Latent user groups of an eHealth physical activity behaviour change intervention for people interested in reducing their cardiovascular risk

mHealth interventions to reduce stress in healthcare workers (fitcor): study protocol for a randomized controlled trial

BACKGROUND

Causes and consequences of chronic stress levels in the context of healthcare work are well examined. Nevertheless, the implementation and evaluation of high-quality interventions to reduce stress of healthcare workers is still missing. Internet and app-based interventions are a promising venue for providing interventions for stress reduction to a population that is otherwise difficult to reach due to shift work and time constraints in general. To do so, we developed the internet and app-based intervention (fitcor), a digital coaching of individual stress coping for health care workers.

METHODS

We applied the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement as a guideline for the present protocol. A randomized controlled trial will be conducted. There are five different intervention groups and one waiting control group. To achieve the sample sizes required by power analysis (G*Power) (β-error 80%; effect size 0.25), the sample sizes of the respective scenarios will be at best as follows: 336 care workers from hospitals, 192 administrative health personnel, 145 care workers from stationary elderly care homes, and 145 care workers from ambulatory care providers in Germany. Participants will randomly be assigned to one of five different intervention groups. A crossover design with a waiting control group is planned. Interventions will be accompanied by three measurement points, first a baseline measure, second a post-intervention measure directly after completion of the intervention, and a follow-up measure 6 weeks after completion of the intervention. At all three measurement points, perceived team conflict, work-related experience patterns, personality, satisfaction with internet-based training, and back pain will be assessed using questionnaires, as well as heart rate variability, sleep quality, and daily movement will be recorded using an advanced sensor.

DISCUSSION

Workers in the health care sector increasingly face high job demands and stress levels. Traditional health interventions fail to reach the respective population due to organizational constraints. Implementation of digital health interventions has been found to improve stress coping behavior; however, the evidence in health care settings has not been established. To the best of our knowledge, fitcor is the first internet and app-based intervention to reduce stress among nursing and administrative health care personnel.

TRIAL REGISTRATION

The trial was registered at DRKS.de on 12 July 2021, registration number: DRKS00024605.

Efficacy of Individualized Sensory-Based mHealth Interventions to Improve Distress Coping in Healthcare Professionals: A Multi-Arm Parallel-Group Randomized Controlled Trial

Detrimental effects of chronic stress on healthcare professionals have been well-established, but the implementation and evaluation of effective interventions aimed at improving distress coping remains inadequate. Individualized mHealth interventions incorporating sensor feedback have been proposed as a promising approach. This study aimed to investigate the impact of individualized, sensor-based mHealth interventions focusing on stress and physical activity on distress coping in healthcare professionals. The study utilized a multi-arm, parallel group randomized controlled trial design, comparing five intervention groups (three variations of web-based training and two variations of an app training) that represented varying levels of individualization to a control group. Both self-reported questionnaire data (collected using Limesurvey) as well as electrocardiography and accelerometry-based sensory data (collected using Mesana Sensor) were assessed at baseline and post-intervention (after eight weeks). Of the 995 eligible participants, 170 (26%) completed the post-intervention measurement (Group 1: N = 21; Group 2: N = 23; Group 3: N = 7; Group 4: N = 34; Group 5: N = 16; Control Group: N = 69). MANOVA results indicated small to moderate time-by-group interaction effects for physical activity-related outcomes, including moderate to vigorous physical activity (F(1,5) = 5.8, p = ≤0.001, η2p = 0.057) and inactivity disruption (F(1,5) = 11.2, p = <0.001, η2p = 0.100), in the app-based intervention groups, but not for step counts and inactivity. No changes were observed in stress-related heart rate variability parameters over time. Despite a high dropout rate and a complex study design, the individualized interventions showed initial positive effects on physical activity. However, no significant changes in stress-related outcomes were observed, suggesting that the intervention duration was insufficient to induce physiological adaptations that would result in improved distress coping.

Mobile-Health based physical activities co-production policies towards cardiovascular diseases prevention: findings from a mixed-method systematic review

BACKGROUND

Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

METHODS

A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

RESULTS

We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

CONCLUSIONS

While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how "value co-creation" could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

Investigating When, Which, and Why Users Stop Using a Digital Health Intervention to Promote an Active Lifestyle: Secondary Analysis With A Focus on Health Action Process Approach–Based Psychological Determinants

Background

Digital health interventions have gained momentum to change health behaviors such as physical activity (PA) and sedentary behavior (SB). Although these interventions show promising results in terms of behavior change, they still suffer from high attrition rates, resulting in a lower potential and accessibility. To reduce attrition rates in the future, there is a need to investigate the reasons why individuals stop using the interventions. Certain demographic variables have already been related to attrition; however, the role of psychological determinants of behavior change as predictors of attrition has not yet been fully explored.

Objective

The aim of this study was to examine when, which, and why users stopped using a digital health intervention. In particular, we aimed to investigate whether psychological determinants of behavior change were predictors for attrition.

Methods

The sample consisted of 473 healthy adults who participated in the intervention MyPlan 2.0 to promote PA or reduce SB. The intervention was developed using the health action process approach (HAPA) model, which describes psychological determinants that guide individuals in changing their behavior. If participants stopped with the intervention, a questionnaire with 8 question concerning attrition was sent by email. To analyze when users stopped using the intervention, descriptive statistics were used per part of the intervention (including pre- and posttest measurements and the 5 website sessions). To analyze which users stopped using the intervention, demographic variables, behavioral status, and HAPA-based psychological determinants at pretest measurement were investigated as potential predictors of attrition using logistic regression models. To analyze why users stopped using the intervention, descriptive statistics of scores to the attrition-related questionnaire were used.

Results

The study demonstrated that 47.9% (227/473) of participants stopped using the intervention, and drop out occurred mainly in the beginning of the intervention. The results seem to indicate that gender and participant scores on the psychological determinants action planning, coping planning, and self-monitoring were predictors of first session, third session, or whole intervention completion. The most endorsed reasons to stop using the intervention were the time-consuming nature of questionnaires (55%), not having time (50%), dissatisfaction with the content of the intervention (41%), technical problems (39%), already meeting the guidelines for PA/SB (31%), and, to a lesser extent, the experience of medical/emotional problems (16%).

Conclusions

This study provides some directions for future studies. To decrease attrition, it will be important to personalize interventions on different levels, questionnaires (either for research purposes or tailoring) should be kept to a minimum especially in the beginning of interventions by, for example, using objective monitoring devices, and technical aspects of digital health interventions should be thoroughly tested in advance.

Trial Registration

ClinicalTrials.gov NCT03274271; https://clinicaltrials.gov/ct2/show/NCT03274271

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-019-3456-7

Toward understanding the impact of mHealth features for people with HIV: a latent class analysis of PositiveLinks usage

PositiveLinks (PL) is a multi-feature smartphone-based platform to improve engagement-in-care and viral suppression (VS) among clinic patients living with HIV. Features include medication reminders, mood/stress check-ins, a community board, and secure provider messaging. Our goal was to examine how PL users interact with the app and determine whether usage patterns correlate with clinical outcomes. Patients (N = 83) at a university-based Ryan White clinic enrolled in PL from June 2016 to March 2017 and were followed for up to 12 months. A subset (N = 49) completed interviews after 3 weeks of enrollment to explore their experiences with and opinions of PL. We differentiated PL members based on 6-month usage of app features using latent class analysis. We explored characteristics associated with class membership, compared reported needs and preferences by class, and examined association between class and VS. The sample of 83 PL members fell into four classes. "Maximizers" used all app features frequently (27%); "Check-in Users" tended to interact only with daily queries (22%); "Moderate All-Feature Users" used all features occasionally (33%); and "As-Needed Communicators" interacted with the app minimally (19%). VS improved or remained high among all classes after 6 months. VS remained high at 12 months among Maximizers (baseline and 12-month VS: 100%, 94%), Check-in Users (82%, 100%), and Moderate All-Feature Users (73%, 94%) but not among As-Needed Communicators (69%, 60%). This mixed-methods study identified four classes based on PL usage patterns that were distinct in characteristics and clinical outcomes. Identifying and characterizing mHealth user classes offers opportunities to tailor interventions appropriately based on patient needs and preferences as well as to provide targeted alternative support to achieve clinical goals.

The Benefits of Telemedicine in Personalized Prevention of Cardiovascular Diseases (CVD): A Systematic Review

INTRODUCTION

Adverse effects on personalized care and outcomes of cardiovascular diseases (CVD) could occur if health systems do not work in an efficient manner. The pandemic caused by COVID-19 has opened new perspectives for the execution and advancement of cardiovascular tests through telemedicine platforms.

OBJECTIVE

This study aimed to analyze the usefulness of telemedical systems for providing personal care in the prevention of CVD.

METHODS

A systematic review analysis was conducted on the literature available from libraries such as PubMed (Medline), Scopus (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Data available in the last 10 years (2011-2020) were also examined by PRISMA guidelines. The selected studies were divided into two categories: (1) benefits of telemedicine in CVD prevention, and (2) recent progress in telemedical services for personalized care of CVD.

RESULTS

The literature search produced 587 documents, and 19 articles were considered in this review. Results highlighted that the timely delivery of preventive care for CVD which can be implemented virtually can benefit and modify morbidity and mortality. This could also reduce the pressure on hospitals by decreasing acute CVD occurrence among the general population. The use of these technologies can also help to reduce access to hospitals and other medical devices when not necessary.

CONCLUSIONS

Telemedicine platforms can be used for regular checkups for CVD and contribute to preventing the occurrence of acute events and more in general the progression of CVD.

An 8-Week Study on Social-Cognitive Variables for Physical Activity and Fruit and Vegetable Intake: Are there Stage Transitions?

BACKGROUND

Health behavior change can be modelled in terms of stages, and outcomes of transitions between stages can be categorized into progression, regression, and stagnation. Based on the Health Action Process Approach this study tested whether changes in social-cognitive variables are associated with transitions between stages regarding physical activity (PA) and fruit and vegetable intake (FVI).

METHODS

N = 132 participants (M = 50.86 years, SD = 13.17, 61.4% women) were assessed at baseline and 8 weeks later. Data were analysed using multivariate analyses of variance (MANOVA) and post-hoc comparisons.

RESULTS

Changes in motivational self-efficacy (η²  = 0.081), maintenance self-efficacy (η²  = 0.119), and recovery self-efficacy (η²  = 0.049) as well as positive outcome expectancies (η²  = 0.070), negative outcome expectancies (η²  = 0.055), and coping planning (η²  = 0.065) were associated with FVI stage progression. For PA, changes were not associated with stage progression.

CONCLUSION

To facilitate behavior change effectively, at least for FVI, it is essential to consider underlying mechanisms such as several aspects of self-efficacy in performing the desired health behaviors, outcome expectations, and planning how to overcome barriers. Additionally, the adoption of a stage approach may be a useful starting point to develop stage-matched interventions.

Lifestyle behaviors among undergraduate nursing students: A latent class analysis

This is a cross-sectional study whose objective was to identify clustering of lifestyle behaviors among undergraduate nursing students to inform health promotion efforts and improve health outcomes later in life. All 353 undergraduate nursing students from the School of Nursing in a public university, Bahia, Brazil were invited to participate. The inclusion and exclusion criteria were according to the major project. Participants must be enrolled and attending the 1st to 10th semester, with a minimum age of 18 years. Participants were excluded if they had any physical disabilities that limited the collection of anthropometric measures or were completing an internship off-campus. A total of 286 undergraduate nursing students met the criteria and completed the survey. The questionnaires included standardized measures for demographic, academic, and lifestyle behaviors (e.g., tobacco use, alcohol use, physical activity level, sedentary behavior, and fruits and vegetables consumed). Latent class analysis was performed to identify any clustering of lifestyle behaviors. Descriptive analyses indicated that 3.1% of the students were smokers, 23.1% consumed alcohol, 34.3% were inactive, 85.0% were sedentary, and 80.8% did not consume recommended amounts of fruits and vegetables. Latent class analysis produced four distinct subtypes of health risk: (a) low-health risk (33.57%); (b) moderate-health risk (27.97%); (c) high-health risk (19.58%); and (d) very high-health risk (18.88%). Approximately 38.5% of students were in the very high or high-risk classes. The proportion of students with very high and high-health risks emphasizes the importance of health promotion programs for university nursing students.

Weight bias internalization and its association with health behaviour adherence after bariatric surgery

This study tested the hypothesis that internalized weight bias (WBI) is negatively associated with health-related quality of life, weight loss and health behaviour adherence (eg, physical activity, diet, vitamin adherence) in patients who had weight loss surgery (WLS). It also tested whether self-efficacy for exercise, barriers to being active and depression were mediators between WBI and moderate-to-vigorous physical activity (MVPA). Participants were recruited from online support forums. They completed an anonymous online survey assessing WBI, physical activity, health behaviour adherence, depression, health-related quality of life, self-efficacy for exercise and barriers to being physically active. Multiple regression analyses and a bootstrapping approach for mediation were used. The sample included 112 primarily white and female adults, who had surgery 1 month to 24 years prior. WBI was negatively associated with weight loss since surgery, MVPA, dietary adherence, vitamin adherence and mental health-related quality of life, and was not associated with walking, physical health-related quality of life or fluid intake adherence. Self-efficacy for exercise, barriers to being active and depression were partial mediators between WBI and physical activity. After WLS, WBI may signal poorer adherence to critical health behaviours. It also is associated with less weight loss. WBI should be assessed and treated by WLS providers.

Football can tackle type 2 diabetes: a systematic review of the health effects of recreational football practice in individuals with prediabetes and type 2 diabetes

This work aimed to summarize the health effects of recreational football practice in individuals with prediabetes and type 2 diabetes (T2D), through a systematic review. An electronic search was performed in PubMed, Scopus, Web of Science, LILACS and list of references of the available reviews, until July 2019. Studies were eligible if they included any form of football practice, in patients diagnosed with prediabetes or T2D. After recreational football practice, participants with prediabetes or T2D improved fasting glucose, total and LDL cholesterol, triglycerides, body mass, body fat percentage, waist circumference, blood pressure, and maximal oxygen uptake. Further benefits were found in fat-free mass and resting heart rate for participants with prediabetes, and in glycated haemoglobin, body mass index and fat mass in individuals with T2D. This systematic review showed promising benefits of recreational football practice on both the prevention and control of T2D and related cardiovascular risk.

Amateur endurance cycling practice and adult's physical and psychosocial health: a cross-sectional study of the influence of training volume

This study aimed to analyse the association between amateur cycling training volume and physical and psychosocial health. A cross-sectional study was developed, via self-reported survey, among 1669 cyclists and 1039 controls, where analysis of variance and hierarchical multiple linear regression test were developed. Independent of gender, high volumes of amateur endurance cycling practice benefited cyclists' body mass index and male cyclists' physical conditioning, while psychosocial health did not differ among the training volume groups. Hierarchical multiple linear regression analysis highlighted the contribution of training volume to lower cyclists' body mass index and better male cyclists' physical conditioning. All cyclist groups presented better physical and psychosocial health than controls. High volumes of amateur endurance cycling training were associated with better physical health without jeopardizing psychosocial health. The practice of amateur endurance cycling, both in low and high volumes, was associated with better physical and psychosocial health compared with inactivity.