on the clinical benefits provided by DIs.

PRACTICE IMPLICATIONS

DIs can simultaneously support patient condition management, and HCPs' control of patient health. Tele-monitoring physiological data can promote complex behaviour change amongst patients.

Implementing a telephone based peer support intervention for women with a BRCA1/2 mutation

Women with a BRCA1/2 gene mutation face complex risk management decisions and communication issues that can lead to increased levels of distress and unmet needs. We describe the implementation of a peer-support program that aims to reduce distress among women with a BRCA1/2 mutation, including peer and support recipient satisfaction with the program, challenges and lessons learnt. Participants with a BRCA1/2 mutation were matched with a trained peer volunteer (also a mutation carrier) to have regular one-on-one phone calls, over 4 months. Details of the calls, including topics discussed, time spent and number, were collected. Peers and recipients completed surveys assessing how they felt the contact went, satisfaction with the program, and preferences for matching. Satisfaction with the program was high for both peers and recipients. 80% of pairs ended contact through mutual agreement. Peers and recipients differed in the importance placed on age and surgery experience to determine matches. The most challenging aspect of the program for peers was difficulty in contacting recipients. Peer support for women with a BRCA1/2 mutation is feasible. However, to encourage continued involvement by peers and recipients greater flexibility in the method and delivery of contact is needed. We advocate the use of text-messaging and/or email as mechanisms for pairs to arrange and maintain contact. These strategies should be in addition to, rather than replacing, calls. A mixed medium intervention, where recipients can tailor the method of communication to suit their needs, may be preferable and effective, though this would need to be tested.

Computer technology for self-management: a scoping review

AIMS AND OBJECTIVES

The purpose of this scoping review of literature is to explore the types of computer-based systems used for self-management of chronic disease, the goals and success of these systems, the value added by technology integration and the target audience for these systems.

BACKGROUND

Technology is changing the way health care is provided and the way that individuals manage their health. Individuals with chronic diseases are now able to use computer-based systems to self-manage their health. These systems have the ability to remind users of daily activities, and to help them recognise when symptoms are worsening and intervention is indicated. However, there are many questions about the types of systems available, the goals of these systems and the success with which individuals with chronic illness are using them.

DESIGN

This is a scoping review in which the Cumulative Index of Nursing and Allied Health Literature, PubMed and IEEE Xplore databases were searched. A total of 303 articles were reviewed, 89 articles were read in-depth and 30 were included in the scoping review. The Substitution, Augmentation, Modification, Redefinition model was used to evaluate the value added by the technology integration.

FINDINGS

Research on technology for self-management was conducted in 13 countries. Data analysis identified five kinds of platforms on which the systems were based, some systems were focused on a specific disease management processes, others were not.

CONCLUSIONS

For individuals to effectively use systems to maintain maximum wellness, the systems must have a strong component of self-management and provide the user with meaningful information regarding their health states.

RELEVANCE TO CLINICAL PRACTICE

Clinicians should choose systems for their clients based on the design, components and goals of the systems.

eHealth technologies to support nutrition and physical activity behaviors in diabetes self-management

Diabetes is a chronic, complex condition requiring sound knowledge and self-management skills to optimize glycemic control and health outcomes. Dietary intake and physical activity are key diabetes self-management (DSM) behaviors that require tailored education and support. Electronic health (eHealth) technologies have a demonstrated potential for assisting individuals with DSM behaviors. This review provides examples of technologies used to support nutrition and physical activity behaviors in the context of DSM. Technologies covered include those widely used for DSM, such as web-based programs and mobile phone and smartphone applications. In addition, examples of novel tools such as virtual and augmented reality, video games, computer vision for dietary carbohydrate monitoring, and wearable devices are provided. The challenges to, and facilitators for, the use of eHealth technologies in DSM are discussed. Strategies to support the implementation of eHealth technologies within practice and suggestions for future research to enhance nutrition and physical activity behaviors as a part of broader DSM are provided.

Innovative patient care practices using social media

OBJECTIVE

To characterize the literature on social media applications used to deliver patient care.

DATA SOURCES

A search of the literature was conducted on June 11, 2014, using PubMed, MEDLINE, CINAHL, and Communication Abstracts databases for clinical studies between 2004 and 2014. A combination of the search terms "social media" or "Web 2.0" or "online social networking" or "Facebook" or "Twitter" AND "patient care" or "health care" was used. In addition, 42 additional abstracts were retrieved from www.patientslikeme.com for review.

STUDY SELECTION

Only published, peer-reviewed journal articles were considered and only publications in English were included. The abstracts from this search were reviewed for relevance to Web-based social media platforms being used in patient care activities.

DATA SYNTHESIS

A total of 35 articles were included in the review. A majority of the studies published on social media and patient care used cross-sectional designs and were conducted in the United States. Multiple social media applications were studied, but Facebook was the predominant social media tool found. Patient care opportunities for various diseases with social media have been studied. Recurring themes included overcoming barriers, engaging and empowering patients, enhancing research, providing information for health promotion, scratching the surface, and potential pitfalls.

CONCLUSION

Social media have the potential to help patients and practitioners overcome multiple barriers in the delivery of health care. Maintaining patient privacy, security of information shared in the platform, and integrity of information shared are all concerns when using this type of Web application.

Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study

Background

Chronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective.

Objective

The aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain.

Methods

A 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire.

Results

Targeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients completed questionnaires. Low specificity of the resources to one’s condition and time poorness may have been barriers to engagement.

Conclusions

Results suggest that with refinements, this study design can be implemented successfully when conducting a larger social media study. At present, comment cannot be made on what effect using social media can have on patients on hospital waiting lists, nor whether those who use social media while waiting in pain achieve better outcomes from eventual participation in a chronic pain program. Long-term follow-up should be included in future studies to answer this. Future research should focus on multicenter randomized controlled trials, involving patients in the intervention design for improved participation and outcomes and for evidence to be sound.

Family interventions to improve diabetes outcomes for adults

Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient's disease management, involving them in self-care interventions may positively influence patients' diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients' diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients' self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients' clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement.

The Role of Social Network Technologies in Online Health Promotion: A Narrative Review of Theoretical and Empirical Factors Influencing Intervention Effectiveness

Background

Social network technologies have become part of health education and wider health promotion—either by design or happenstance. Social support, peer pressure, and information sharing in online communities may affect health behaviors. If there are positive and sustained effects, then social network technologies could increase the effectiveness and efficiency of many public health campaigns. Social media alone, however, may be insufficient to promote health. Furthermore, there may be unintended and potentially harmful consequences of inaccurate or misleading health information. Given these uncertainties, there is a need to understand and synthesize the evidence base for the use of online social networking as part of health promoting interventions to inform future research and practice.

Objective

Our aim was to review the research on the integration of expert-led health promotion interventions with online social networking in order to determine the extent to which the complementary benefits of each are understood and used. We asked, in particular, (1) How is effectiveness being measured and what are the specific problems in effecting health behavior change?, and (2) To what extent is the designated role of social networking grounded in theory?

Methods

The narrative synthesis approach to literature review was used to analyze the existing evidence. We searched the indexed scientific literature using keywords associated with health promotion and social networking. The papers included were only those making substantial study of both social networking and health promotion—either reporting the results of the intervention or detailing evidence-based plans. General papers about social networking and health were not included.

Results

The search identified 162 potentially relevant documents after review of titles and abstracts. Of these, 42 satisfied the inclusion criteria after full-text review. Six studies described randomized controlled trials (RCTs) evaluating the effectiveness of online social networking within health promotion interventions. Most of the trials investigated the value of a “social networking condition” in general and did not identify specific features that might play a role in effectiveness. Issues about the usability and level of uptake of interventions were more common among pilot studies, while observational studies showed positive evidence about the role of social support. A total of 20 papers showed the use of theory in the design of interventions, but authors evaluated effectiveness in only 10 papers.

Conclusions

More research is needed in this area to understand the actual effect of social network technologies on health promotion. More RCTs of greater length need to be conducted taking into account contextual factors such as patient characteristics and types of a social network technology. Also, more evidence is needed regarding the actual usability of online social networking and how different interface design elements may help or hinder behavior change and engagement. Moreover, it is crucial to investigate further the effect of theory on the effectiveness of this type of technology for health promotion. Research is needed linking theoretical grounding with observation and analysis of health promotion in online networks.

E-mail to Promote Colorectal Cancer Screening Within Social Networks: Acceptability and Content

Effective techniques to encourage colorectal cancer screening in underscreened populations have included social support interventions and e-mail reminders from physicians. Personalized e-mail messages to promote colorectal cancer screening within social networks could be even more effective but have not been studied. The authors interviewed 387 e-mail users, aged 42-73 years in Georgia, Hawaii, and Massachusetts. Participants were asked to edit a sample message in which the sender shares a recent colonoscopy experience and urges the recipient to discuss colorectal cancer screening with a doctor. For those reporting willingness to send this message, changes to the message and suggested subject lines were recorded. Edited text was analyzed for content and concordance with original message. The majority of participants (74.4%) were willing to e-mail a modifiable message. Of those willing, 63.5% edited the message. Common edits included deletion (17.7%) or modification (17.4%) of a negatively framed sentence on colon cancer risks and addition or modification of personalizing words (15.6%). Few edits changed the meaning of the message (5.6%), and even fewer introduced factual inaccuracies (1.7%). Modifiable e-mail messages offer a way for screened individuals to promote colorectal cancer screening to social network members. The accuracy and effects of such messages should be further studied.

An overview of the role of social network sites in the treatment of adolescent diabetes

Of all the forms of social media, social network sites (SNS) have seen the fastest and broadest uptake, and their role within health care is only starting to be explored. SNS in clinical practice have the potential to provide education and support without the costs and constraints of more conventional treatment approaches. However, in order to effectively utilize SNS, it is important to use the SNS most frequented by adolescents. Despite the increase in the use of SNS in diabetes management, there are very few empirical studies on their efficacy, and the few that have been conducted have been inconclusive or had methodological limitations. Future research needs to be directed toward the impact of SNS on standard objective outcome measures and the comparison of SNS with conventional treatment approaches.

Online social networking services in the management of patients with diabetes mellitus: systematic review and meta-analysis of randomised controlled trials

AIMS

Social networking services (SNS) can facilitate real-time communication and feedback of blood glucose and other physiological data between patients and healthcare professionals. This systematic review and meta-analysis aims to summarise the current evidence surrounding the role of online social networking services in diabetes care.

METHODS

We performed a systematic literature review of the Medline, EMBASE and PsychINFO databases of all studies reporting HbA1c (glycated haemoglobin) as a measure of glycaemic control for social networking services in diabetes care. HbA1c, clinical outcomes and the type of technology used were extracted. Study quality and publication bias were assessed.

RESULTS

SNS interventions beneficially reduced HbA1c when compared to controls, which was confirmed by sensitivity analysis. SNS interventions also significantly improved systolic and diastolic blood pressure, triglycerides and total cholesterol. Subgroup analysis according to diabetes type demonstrated that Type 2 diabetes patients had a significantly greater reduction in HbA1c than those with Type 1 diabetes.

CONCLUSIONS

Online SNS provide a novel, feasible approach to improving glycaemic control, particularly in patients with Type 2 diabetes. Further mechanistic and cost-effectiveness studies are required to improve our understanding of SNS and its efficacy in diabetes care.

Empowering patients through social media: The benefits and challenges

This article explores the range of social media platforms used by patients and examines the benefits and challenges of using these tools from a patient perspective. A literature review was performed to investigate the use of social media technology by patients. The MEDLINE database was searched using the terms “social media” and “patient.” The search was conducted in September 2012 and yielded 765 abstracts. Initially, 63 abstracts were selected. All articles dating from 2004 through 2012 were included. Only 12 articles were found to be relevant for the purposes of the review. The results of this research found that there appears to be an increase in the use of social media by patients across the healthcare spectrum. The research indicates a promising future for the use of social media by patients; however, evidence related to the efficacy and effectiveness of social media is currently limited. Various challenges have also been identified relating to privacy and security concerns, usability, the manipulation of identity, and misinformation. The use of social media technology is an emerging trend for patients who are seeking health information. Conclusions are that such technology holds promise for improving patient engagement and empowerment and community building. Social media has a future in healthcare, especially with regard to patient engagement and empowerment; however, there are several challenges to overcome before the technology can achieve its potential.

Social support strategies in adult patients with diabetes: a review of strategies in the USA and Europe

Improvement of adherence in patients with a chronic disease state such as diabetes can be facilitated through well-crafted social support strategies. Family and friends are support options for many individuals living with diabetes. A systematic search of three databases was conducted to evaluate literature published from 2006 to April 2013 regarding social support in adults with diabetes conducted in the USA and Europe. While various studies had different findings, the overall trend shows that social support can result in a positive influence on both the ability of the patient to initiate and sustain diabetes management that can potentially result in positive health outcomes. This appears true even when the patient has low psychosocial skills and a small social support network. Healthcare professional involvement also correlates with patient improvement in specific outcomes not overlapped by the patient's social network. Support facilitated by peers can be a viable option along with the multitude of electronic options to help with social support.

The impact of social support on outcomes in adult patients with type 2 diabetes: a systematic review

Diabetes is one of the fastest growing chronic diseases globally and in the United States. Although preventable, type 2 diabetes accounts for 90 % of all cases of diabetes worldwide and continues to be a source of increased disability, lost productivity, mortality, and amplified health-care costs. Proper disease management is crucial for achieving better diabetes-related outcomes. Evidence suggests that higher levels of social support are associated with improved clinical outcomes, reduced psychosocial symptomatology, and the adaptation of beneficial lifestyle activities; however, the role of social support in diabetes management is not well understood. The purpose of this systematic review is to examine the impact of social support on outcomes in adults with type 2 diabetes.

Factors affecting acceptability and usability of technological approaches to diabetes self-management: a case study

PURPOSE

This study explored the impact of personal digital assistant (PDA) features, users' perceptions, and other factors that may have hindered PDA acceptability and usability as technology advances in e-health diabetes self-management.

STUDY DESIGN AND RESULTS

An ongoing study on PDA usage is set within the context of the advancements of Web 2.0 for type 2 diabetes mellitus (T2DM) self-management e-interventions. Advancements in technology as it relates to the future of T2DM mobile applications are discussed as possible deterrents of PDA acceptability and usability.

CONCLUSIONS

This case study illustrates the importance of addressing factors that may impede the adoption of electronic devices intended for sustained health behavior change. Recognizing the importance of individual perception within the context of rapid technological advancements is imperative for designing future health interventions. Incorporating electronic devices that individuals are more inclined to utilize, such as smartphones, as the platform for health interventions is a promising strategy to improve acceptability and usability, allowing researchers to more accurately assess the health benefits of self-management programs.

Communicating the noncommunicable

Since 2008, the World Economic Forum has identified noncommunicable diseases (NCDs) as a leading threat to the global economy both in terms of their cost and likelihood of happening. The Global Agenda Council on NCDs, a think tank of leaders in the field, was created by the World Economic Forum to raise awareness on the issue and support action leading up to the United Nations High Level Meeting on NCDs. The current special issue is the outcome of Council discussions as well as individual work of lead authors to highlight the burden of risk factors for NCDs, identify costs and solutions, and call for joint action and coordination across sectors. The special issue comprises two parts: "Risk Factors and Impact," and "Communicating and Acting on Solutions."