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Panayi M, Charalambous GK, Jelastopulu E. Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system. J Patient Rep Outcomes 2024; 8:10. [PMID: 38261120 PMCID: PMC10805742 DOI: 10.1186/s41687-023-00680-x] [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: 10/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The widespread availability of antiretroviral therapy has led to improvements in life expectancy and thus an increase in the number of people living with HIV/AIDS (PLWHA) worldwide. However, a similar increase in the number of newly-diagnosed patients in Cyprus suggests the need for solutions designed to improve monitoring, planning, and patient communication. In this study, we aimed to determine whether the use of an information system to manage PLWHA might contribute to improved quality of life and critical adherence to prescribed drug regimens and ongoing medical care. METHODS A randomized controlled trial study was conducted in Cyprus based on information that we collected using the highly valid and reliable Greek translation of the World Health Organization (WHO) Quality of Life (QOL) HIV-BREF questionnaire to assess sociodemographic variables and patient compliance. We distributed 200 questionnaires before implementing a Health Medical Care (HMC) information system at our clinic. Six months after implementing this system, 68 of the completed questionnaires were selected, including two groups of 34 participants who had been assigned at random to the intervention or the control group. Participants included PLWHA aged ≥ 18 years who had been receiving antiretroviral therapy for more than 12 months between July 15, 2020, and July 15, 2022. RESULTS The changes in baseline to six-month scores reported for the intervention group were significantly higher than in the control group in all six subscales assessed with the WHOQOL-HIV-BREF questionnaire, as well as in the assessment of compliance. Furthermore, compliance with treatment was associated with higher scores in the questionnaire subscales, including physical health, psychological health, degree of autonomy, social relationships, life circumstances, and spirituality/religious/personal beliefs. We also identified specific demographic factors and behaviors that were associated with better compliance with scheduled medical care and the prescribed drug regimen. Specifically, men exhibited better compliance than women and younger PLWHA exhibited better compliance than the elderly as did individuals who reported a higher level of educational attainment. Additionally, individuals who did not use addictive substances, consumed less alcohol, and were managed using the monitoring information system all exhibited better compliance compared to those in the control group. CONCLUSION The results of this study suggest that management of PLWHA via the use of an information system can contribute to improved QOL and drug compliance.
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Affiliation(s)
- Maria Panayi
- Ph.D. Programme Health Management, Frederick University, Nicosia, Cyprus
- Gregorios AIDS Clinic, General Hospital of Larnaca, Larnaca, Cyprus
| | - Georgios K Charalambous
- Ph.D. Programme Health Management, Frederick University, Nicosia, Cyprus
- Hippocration General Hospital, Athens, Greece
| | - Eleni Jelastopulu
- Ph.D. Programme Health Management, Frederick University, Nicosia, Cyprus.
- Department of Public Health, School of Medicine, University of Patras, Patras, Greece.
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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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Heydari M, Mehraeen E, Javaherikiyan E, Mehrabi N, Langarizadeh M, Aghamohammadi V, Moghaddam HR, Nasiri K. Design, development and evaluation of a mobile-based self-care application for patients with COVID-19 not requiring hospitalization; a study of Northwest of Iran. BMC Med Inform Decis Mak 2023; 23:280. [PMID: 38057860 PMCID: PMC10698913 DOI: 10.1186/s12911-023-02381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Given the effective role of a mobile applications in disease management, disease monitoring, and self-care in patients with COVID-19 disease, we aimed to design, development and evaluation of a self-care Mobile app for COVID-19 patients not requiring hospitalization. METHODS The design, development and evaluation the usability of the self-care and education mobile app for patients with COVID-19 disease were conducted in two main phases at 2021 in Northwest of IRAN; (1) Determine the features and capabilities and (2) Design, development and evaluation of self-care mobile App. JAVA programming languages and Android Operating System were used and selected to design and development of a mobile app. There were 25 participants who conducted evaluations of the mobile app's usability and impact using the mobile health app usability a Questionnaire of User Interface Satisfaction was administered to assess the usability of the developed application. The results were analyzed via Excel 2013. RESULTS The model of developing a mobile app as an Information System was the Waterfall model. The smartphone application based on a set of capabilities and features was designed and consists of two main parts: the login screen for user registration, and the main home menu. The user interface includes three main pages or activities; (a) Main Menu for quick access to all of the pages, (b) Symptom management and monitoring to monitor the signs and symptoms during the illness, and (c) Set Reminders and Alarms to notify patients. The users' mean score of the application usability was calculated as 7.91 out of 9 indicating a good level of satisfaction. CONCLUSION This app can be a guideline and a useful tools for managing and monitoring symptoms, reminding medications, and implementing self-care instructions in outpatients. The authors suggest evaluating the efficacy and functionality test of mobile-based applications for COVID-19 in clinical trial studies.
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Affiliation(s)
- Mohammad Heydari
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran.
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | | | - Nahid Mehrabi
- Department of Health Information Technology, Aja University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Department of health information management, School of health management and information sciences, Iran university of medical sciences, Tehran, Iran
| | | | | | - Khadijeh Nasiri
- Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran.
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Ismail R, Yona S, Nurachmah E, Khariroh S, Sujianto U, Santoso W, Bangun SA, Voss JG. Feasibility of Lantern Using WhatsApp to Improve Antiretroviral Therapy Adherence. Comput Inform Nurs 2023; 41:915-920. [PMID: 37580048 DOI: 10.1097/cin.0000000000001054] [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: 08/16/2023]
Abstract
This pilot study tested the feasibility of Lantern program, an adherence program to HIV medications using WhatsApp, a secure social media messaging application from Meta, for a smartphone-based platform to enhance medication-taking adherence of antiretroviral therapy among people living with HIV in Indonesia. Thirty participants were recruited for this 8-week study. We recruited persons if they had taken antiretroviral therapy for at least 3 months prior to the study, had a smartphone, Internet access, and could use Lantern with WhatsApp. Here, we report the results from the focus group discussions, with the participants evaluating the qualitative aspects of the experiences. The WhatsApp platform was found to be safe, practical, and relatively inexpensive and provided confidentiality for the participants. Three themes emerged from the focus groups: the study motivated participants to take their antiretroviral therapy medications on time, they still set medication reminder alarms, and being in the study made them feel supported. The Lantern program indicated good feasibility and acceptability for adherence to antiretroviral therapies among people living with HIV. Future research should examine on how community organizations and healthcare providers can take advantage of the WhatsApp program to improve adherence to antiretroviral therapies.
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Affiliation(s)
- Rita Ismail
- Author Affiliations: Faculty of Health Sciences, Universitas Pembangunan Nasional Veteran Jakarta (Dr Ismail); Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Jawa Barat (Drs Yona and Nurachmah); Stikes Hang Tuah Tanjung Pinang, Tanjung Pinang, Kepulauan Riau (Dr. Khariroh); Department Ilmu Keperawatan, Fakultas Kedokteran, Universitas Dipanegoro, Semarang, Jawa Tengah (Dr. Sujianto); Stikes Bina Sehat PPNI Mojokerto, Mojokerto, Jawa Timur (Dr. Santoso); and Ministry of Health Republic of Indonesia, Poltekkes Kemenkes Jakarta III, Jakarta (Mr Bangun), Indonesia; and Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Dr Voss)
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Green SMC, Hall LH, French DP, Rousseau N, Parbutt C, Walwyn R, Smith SG. Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment. Ann Behav Med 2023; 57:988-1000. [PMID: 37494669 PMCID: PMC10578395 DOI: 10.1093/abm/kaad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence. PURPOSE To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs. METHODS We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet. RESULTS There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component. CONCLUSIONS The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.
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Affiliation(s)
- Sophie M C Green
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Parbutt
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust Leeds, Leeds, UK
| | - Rebecca Walwyn
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Loveys K, Sagar M, Antoni M, Broadbent E. The Impact of Virtual Humans on Psychosomatic Medicine. Psychosom Med 2023; 85:619-626. [PMID: 37363995 DOI: 10.1097/psy.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Virtual humans are likely to enhance the delivery of health care over the next decade. Virtual humans are artificially intelligent computer agents with hyperrealistic, autonomously animated embodiments based on affective computing techniques. Virtual humans could be programmed to screen for health conditions, triage patients, and deliver health interventions, with appropriate facial expressions and body gestures, functioning as a supplement to human care. This article provides a perspective on the implications of virtual humans for behavioral and psychosomatic medicine, and health psychology. METHODS A narrative review was conducted to integrate observations and findings from research on virtual humans from 91 articles in this multidisciplinary area. RESULTS Virtual humans can be used for multimodal behavior analysis of patients, individualized tailoring of interventions, and detection of changes of psychological and behavioral measures over time. Virtual humans can also pair the scalability of a website with the interactivity and relational skills of a human tele-therapist. Research is beginning to show the acceptability, feasibility, and preliminary effectiveness of virtual humans in a range of populations. Virtual humans can be easily tailored in terms of their appearance, voice, and language, and may be adapted to fit the characteristics of a patient population or hard-to-reach groups. If co-designed with these communities, virtual humans may help to promote health care engagement and improve outcomes. CONCLUSIONS Virtual humans can engage and motivate patients, and deliver personalized psychological and behavioral health care. This article provides an overview of the potential impact of virtual humans on psychosomatic medicine and discusses ethical implications.
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Affiliation(s)
- Kate Loveys
- From the Department of Psychological Medicine (Loveys, Broadbent), The University of Auckland; Soul Machines Ltd (Loveys, Sagar); Auckland Bioengineering Institute (Sagar), The University of Auckland, Auckland, New Zealand; and Center for Psycho-Oncology Research (Antoni), University of Miami, Coral Gables, Florida
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van den Elshout MA, Hoornenborg E, Coyer L, Anderson PL, Davidovich U, de Vries HJ, Prins M, Schim van der Loeff MF. Determinants of adherence to daily PrEP measured as intracellular tenofovir diphosphate concentrations over 24 months of follow-up among men who have sex with men. Sex Transm Infect 2023; 99:303-310. [PMID: 37258273 PMCID: PMC10359585 DOI: 10.1136/sextrans-2022-055499] [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: 04/12/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Adherence is key to the effectiveness of oral pre-exposure prophylaxis (PrEP) to prevent HIV. Therefore, we aimed to explore factors associated with adherence to daily PrEP (dPrEP). METHODS Men who have sex with men (MSM) using dPrEP (emtricitabine/tenofovir disoproxil) within the Amsterdam PrEP demonstration project at the Public Health Service of Amsterdam, provided dried blood spots (DBS) 12 and 24 months after PrEP initiation. From DBS, we determined intracellular tenofovir diphosphate (TFV-DP) concentrations to assess adherence; TFV-DP ≥700 fmol/punch was considered adequate. We assessed associations of sociodemographic, clinical and behavioural characteristics with TFV-DP concentrations using multivariable linear regression. RESULTS Of 263 participants who attended 12-month or 24-month study visits while on dPrEP, 257 (97.7%) provided DBS at one or both visits (492 DBS in total). Median TFV-DP concentration was 1299 (IQR 1021-1627) fmol/punch (12 months: 1332 (1087-1687); 24 months: 1248 (929-1590]). Higher TFV-DP concentrations were associated with: older age (p=0.0008), condomless anal sex with a casual partner in 6 months preceding PrEP initiation (+166 fmol/punch; 95% CI 36.5 to 296) and using a mobile application providing visualised feedback on PrEP use and sexual behaviour (+146 fmol/punch; 95% CI 28.1 to 263). Lower TFV-DP concentrations were associated with longer duration of PrEP use (24 vs 12 months; -91.5 fmol/punch; 95% CI -155 to -28.1). Time-updated number of sex partners, diagnosed STIs and chemsex were not associated with TFV-DP concentrations. CONCLUSIONS Overall, TFV-DP concentrations were high among MSM using dPrEP, indicating excellent adherence. Especially older participants, those who reported condomless anal sex with a casual partner prior to PrEP initiation and those who used an app with visualised feedback showed higher levels of adherence. As TFV-DP concentrations had decreased slightly at 2 years of PrEP use when compared with 1 year, we emphasise the importance of adherence counselling to those who continue using PrEP. TRIAL REGISTRATION NUMBER NL5413.
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Affiliation(s)
- Mark Am van den Elshout
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Liza Coyer
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Udi Davidovich
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam Faculty of Social and Behavioural Sciences, Amsterdam, The Netherlands
| | - Henry Jc de Vries
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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Liu Y, Lyden E, Furl R, Havens JP. Patient perspectives of antiretroviral pharmacy services: A cross-sectional cohort study. PLoS One 2023; 18:e0285694. [PMID: 37220118 DOI: 10.1371/journal.pone.0285694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) remains the main predictor of sustained HIV virologic suppression for people with HIV (PWH). Mail-order pharmacy services are often offered to patients as an alternative option to traditional pharmacy services. Some payers mandate ART to be dispensed from specific mail-order pharmacies regardless of patient choice complicating ART adherence for patients affected by social disparities. Yet, little is known about patient perspectives regarding mail-order mandates. METHODS Eligible patients of the HIV program at University of Nebraska Medical Center with experience receiving ART from both a local and mail-order pharmacy were invited to complete a 20-question survey with three core sections: experiences/perspectives on local and mail-order pharmacy settings; pharmacy attributes rankings; and pharmacy preference. Paired t-tests and Mann-Whitney tests were used to compare the agreement scores of pharmacy attributes. RESULTS Sixty patients (N = 146; 41.1%) responded to the survey. Mean age was 52 years. Most were male (93%) and White (83%). The majority of participants were on ART for HIV treatment (90%) and 60% were using mail-order pharmacies for their prescription services. Significant scoring differences (p<0.05) were observed for all pharmacy attributes favoring local pharmacies. Refilling ease was the most important attribute noted. More respondents (68%) preferred local pharmacies versus mail-order pharmacies. Payer associated mail-order pharmacy mandates were experienced by 78% with half believing the mandates impacted their medical care negatively. CONCLUSIONS In this cohort study, respondents preferred local pharmacies compared to mail-order pharmacy for ART prescription services and noted ease of refilling as the most important pharmacy attribute. Two-thirds of respondents believed mail-order pharmacy mandates negatively affected their health. Insurance payers should consider the removal of mail-order pharmacy mandates to allow patient choice of pharmacy, which may help remove barriers to ART adherence and improve long-term health outcomes.
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Affiliation(s)
- Yadi Liu
- University of Nebraska Medical Center, College of Pharmacy, Omaha, NE, United States of America
| | - Elizabeth Lyden
- University of Nebraska Medical Center, College of Public Health, Omaha, NE, United States of America
| | - Renae Furl
- University of Nebraska Medical Center, College of Medicine, Omaha, NE, United States of America
| | - Joshua P Havens
- University of Nebraska Medical Center, College of Pharmacy, Omaha, NE, United States of America
- University of Nebraska Medical Center, College of Medicine, Omaha, NE, United States of America
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Wirtz AL, Logie CH, Mbuagbaw L. Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research. Epidemiol Rev 2022; 44:87-109. [PMID: 36124659 PMCID: PMC10362940 DOI: 10.1093/epirev/mxac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/29/2022] Open
Abstract
Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.
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Affiliation(s)
- Andrea L Wirtz
- Correspondence to Dr. Andrea L. Wirtz, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 (e-mail: )
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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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Krishna M, Sybil D, Shrivastava PK, Premchandani S, Kumar H, Kumar P. An Innovative App (ExoDont) for Postoperative Care of Patients After Tooth Extraction: Prototype Development and Testing Study. JMIR Perioper Med 2021; 4:e31852. [PMID: 34982720 PMCID: PMC8760618 DOI: 10.2196/31852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 12/15/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The postoperative period is crucial for the initiation of healing and prevention of complications after any surgical procedure. Due to factors such as poor compliance, comprehension, and retention of instructions, and other unaccounted factors, the objectives of postoperative care are not always achieved. Therefore, an Android-based mobile health app (ExoDont) was developed to ensure a smooth postoperative period for patients after a dental extraction. The ExoDont app delivers reminders for postoperative instructions and drug intake at defined intervals, thus fostering self-reliance among patients in taking their prescribed dose of medication. OBJECTIVE The aim of this study is to design, develop, and validate ExoDont, an innovative app for improved adherence to postoperative instructions after tooth extraction. METHODS A postoperative treatment protocol was developed by a team of oral and maxillofacial surgeons and general dentists, following which the clinical and technological requirements of the app were determined along with the software engineers, graphic designers, and applications architect in the team. ExoDont was developed to provide timely reminders for medication and postoperative care. The app was field tested and validated using the User Version of the Mobile Application Rating Scale. RESULTS The ExoDont software design was divided into a 3-level architecture comprising a user interface application, logical layer, and database layer. The software architecture consists of an Android-based ExoDont app for patients and a web version of the admin panel. The testing and validation of the ExoDont app revealed that Perceived Impact received the highest mean score of all rated components (mean 4.6, SD 0.5), while Engagement received the lowest mean score (mean 3.5, SD 0.8). CONCLUSIONS The testing and validation of the app support its usability and functionality, as well as its impact on users. The ExoDont app has been designed, keeping the welfare of patients in view, in a user-friendly manner that will help patients adhere to the prescribed drug regimen and ensure easy and efficient dissemination of postoperative instructions. It could play an instrumental role in fostering compliance among patients and significantly decrease the complication rate following dental extractions.
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Affiliation(s)
| | - Deborah Sybil
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Mohammad H, Elham M, Mehraeen E, Aghamohammadi V, Seyedalinaghi S, Kalantari S, Nahid M, Nasiri K. Identifying data elements and key features of a mobile-based self-care application for patients with COVID-19 in Iran. Health Informatics J 2021; 27:14604582211065703. [PMID: 34936526 DOI: 10.1177/14604582211065703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mobile Health applications have shown different usages in the COVID-19 pandemic, which consisted of empowering patient's awareness, promoting patient's self-care, and self-monitor behaviors. The purpose of this study is to identify key features and capabilities of a mobile-based application for self-care and self-management of people with COVID-19 disease. This study was a descriptive-analytical study that was conducted in two main phases in 2020. In the first phase, a literature review study was performed. In the second phase, using the information obtained from the review of similar articles, a questionnaire was designed to validate identified requirements. Based on the results of the first phase, 53 data elements and technical key features for mobile-based self-care application for people with COVID-19 were identified. According to the statistical population, 11 data elements for demographic requirements, 11 data elements for clinical requirements, 15 data elements for self-care specifications, and 16 features for the technical capability of this app were determined. Most of the items were selected by infectious and internal medicine specialists (94%). This study supports that the use of mobile-based applications can play an important role in the management of this disease. Software design and development could help manage and improve patients' health status.
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Affiliation(s)
- Heydari Mohammad
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Monaghesh Elham
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Khalkhal, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, 48439Tehran University of Medical Sciences, Khalkhal, Iran
| | - Vahideh Aghamohammadi
- Department of Nutrition, 6339Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Seyedahmad Seyedalinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Saieed Kalantari
- Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrabi Nahid
- Assistant Professor of Health information management, Aja University of Medical Sciences (AUMS), Aja, Iran
| | - Khadije Nasiri
- Department of Medical- Surgical Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
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The effect of visual interventions on illness beliefs and medication adherence for chronic conditions: A scoping review of the literature and mapping to behaviour change techniques (BCTs). Res Social Adm Pharm 2021; 18:3239-3262. [PMID: 34815181 DOI: 10.1016/j.sapharm.2021.11.006] [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] [Received: 05/05/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maintaining health with chronic conditions often involves taking multiple medications; however, approximately 50% of patients with chronic conditions are non-adherent to medication. Patients' illness beliefs inform health behaviour, including medication-taking. Research has shown that visuals accompanying health information increased patient comprehension and the accuracy of illness perceptions. To date, the influence of visuals on illness beliefs and medication adherence has not been comprehensively reviewed. OBJECTIVES The review aimed to collate available literature on visualisation interventions for illness beliefs and medication adherence in chronic conditions and identify key intervention characteristics. METHODS A scoping review was conducted according to recommended guidelines and the PRISMA-ScR statement. Searches used keywords relating to 'illness', 'visual', 'adherence', 'illness perception', 'intervention', and 'medication'. Six databases were searched from inception to 2019; reference-list searching provided additional articles. Articles were included if the study population had a chronic health condition, the intervention included a visual element, had a measure of illness beliefs or medication adherence. Data regarding intervention characteristics and outcomes were extracted. Behaviour change techniques (BCTs) were identified to provide further insight into intervention characteristics. RESULTS Initially, 18,012 articles were identified. Screening led to 293 full-text articles, ultimately resulting in 45 studies for final analysis. Forty-four were quantitative studies, 1 was qualitative. Studies were grouped into those using visuals to conceptualise a condition, medication reminders and educational interventions. Almost two-thirds of visual interventions were effective post-intervention, 3 sustained post-1-year, although many studies only assessed impact immediately post-intervention. BCTs from 'Natural consequences', 'Socialsupport' and 'Feedback and monitoring' categories were prevalent in effective interventions for both outcomes, particularly the 'Salience of consequences' BCT. CONCLUSIONS This comprehensive scoping review found that visual interventions can positively influence illness beliefs and medication adherence. These findings highlight the need to further evaluate the impact and sustainability of visual interventions.
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van den Elshout MAM, Hoornenborg E, Achterbergh RCA, Coyer L, Anderson PL, Davidovich U, de Vries HJC, Prins M, van der Loeff MFS. Improving adherence to daily preexposure prophylaxis among MSM in Amsterdam by providing feedback via a mobile application. AIDS 2021; 35:1823-1834. [PMID: 34001705 DOI: 10.1097/qad.0000000000002949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Improving adherence to preexposure prophylaxis (PrEP) by providing automated feedback on self-reported PrEP use via a mobile application (app). DESIGN Randomized clinical trial among MSM participating in the Amsterdam PrEP demonstration project (AMPrEP). METHODS Eligible participants were randomized 1 : 1 to the control or intervention app. Both allowed daily reporting of sexual behaviour and medication intake; the intervention app also provided visual feedback. Dried blood spots collected at 12 and 24 months yielded intracellular tenofovir diphosphate concentrations (TFV-DP). We assessed proportions of participants with poor (TFV-DP <700 fmol/punch; primary outcome), good (TFV-DP ≥700 fmol/punch) and excellent (TFV-DP ≥1250 fmol/punch; secondary outcome) adherence at both time-points, and the association with the control or intervention app. RESULTS We randomized 229 participants, 118 to the intervention and 111 to the control arm. The primary, per-protocol, analysis included 83 participants per arm. In total, 22/166 (13%) of participants adhered poorly, 144/166 (87%) good and 66/166 (40%) excellently. App feedback did not result in a lower proportion of participants with poor adherence [control: 9 of 83 (11%); intervention: 13 of 83 (16%); P = 0.36]. App feedback did result in a larger proportion of participants with excellent adherence [control: 26/83 (31%); intervention: 40/83 (48%); P = 0.026]. CONCLUSION In this highly adherent population, app feedback did not improve the proportion of participants with poor adherence to PrEP.Clinical Trial Number Netherlands Trial Register: NL5413.
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Affiliation(s)
- Mark A M van den Elshout
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Roel C A Achterbergh
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Social Psychology, University of Amsterdam
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
- Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
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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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Shelby T, Zhou X, Barber D, Altice F. Acceptability of an mHealth App That Provides Harm Reduction Services Among People Who Inject Drugs: Survey Study. J Med Internet Res 2021; 23:e25428. [PMID: 34259640 PMCID: PMC8319773 DOI: 10.2196/25428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/27/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Background Harm reduction services reduce the negative consequences of drug injection and are often embedded within syringe service programs (SSPs). However, people who inject drugs (PWID) suboptimally engage with such services because of stigma, fear, transportation restrictions, and limited hours of operation. Mobile health (mHealth) apps may provide an opportunity to overcome these barriers and extend the reach of SSPs beyond that of the traditional brick-and-mortar models. Objective This study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app. Methods We administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components. Results Most participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04). Conclusions Our findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population.
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Affiliation(s)
- Tyler Shelby
- Yale University School of Medicine, New Haven, CT, United States.,Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States
| | - Xin Zhou
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States
| | - Douglas Barber
- Yale University School of Medicine, New Haven, CT, United States
| | - Frederick Altice
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, United States.,Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, United States.,Centre of Excellence on Research on AIDS, University of Malaya, Kuala Lumpur, Malaysia
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18
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Hilt AD, Hierck BP, Eijkenduijn J, Wesselius FJ, Albayrak A, Melles M, Schalij MJ, Scherptong RWC. Development of a patient-oriented Hololens application to illustrate the function of medication after myocardial infarction. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:511-520. [PMID: 36713611 PMCID: PMC9707881 DOI: 10.1093/ehjdh/ztab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/25/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
Aims Statin treatment is one of the hallmarks of secondary prevention after myocardial infarction. Adherence to statins tends to be difficult and can be improved by patient education. Novel technologies such as mixed reality (MR) expand the possibilities to support this process. To assess if an MR medication-application supports patient education focused on function of statins after myocardial infarction. Methods and results A human-centred design-approach was used to develop an MR statin tool for Microsoft HoloLens™. Twenty-two myocardial infarction patients were enrolled; 12 tested the application, 10 patients were controls. Clinical, demographic, and qualitative data were obtained. All patients performed a test on statin knowledge. To test if patients with a higher tendency to become involved in virtual environments affected test outcome in the intervention group, validated Presence- and Immersive Tendency Questionnaires (PQ and ITQ) were used. Twenty-two myocardial infarction patients (ST-elevation myocardial infarction, 18/22, 82%) completed the study. Ten out of 12 (83%) patients in the intervention group improved their statin knowledge by using the MR application (median 8 points, IQR 8). Test improvement was mainly the result of increased understanding of statin mechanisms in the body and secondary preventive effects. A high tendency to get involved and focused in virtual environments was moderately positive correlated with better test improvement (r = 0.57, P < 0.05). The median post-test score in the control group was poor (median 6 points, IQR 4). Conclusions An MR statin education application can be applied effectively in myocardial infarction patients to explain statin function and importance.
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Affiliation(s)
- Alexander D Hilt
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Beerend P Hierck
- Leiden University Medical Center, Center for Innovation of Medical Education, Albinusdreef 2, 2333 ZA Leiden, The Netherlands,Leiden University, Teachers Academy, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Joep Eijkenduijn
- Faculty of Technical Medicine, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Fons J Wesselius
- Faculty of Technical Medicine, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Armagan Albayrak
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, The Netherlands,Department of Public and Occupational Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Roderick W C Scherptong
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands,Corresponding author. Tel: +31 71 5262020,
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Gaviria-Mendoza A, Emura-Vélez MH, García-Ospina DA, Machado-Duque ME, Machado-Alba JE. eHealth and mHealth: Adherence to treatment in chronic diseases. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.78766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Poor adherence to treatment is a common problem in patients with chronic diseases since, given their nature, they involve long-term therapeutic regimens, hence the importance of permanent follow-up. In general, it is known that adherence to treatment is necessary to achieve better health outcomes, improve quality of life, and reduce health care-related costs. The growth of eHealth, particularly telemedicine and mobile health (mHealth), has resulted in a real benefit of technological platforms in the therapeutic adherence of these patients. With this in mind, the aim of this reflection paper is to briefly describe the current state of eHealth strategies and the impact they may have on adherence to treatment in patients with chronic diseases.
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Bridging the gap between respiratory research and health literacy: an
interactive web-based platform. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:163-166. [DOI: 10.1136/bmjstel-2020-000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 11/03/2022]
Abstract
Many patients with respiratory disease lack an understanding of basic
respiratory physiology and the changes occurring in their lungs due to disease.
Describing how the lungs work using realistic 3D visualisation of lung structure
and function will improve communication of complicated concepts, resulting in
improved health literacy. We developed a web-based platform, using anatomically
realistic 3D lung models, to create an interactive visualisation tool to improve
health literacy for patients with respiratory disease. A small amount of
non-identifying personal information including gender, age, weight, height and
smoking history can be used to customise the visualisation to an individual user.
3D computer modelling was used to create a web-based application that helps people
understand how their lungs work in health and disease. The web-based application
includes pages describing and visualising how the lungs work and the changes that
occur during asthma and damage that smoking may be doing to their lungs. The
application is freely available and located at https://sites.bioeng.auckland.ac.nz/silo6/lung_new/. This
application bridges the gap between computational modelling and patient education,
giving a visually compelling view into the patient’s body that cannot be provided
with any existing tools, hence providing a novel platform for enhancing
patient–clinician interaction.
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Whittaker R, Dobson R, Candy S, Tane T, Burrowes K, Reeve J, Tawhai M, Taylor D, Robertson T, Garrett J, Humphrey G, Brott T, Khan SR, Hu F, Warren J. Mobile Pulmonary Rehabilitation: Feasibility of Delivery by a Mobile Phone-Based Program. FRONTIERS IN COMPUTER SCIENCE 2021. [DOI: 10.3389/fcomp.2021.546960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary rehabilitation (PR) has been proven effective but is not well accessed due to transport, time, cost, and physical limitations of patients. We have developed a mobile phone-based PR program (mPR) that could be offered as an alternative for those unable to attend in-person. This was developed following formative research with patients, their families and clinicians. mPR has a core text message program plus an app that includes an action plan, exercise videos, lung visualization, symptom score questionnaire and 1-min sit-to-stand test.Aims: To determine the feasibility of delivering pulmonary rehabilitation by mobile phone.Methods: A 9-week non-randomized (1-arm) pilot study was conducted. Participants were 26 adults with chronic obstructive pulmonary disease plus four family members, who were offered participation at first assessment or during group PR sessions. Outcomes included satisfaction, engagement with the program, and perceived impacts.Results: Eight people (31%) opted for text messages only, and 18 (69%) chose text messages plus the app. Three people stopped the program early, 20 said they would recommend it to others, 19 said it helped them to feel more supported, 17 said it helped them to change their behavior.Conclusion: It is feasible to deliver PR support via mobile phone, including exercise prescription and support. Our mPR program was appreciated by a small number of people with chronic respiratory disorders and family members. Suggestions for improvements are being used to inform the further development of the program, which will then be tested for effectiveness. Registered with the Australia New Zealand Clinical Trials Registry ACTRN12619000884101 (www.anzctr.org.au).
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Melilli E, Cestone G, Revuelta I, Meneghini M, Lladó L, Montero N, Manonelles A, Diaz M, Coloma A, Torregrosa V, Baliellas C, Cruzado JM, Diekmann F, Grinyó J, Bestard O. Adoption of a novel smart mobile-health application technology to track chronic immunosuppression adherence in solid organ transplantation: Results of a prospective, observational, multicentre, pilot study. Clin Transplant 2021; 35:e14278. [PMID: 33682207 DOI: 10.1111/ctr.14278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/06/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low adherence to chronic immunosuppression is associated with suboptimal transplantation outcomes. Mobile-health technology is a promising tool to monitor medication adherence, but data on patient engagement to these tools are lacking. METHODS Prospective, observational, multicenter, 2-phase trial in kidney and liver transplant recipients, investigating the degree of engagement to TrackYourMed® (TYM), a novel m-Health technology with a QR code-scan app to track immunosuppression adherence and its association with drug monitoring. RESULTS Out of 204 consecutive transplant patients, 90 patients were eligible to participate. 61 (68%) used TYM regularly, 21 (23%) never or barely used it, 5 (5.5%) were irregular users, and 3 (3.3%) were lost to follow-up. 6-month total correct intakes (CIN) ranged between 69%-76%, 12%-19% intakes were out-of-time (OUT), and 9%-12% were missed (MIS). Notably, a rate of intakes out of the scheduled time higher than 20% in the 6 days prior to blood immunosuppressant trough levels was associated with a higher intra-patient variability (17 IQR 13-21% vs. 29 IQR 23%-36%, p = .001), and with a higher dose-adjustment (p < .001). At 1 year, 53(59%) patients were still active users of TYM. CONCLUSIONS Implementing m-Health technologies promoting immunosuppression adherence may be useful for a relevant number of transplant patients and help transplant physicians identifying erratic immunosuppression adherence.
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Affiliation(s)
- Edoardo Melilli
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Giuseppe Cestone
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Ignacio Revuelta
- Renal Transplant Unit, Nephrology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Maria Meneghini
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Laura Lladó
- Liver Transplant Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Nuria Montero
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Anna Manonelles
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Maribel Diaz
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Ana Coloma
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Vicenç Torregrosa
- Renal Transplant Unit, Nephrology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Carme Baliellas
- Liver Transplant Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Josep M Cruzado
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Fritz Diekmann
- Renal Transplant Unit, Nephrology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Josep Grinyó
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Oriol Bestard
- Renal Transplant Unit, Nephrology Department, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
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Havens JP, Sayles H, Fadul N, Bares SH. Impact of Pharmacy Type on HIV Viral Suppression: A Retrospective Cross-Sectional Cohort Study. Open Forum Infect Dis 2020; 7:ofaa351. [PMID: 32939355 PMCID: PMC7486952 DOI: 10.1093/ofid/ofaa351] [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: 05/05/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background People with HIV (PWH) use various pharmacy types beyond traditional local pharmacies. Some specialized pharmacies offer additive adherence services such as refill reminders, expedited delivery, and adherence packaging. Methods This single-center, retrospective cohort study evaluated the impact of pharmacy type on the gain or loss of HIV viral suppression (VS; HIV RNA ≤50 copies/mL). Patients (≥19 years) were categorized by VS and pharmacy type: HIV-specialized (additive adherence/delivery services) vs traditional (without adherence/delivery services). Fisher exact tests examined the effect of pharmacy type on differences in VS between years, and logistic regression models identified possible predictors of gaining or losing VS. Results During 2017–2018, no differences were observed for the gain or loss of VS across pharmacy types (VS gain vs continued viremia, P = .393; VS loss vs continued VS, P = .064). Predictors for the gain of VS included antiretroviral therapy adherence as percentage of days covered (PDC; adjusted odds ratio [aOR], 1.05; P < .001) and Federal Poverty Level 100%–138% (FPL; aOR, 0.17; P = .032). Predictors for the loss of VS included use of protease inhibitor (aOR, 2.85; P = .013), ≥1 other illicit substance including tobacco (aOR, 2.96; P = .024), PDC (aOR, 0.95; P < .001), FPL 139%–200% (aOR, 0.09; P = .031), and CD4 >200 cells/ccm (aOR, 0.19; P = .013). Conclusions The gain or loss of VS among PWH in this retrospective cohort was not impacted by pharmacy transitions within the 2-year study period. However, PDC, FPL, illicit substance use, protease inhibitor use, and CD4 >200 cells/ccm were identified as factors associated with changes in VS.
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Affiliation(s)
- Joshua P Havens
- University of Nebraska Medical Center, College of Pharmacy, University of Nebraska, Omaha, Nebraska, USA.,University of Nebraska Medical Center, College of Medicine, University of Nebraska, Omaha, Nebraska, USA
| | - Harlan Sayles
- Univeristy of Nebraska Medical Center, College of Public Health, University of Nebraska, Omaha, Nebraska, USA
| | - Nada Fadul
- University of Nebraska Medical Center, College of Medicine, University of Nebraska, Omaha, Nebraska, USA
| | - Sara H Bares
- University of Nebraska Medical Center, College of Medicine, University of Nebraska, Omaha, Nebraska, USA
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Mehraeen E, Safdari R, SeyedAlinaghi S, Noori T, Kahouei M, Soltani-Kermanshahi M. A mobile-based self-management application- usability evaluation from the perspective of HIV-positive people. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lee SB, Valerius J. mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review. JMIR Mhealth Uhealth 2020; 8:e14739. [PMID: 32568720 PMCID: PMC7486676 DOI: 10.2196/14739] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 02/24/2020] [Accepted: 06/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Antiretrovirals (ARVs) are key in the management of HIV. Although no cure exists, ARVs help patients live healthy lives and prevent transmission to others. Adherence to complex regimens is paramount to outcomes and in avoiding the emergence of drug-resistant viruses. The goal of therapy is to reach an undetectable viral load. However, adherence is a common problem, stemming from issues such as mental health, chaotic home situations, and busy work schedules. Mobile health (mHealth) represents a new approach in improving medication adherence, and multiple studies have been performed in this area. Objective This study aims to review the current implementation of mHealth in the management of HIV among different groups of patients. Methods We used PubMed, Academic Search Elite, and 1 journal database with various search terms to review the current implementation of mHealth in HIV care. Results Titles and abstracts were screened, and 61 papers were identified and fully reviewed. The literature was divided into lower- and higher-income nations, as defined by the United Nations. A total of 20 studies with quantitative results were identified, with 10 being text- and SMS-based interventions (the majority of these being in lower-income countries) and 8 being smartphone-based apps (primarily in higher-income countries). The majority of these studies determined whether there was an effect on adherence or biochemical parameters (viral load and CD4 count). Various qualitative studies have also been conducted, and many have focused on determining the specific design of interventions that were successful (frequency of messaging, types of messages, etc) as well as priorities for patients with regard to mHealth interventions. Conclusions There seems to be a role of mHealth in the management of HIV in lower-income nations; however, the optimal design of an intervention needs to be delineated. In higher-income countries, where the 2 significant risk factors were injection drugs and men who have sex with men, the benefit was less clear, and more research is needed.
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Affiliation(s)
- Stephen B Lee
- Department of Medicine, Division of Infectious Diseases, University of Saskatchewan College of Medicine, Regina, SK, Canada.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Joanne Valerius
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
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Zia A, Brassart A, Thomas S, Ye F, Stephenson JJ, Mullins CD, Jones CA. Patient-Centric Structural Determinants of Adherence Rates Among Asthma Populations: Exploring the Potential of Patient Activation and Encouragement Tool TRUSTR to Improve Adherence. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2020; 7:111-122. [PMID: 32766376 PMCID: PMC7398613 DOI: 10.36469/jheor.2020.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Lack of adherence with prescribed medications among the asthma populations exacerbates health outcomes and increases social and economic costs. OBJECTIVES The proposed study aims to model patient-centric structural determinants of adherence rates among asthma patients and explore the potential of mobile health apps such as the TRUSTR platform to improve adherence using its power of monetary and non-monetary chatbotting and non-non-monetary nudges. Following specific hypotheses are tested: (1) Patient attributes, such as their age and monetary medical condition, have significant effect on their adherence with the prescribed treatment plans. (2) Behavioral nudging with rewards and engagement via mobile health apps will increase adherence rates. METHODS The patient population (N = 37 359) consists of commercially insured patients with asthma who have been identified from administrative claims in the HealthCore Integrated Research Database (HIRD) between April 1, 2018 and March 31, 2019. Two Structural Equation Models (SEMs) are estimated to quantify direct, indirect, and total effect sizes of age and medical condition on proportion of days covered (PDC) and medical possession ratio (MPR), mediated by patient medical and pharmacy visits. Fourteen additional SEMs were estimated to lateralize TRUSTR findings and conduct sensitivity analysis. RESULTS HIRD data reveal mean adherence rate of 59% (standard deviation (SD) 29%) for PDC and 58% for MPR (SD 36%). Key structural findings from SEMs derived from the HIRD dataset indicate that each additional year in the age of the patient has a positive total effect on the adherence rate. Patients with poor medical condition are likely to have lower adherence rate, but this direct effect is countered by mediating variables. Further, each additional reward and higher engagement with a mobile app is likely to have a positive total effect on increasing the adherence rate. CONCLUSIONS HIRD data reveal mean adherence rate of 59% (SD 29%), providing the evidence for the opportunity to increase adherence rate by around 40%. Statistical modeling results reveal structural determinants, such as the opportunity to nudge, are higher among younger patients, as they have higher probability of being non-adherent. Methodologically, lateralization approach demonstrates the potential to capture real-world evidence beyond clinical data and merge it with clinical data.
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Affiliation(s)
- Asim Zia
- Community Development and Applied Economics & Computer Science, University of Vermont, Burlington, VT,
USA
- trUSX, Inc., South Burlington, VT,
USA
| | | | | | - Fen Ye
- Sanofi, Inc., Bridgewater, NJ,
USA
| | | | - C. Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy Baltimore, MD,
USA
| | - Christopher A. Jones
- trUSX, Inc., South Burlington, VT,
USA
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy Baltimore, MD,
USA
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Christodoulou J, Abdalian SE, Jones ASK, Christodoulou G, Pentoney SL, Rotheram-Borus MJ. Crystal Clear with Active Visualization: Understanding Medication Adherence Among Youth Living with HIV. AIDS Behav 2020; 24:1207-1211. [PMID: 31696369 DOI: 10.1007/s10461-019-02721-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adherence to antiretroviral therapy (ART) among youth remains low. We piloted an adapted active visualization device that demonstrates how ART works in the body. Youth living with HIV were randomized to: (1) standard care (n = 14) or the (2) adapted active visualization intervention (n = 14) and 71% of the sample (n = 19) were re-assessed on viral load, adherence behaviors, and illness perceptions 2.5 months later. Intervention youth had lower viral loads, reported less difficulty in adhering to ART, and more motivation and control over their HIV than standard care at follow-up. Active visualization may be an acceptable tool to address ART adherence among youth.
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Affiliation(s)
- Joan Christodoulou
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920, Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
| | - Sue Ellen Abdalian
- School of Medicine, Tulane University, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Annie S K Jones
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Georgia Christodoulou
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | | | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920, Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA
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Pang Y, Molton JS, Ooi WT, Paton NI, He HG. Preliminary Effects of a Mobile Interactive Supervised Therapy Intervention on People Living With HIV: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e15702. [PMID: 32217500 PMCID: PMC7148554 DOI: 10.2196/15702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND As people living with HIV infection require lifelong treatment, nonadherence to medication will reduce their chance of maintaining viral suppression and increase the risk of developing drug resistance and HIV transmission. OBJECTIVE This study aimed to evaluate the efficacy of a mobile app, Mobile Interactive Supervised Therapy (MIST), for improving adherence to oral HIV medications among HIV-infected adults in Singapore. METHODS We conducted a two-group pilot randomized controlled trial (RCT) with a process evaluation, in which 40 HIV-infected participants with once-daily medication regimes were recruited from a public tertiary hospital in Singapore and randomly assigned equally to either the intervention (receiving MIST and routine care) or control (receiving routine care only) groups. The intervention lasted for 2 months. The outcome of antiretroviral therapy (ART) adherence was measured by a 7-day recall self-report (SR), pill count (PC), an electronic medical device-Medication Event Monitoring System (MEMS)-and a mobile app-MIST (for the intervention group only). In total, 20 participants from the intervention group were interviewed at the end of the intervention to assess the acceptability of MIST. Data were collected at baseline and at 1-month and 2-month postintervention. RESULTS All participants had excellent medication adherence at baseline (median 100, IQR 100-100). The use of MIST did not result in a significant improvement in ART adherence when measured by the SR, PC, and MEMS, as compared with the control group at 1-month (P values >.99, .86, and .74, respectively) and 2-month (P values=.80, .84, and .82, respectively) postintervention. ART adherence also did not improve in each group over the same period. MIST was perceived to be a beneficial tool based on the process evaluation results. CONCLUSIONS Although MIST did not enhance medication adherence to HIV treatments, mainly owing to the ceiling effect, it was perceived to be beneficial among the participants of this study. Our process evaluation provided useful data to further develop MIST for bigger and long-term mobile phone app-assisted intervention RCTs in the future. TRIAL REGISTRATION ClinicalTrials.gov NCT03794648; https://clinicaltrials.gov/ct2/show/NCT03794648.
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Affiliation(s)
- Yan Pang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
- University Medicine Cluster, National University Health System, Singapore, Singapore
| | - James Steven Molton
- University Medicine Cluster, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Tsang Ooi
- School of Computing, National University of Singapore, Singapore, Singapore
| | - Nicholas Iain Paton
- University Medicine Cluster, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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Zárate-Bravo E, García-Vázquez JP, Torres-Cervantes E, Ponce G, Andrade ÁG, Valenzuela-Beltrán M, Rodríguez MD. Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14680. [PMID: 32130164 PMCID: PMC7076413 DOI: 10.2196/14680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users' attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. OBJECTIVE This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. METHODS A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. RESULTS The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD's external cues not only improved older adults' medication adherence but also mediated family caregivers' involvement. CONCLUSIONS The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. TRIAL REGISTRATION ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97.
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Affiliation(s)
- Ernesto Zárate-Bravo
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | | | - Gisela Ponce
- Facultad de Enfermería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - Ángel G Andrade
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Marcela D Rodríguez
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
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Escobar-Viera C, Zhou Z, Morano JP, Lucero R, Lieb S, McIntosh S, Clauson KA, Cook RL. The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes. JMIR Mhealth Uhealth 2020; 8:e14557. [PMID: 31913127 PMCID: PMC6996722 DOI: 10.2196/14557] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/11/2019] [Accepted: 09/28/2019] [Indexed: 01/11/2023] Open
Abstract
Background For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. Although research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with the usage of a commercially available, regularly updated mobile health (mHealth) app for improving ART adherence among PLWH. Objective This study aimed to assess the feasibility, acceptability, and clinical outcomes of Care4Today, an existing, free, biprogrammatic mHealth app for improving ART adherence among PLWH. Methods The Florida mHealth Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in 3 public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% (44/132) declined, 31.1% (41/132) agreed but never used the app, and 35.6% (47/132) used the app. All were asked to complete follow-up surveys at 30 days and 90 days after enrollment. Usage data were used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) versus those who did not (nonusers). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis. Results Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and nonusers, respectively. Among users, a Kaplan-Meier plot showed that 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3%) of those who used the mHealth app reported ≥95% ART adherence, compared with 17 (58.6%) nonusers (P=.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants’ favorite features were medication reminders, ability to create custom reminders, and adherence reports. Conclusions This longitudinal study found that a commercially available medication adherence mHealth app was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across 3 public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than nonusers, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage.
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Affiliation(s)
- César Escobar-Viera
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zhi Zhou
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Jamie P Morano
- Division of Infectious Disease and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Robert Lucero
- College of Nursing, University of Florida, Gainesville, FL, United States
| | | | | | - Kevin A Clauson
- College of Pharmacy & Health Sciences, Lipscomb University, Nashville, TN, United States
| | - Robert L Cook
- Southern HIV and Alcohol Research Consortium Center for Translational HIV Research, University of Florida, Gainesville, FL, United States
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Canan CE, Waselewski ME, Waldman ALD, Reynolds G, Flickinger TE, Cohn WF, Ingersoll K, Dillingham R. Long term impact of PositiveLinks: Clinic-deployed mobile technology to improve engagement with HIV care. PLoS One 2020; 15:e0226870. [PMID: 31905209 PMCID: PMC6944340 DOI: 10.1371/journal.pone.0226870] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/07/2019] [Indexed: 01/23/2023] Open
Abstract
Background PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a community message board, and an ability to message providers. The objective of this study was to evaluate the impact of up to 24 months of PL use on HIV viral suppression and engagement in care and to examine whether greater PL use was associated with improved outcomes. Setting This study occurred between September 2013 and March 2017 at a university-based Ryan White HIV clinic. Methods We assessed engagement in care and viral suppression from study baseline to the 6-, 12-, 18- and 24-month follow-up time periods and compared trends among high vs. low PL users. We compared time to viral suppression, proportion of days virally suppressed, and time to engagement in care in patients with high vs. low PL use. Results 127 patients enrolled in PL. Engagement in care and viral suppression improved significantly after 6 months of PL use and remained significantly improved after 24 months. Patients with high PL use were 2.09 (95% CI 0.64–6.88) times more likely to achieve viral suppression and 1.52 (95% CI 0.89–2.57) times more likely to become engaged in care compared to those with low PL use. Conclusion Mobile technology, such as PL, can improve engagement in care and clinical outcomes for PLWH. This study demonstrates long-term acceptability of PL over two years and provides evidence for long-term improvement in engagement in care and viral suppression associated with PL use.
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Affiliation(s)
- Chelsea E. Canan
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Marika E. Waselewski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Ava Lena D. Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - George Reynolds
- Health Decision Technologies, Oakland, CA, United States of America
| | - Tabor E. Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Wendy F. Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
- * E-mail:
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Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc 2020; 23:e25439. [PMID: 31909896 PMCID: PMC6945883 DOI: 10.1002/jia2.25439] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Electronic and other new media technologies (eHealth) can facilitate large-scale dissemination of information and effective delivery of interventions for HIV care and prevention. There is a need to both monitor a rapidly changing pipeline of technology-based care and prevention methods and to assess whether the interventions are appropriately diversified. We systematically review and critically appraise the research pipeline of eHealth interventions for HIV care and prevention, including published studies and other funded projects. METHODS Two peer-reviewed literature databases were searched for studies describing the development, trial testing or implementation of new technology interventions, published from September 2014 to September 2018. The National Institutes of Health database of grants was searched for interventions still in development. Interventions were included if eHealth was utilized and an outcome directly related to HIV treatment or prevention was targeted. We summarized each intervention including the stage of development, eHealth mode of delivery, target population and stage of the HIV care and prevention continua targeted. RESULTS AND DISCUSSION Of 2178 articles in the published literature, 113 were included with 84 unique interventions described. The interventions utilize a variety of eHealth technologies and target various points on the prevention and care continua, with greater emphasis on education, behaviour change and testing than linkage to medical care. There were a variety of interventions for HIV care support but none for PrEP care. Most interventions were developed for populations in high income countries. An additional 62 interventions with funding were found in the development pipeline, with greater emphasis on managing HIV and PrEP care. CONCLUSIONS Our systematic review found a robust collection of eHealth interventions in the published literature as well as unpublished interventions still in development. In the published literature, there is an imbalance of interventions favouring education and behaviour change over linkage to care, retention in care, and adherence, especially for PrEP. The next generation of interventions already in the pipeline might address these neglected areas of care and prevention, but the development process is slow. Researchers need new methods for more efficient and expedited intervention development so that current and future needs are addressed.
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Affiliation(s)
| | - Anna Bratcher
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
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Relación entre representación de enfermedad, representación del tratamiento y adherencia en adultos con asma: Una revisión. REVISTA DIGITAL INTERNACIONAL DE PSICOLOGÍA Y CIENCIA SOCIAL 2020. [DOI: 10.22402/j.rdipycs.unam.6.1.2020.200.41-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
La adherencia al medicamento de control es el pilar fundamental para el control del asma; sin embargo, se ha identificado que una representación negativa de la enfermedad y el tratamiento impactan de modo negativo en esta. Se hizo una revisión narrativa para identificar los estudios empíricos acerca de representación de enfermedad, representación del tratamiento y adherencia a medicamentos de control en adultos con asma, desde el modelo de sentido común y representación de la enfermedad (MSCRE). Se identificaron 17 estudios divididos en transversales y longitudinales (12), experimentales (3) y de intervención (2), reportando que las principales dimensiones del MSCRE asociadas con la adherencia son la necesidad del tratamiento, preocupación, control de la enfermedad y del tratamiento, temporalidad crónica y consecuencias. Se concluye que el MSCRE es un modelo psicológico que tiene aplicaciones en la investigación y atención clínica para explicar y promover conductas de adherencia a medicamentos de control en adultos con asma.
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Revista Digital Internacional de Psicología y Ciencia Social | Volumen 6 | Número 1 | Enero-Junio 2020 | Investigación y acción para el cambio social. REVISTA DIGITAL INTERNACIONAL DE PSICOLOGÍA Y CIENCIA SOCIAL 2020. [DOI: 10.22402/j.rdipycs.unam.6.1.2020.281.1-246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
El nombre del presente número es “La investigación para la acción y el cambio social”, decidimos titularlo de esa manera porque consideramos de fundamental interés destacar la importancia que ha adquirido el trabajo científico desarrollado por los profesionales de distintas disciplinas para favorecer a la población que atienden respectivamente, pues en los trabajos presentados se muestra una excelente articulación entre la teoría y la práctica, poniendo en evidencia que se parte de una concepción social y científica, holística, pluralista e igualitaria.
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You WX, Comins CA, Jarrett BA, Young K, Guddera V, Phetlhu DR, Mulumba N, Mcingana M, Hausler H, Baral S, Schwartz S. Facilitators and barriers to incorporating digital technologies into HIV care among cisgender female sex workers living with HIV in South Africa. Mhealth 2020; 6:15. [PMID: 32270007 PMCID: PMC7136657 DOI: 10.21037/mhealth.2019.12.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An estimated 44-69% of female sex workers (FSW) in South Africa are living with HIV, among whom 39% are virally suppressed. Digital technologies-increasingly advanced and accessible to marginalized populations-present new opportunities to improve the HIV care continuum. The objective of this study was to explore potential facilitators and barriers to incorporating mobile phones and advanced technologies (e.g., biometric identification methods, mobile phone applications for social media and other uses, and chatbots) to deliver HIV-related interventions to cisgender FSW living with HIV in Durban, South Africa. METHODS Four semi-structured, focus group discussions (FGDs) were conducted with 22 cisgender FSWs in December 2018. Participants were recruited from the ongoing Siyaphambili trial using maximum variation sampling to optimize diversity in participant age and sex work venue. FGDs were audio recorded in isiZulu, and translated and transcribed into English. Transcripts were inductively coded using thematic analysis and sub-themes were iteratively refined to connect and evaluate the saliency of codes. RESULTS Phone ownership was motivated by a desire to remain safe and to connect with family, peers, and clients. When FSW did not have access to a mobile phone, they reported sharing phones with their peers, though sharing only occurred under specific conditions. Still, to integrate mobile phones into HIV care, FSW identified consistent access to mobile phones as a key barrier. Mobile phone turnover due to frequent selling of phones to meet other financial priorities, substance use, and theft were common. To integrate advanced technologies into HIV care, FSW identified convenience, security, and additional opportunities for social support as the main facilitators. For example, FSW described how biometric identification at clinics could eliminate the need to retain a clinic card. FSW also described how chatbots could easily set medication alarms or be available to assist in emergencies. Barriers for advanced technologies included maintaining privacy, potential threats to security, and cost. CONCLUSIONS FSWs were receptive to digital technologies for HIV care and beyond, but they also described many barriers such as inconsistent phone ownership and threats to privacy. As phone ownership grows and HIV programs increasingly leverage digital tools, strong considerations are needed to ensure the most vulnerable are not systematically excluded.
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Affiliation(s)
- William X. You
- Johns Hopkins Bloomberg School of Public Health, Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA
| | - Carly A. Comins
- Johns Hopkins Bloomberg School of Public Health, Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA
| | - Brooke A. Jarrett
- Johns Hopkins Bloomberg School of Public Health, Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA
| | | | | | - Deliwe R. Phetlhu
- University of Western Cape, School of Nursing, Cape Town, South Africa
| | | | | | | | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Baltimore, USA
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Gomolin A, Lebouché B, Engler K, Vedel I. Optimizing smartphone intervention features to improve chronic disease management: A rapid review. Health Informatics J 2019; 26:1795-1809. [PMID: 31826703 DOI: 10.1177/1460458219891377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While there are an increasing number of mobile health applications to facilitate self-management in patients with chronic disease, little is known about which application features are responsible for impact. The objective was to uncover application features associated with increased usability or improved patient outcomes. A rapid review was conducted in MEDLINE for recent studies on smartphone applications. Eligible studies examined applications for adult chronic disease populations, with self-management content, and assessed specific features. The features studied and their impacts on usability and patient outcomes were extracted. From 3661 records, 19 studies were eligible. Numerous application features related to interface (e.g. reduced number of screens, limited manual data entry) and content (e.g. simplicity, self-tracking features) were linked to improved usability. Only three studies examined patient outcomes. Specific features were shown to have a higher impact. Implementing them can improve chronic disease management and reduce app development efforts.
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Affiliation(s)
| | - Bertrand Lebouché
- McGill University, Canada; Research Institute of the McGill University Health Centre, Canada
| | - Kim Engler
- Research Institute of the McGill University Health Centre, Canada
| | - Isabelle Vedel
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
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Ramsey S, Ames E, Uber J, Habib S, Clark S. A Mobile Health App to Improve HIV Medication Adherence: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e15356. [PMID: 31719030 PMCID: PMC6881780 DOI: 10.2196/15356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/31/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence. OBJECTIVE The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes. METHODS This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations. RESULTS Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020. CONCLUSIONS This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus. TRIAL REGISTRATION ClinicalTrials.gov NCT02676128; https://clinicaltrials.gov/ct2/show/NCT02676128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15356.
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Affiliation(s)
- Susan Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
| | - Evan Ames
- Rhode Island Hospital, Providence, RI, United States
| | - Julia Uber
- Rhode Island Hospital, Providence, RI, United States
| | - Samia Habib
- Rhode Island Hospital, Providence, RI, United States
| | - Seth Clark
- The Warren Alpert Medical School of Brown University, Providence, RI, United States.,Rhode Island Hospital, Providence, RI, United States
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Han A, Min SI, Ahn S, Min SK, Hong HJ, Han N, Kim YS, Ahn C, Ha J. Mobile medication manager application to improve adherence with immunosuppressive therapy in renal transplant recipients: A randomized controlled trial. PLoS One 2019; 14:e0224595. [PMID: 31689320 PMCID: PMC6830819 DOI: 10.1371/journal.pone.0224595] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/17/2019] [Indexed: 01/01/2023] Open
Abstract
Background Nonadherence to immunosuppressive therapy after renal transplantation is associated with poor graft outcomes. We aimed to evaluate whether the use of the Adhere4U mobile medication manager application could improve adherence among renal transplant recipients ≥1 year posttransplantation. Adhere4U can provide medication reminders, monitor medication use, and provide information on immunosuppressants. Methods We conducted a prospective randomized controlled study to compare the rate of nonadherence to index immunosuppressant (tacrolimus or cyclosporine) in a group using the Adhere4U app (mobile group) and in another group receiving conventional care (control group). The primary outcome was the nonadherence rate, which was evaluated using an electronic medication event monitoring system during the 6-month intervention period. Our secondary outcome included self-reported adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS) and the visual analog scale (VAS) based on a 4-week recall on days 28, 90, and 180. Longitudinal data of repeated measures of self-rated adherence were analyzed using generalized estimating equations (GEE) to compare the between-group difference in adherence change over time. Results Between November 2013 and May 2015, 138 renal transplant recipients were randomly allocated to the control (n = 67) or the mobile group (n = 71). The overall nonadherence rate over the 6-month study period by electronic monitoring was 63.6%, with no between-group difference [mobile group, 65.0% (n = 39/60); control group, 62.1% (n = 36/58); odds ratio 1.14; 95% confidence interval 0.53–2.40; p = 0.89]. Self-rated nonadherence assessed using the BAASIS and VAS at baseline was 53.7% and 51.5%, respectively. Although the self-rated nonadherence by BAASIS of the mobile group was lower than the control group throughout the study period, there was no between-group difference in the change of nonadherence over time (χ2 = 2.82, df = 3, p = 0.42 by logistic GEE). There also was no significant between-group difference in the nonadherence by VAS (χ2 = 1.71, df = 3, p = 0.63 by logistic GEE) over time. The main limitation of this study was the low rate of patient engagement with the app among the mobile group. The rate of app use was 47.6% (31/65) at 28 days, 33.9% (19/56) at 90 days, and 11.5% (6/52) at 180 days. Conclusions The Adhere4U application did not improve adherence to immunosuppressive therapy. Our evidence is limited by the high rate of attrition. Further studies on strategies to facilitate patient engagement with mobile interventions are warranted.
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Affiliation(s)
- Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-jin Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nayoung Han
- Research Institute of Pharmaceutical Science, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Andrikopoulou E, Scott P, Herrera H, Good A. What are the important design features of personal health records to improve medication adherence for patients with long-term conditions? A systematic literature review. BMJ Open 2019; 9:e028628. [PMID: 31558449 PMCID: PMC6773318 DOI: 10.1136/bmjopen-2018-028628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions. DATA SOURCES PubMed (including MEDLINE), CINAHL, Science Direct (including EMBASE), BioMed Central, ACM digital, Emerald Insight, Google Scholar and Research Gate. METHODS Studies that were published between 1 January 2002 and 31 May 2018 in English were included if the participants were adults, with at least one long-term condition, were able to self-administer their medication and were treated in primary care settings. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the risk of bias was appraised using the Cochrane risk of bias tool. RESULTS From a total of 27 studies that matched the inclusion criteria, 12 were excluded due to low quality of evidence, 10 were rated moderate and 5 were rated high quality. All the included studies had low sample size and limited follow-up duration. Thirteen of the included studies found that the use of a PHR has increased medication adherence. The identified design features are reminders, education, personalisation and tailoring, feedback and alerts, gamification, medication management, medical appointment management, diary and self-monitoring, health condition management, set goals, patient's blog and tethered. It was impossible to draw conclusions as to which feature is important to what group of patients and why. The most frequently identified conditions were HIV and diabetes. This review did not identify any papers with negative results. It was not possible to numerically aggregate the PHR effect due to high heterogeneity of the medication adherence measurement, study type, participants and PHRs used. CONCLUSION Although we found recurrent evidence that PHRs can improve medication adherence, there is little evidence to date to indicate which design features facilitate this process. PROSPERO REGISTRATION NUMBER CRD42017060542.
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Affiliation(s)
- Elisavet Andrikopoulou
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
- School of Computing, Buckingham Building, Lion Terrace, Portsmouth, UK
| | - Philip Scott
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portsmouth, Portsmouth, UK
| | - Alice Good
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
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Santos VDF, Costa AKB, Lima ICVD, Alexandre HDO, Gir E, Galvão MTG. Use of the telephone for accessing people living with HIV/AIDS to antiretroviral therapy: systematic review. CIENCIA & SAUDE COLETIVA 2019; 24:3407-3416. [PMID: 31508759 DOI: 10.1590/1413-81232018249.31112017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/20/2018] [Indexed: 11/21/2022] Open
Abstract
This paper aims to evaluate the effectiveness of telephone use for the adherence of people with HIV/AIDS to antiretroviral therapy. A systematic review was carried out in the following databases: Latin American and Caribbean Literature in Health Sciences (Lilacs/ Bireme), SCOPUS, Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science; and in the Scientific Electronic Library Online (SciELO) and Cochrane libraries, using the following descriptors: "HIV", "Cell Phones", "Acquired Immunodeficiency Syndrome" and "Antiretroviral Therapy, Highly Active". We gathered a sample of 17 papers. The proposed cellphone interventions were the use of cellular applications, Short Message Service, and telephone calls. In most studies, telephone use has had a significant impact on adherence to treatment. The evaluation of the studies showed good methodological quality and adequate allocation secrecy. Self-reported adherence emerged among the adherence measuring methods. Cellphone use was effective in improving adherence to antiretroviral therapy for people living with HIV.
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Affiliation(s)
- Vanessa da Frota Santos
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | - Ana Karoline Bastos Costa
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | - Ivana Cristina Vieira de Lima
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | | | - Elucir Gir
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto SP Brasil
| | - Marli Teresinha Gimeniz Galvão
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
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Serlachius A, Schache K, Kieser A, Arroll B, Petrie K, Dalbeth N. Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e15021. [PMID: 31411147 PMCID: PMC6711037 DOI: 10.2196/15021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout. Objective Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions. Methods Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention. Results Participants rated the gout app as more engaging (mean difference –0.58, 95% CI –0.96 to –0.21) and more informative (mean difference –0.34, 95% CI –0.67 to –0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference –0.64, 95% CI –1.27 to –0.003) and higher knowledge/understanding of gout (mean difference –0.70, 95% CI –1.30 to –0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference –2.43, 95% CI –3.68 to –1.18), stronger beliefs regarding the severity of symptoms (mean difference –1.97, 95% CI –3.12 to –0.82), and a stronger emotional response to gout (mean difference –2.38, 95% CI –3.85 to –0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information. Conclusions Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217.
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Affiliation(s)
- Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anel Kieser
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bruce Arroll
- General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Mitzel LD, Vanable PA. Necessity and concerns beliefs and HIV medication adherence: a systematic review. J Behav Med 2019; 43:1-15. [PMID: 31396819 DOI: 10.1007/s10865-019-00089-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/30/2019] [Indexed: 01/02/2023]
Abstract
According to the Necessity-Concerns Framework, beliefs about medication necessity and concerns are two core themes from diverse patient medication beliefs across chronic illnesses that may directly influence adherence. Past work has supported associations of necessity and concerns to adherence in the chronic disease literature and in HIV research. However, there has not been a focused review of the literature on associations of necessity and concerns to HIV medication adherence, nor on what variables may influence these associations. This systematic review synthesized findings from 26 studies regarding associations of necessity and concerns to HIV medication adherence. Both beliefs showed small, clinically significant effects on adherence. A subset of studies identified perceptions of healthcare providers as determinants of necessity and concerns beliefs with indirect effects on adherence. Overall, necessity and concerns demonstrated clinically significant associations to adherence among people with HIV.
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Affiliation(s)
- Luke D Mitzel
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
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Jones ASK, Coetzee B, Kagee A, Fernandez J, Cleveland E, Thomas M, Petrie KJ. The Use of a Brief, Active Visualisation Intervention to Improve Adherence to Antiretroviral Therapy in Non-adherent Patients in South Africa. AIDS Behav 2019; 23:2121-2129. [PMID: 30259346 DOI: 10.1007/s10461-018-2292-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Non-adherence remains the largest cause of treatment failure to antiretroviral therapy (ART). Despite having the largest HIV pandemic, few successful adherence interventions have been conducted in South Africa. Active visualisation is a novel intervention approach that may help effectively communicate the need for consistent adherence to ART. The current study tested an active visualisation intervention in a sample of non-adherent patients. 111 patients failing on first- or second-line ART were recruited from two sites in the Western Cape, South Africa. Participants were randomly allocated to receive the intervention or standard care (including adherence counselling). The primary outcome was adherence as measured by plasma viral load (VL). There was a clinically significant difference (p = 0.06) in VL change scores between groups from baseline to follow-up, where the intervention had a greater decrease in log VL (Madj = - 1.92, CI [- 2.41, - 1.43), as compared to the control group (Madj = - 1.24, [- 1.76, - 0.73]). Participants in the intervention group were also significantly more likely to have a 0.5 log improvement in VL at follow-up ([Formula: see text] = 4.82, p = 0.028, ɸ = 0.28). This study provides initial evidence for the utility of this novel, brief intervention as an adjunct to standard adherence counselling, for improving adherence to ART.
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Shah R, Watson J, Free C. A systematic review and meta-analysis in the effectiveness of mobile phone interventions used to improve adherence to antiretroviral therapy in HIV infection. BMC Public Health 2019; 19:915. [PMID: 31288772 PMCID: PMC6617638 DOI: 10.1186/s12889-019-6899-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiretroviral therapy is effective in preventing the progression of HIV to AIDS, but adherence to HIV medication is lower than ideal. A previous Cochrane review concluded that SMS interventions increased adherence to HIV medication, but more recent trials have reported mixed results. Our review aims to provide an up-to-date synthesis of the effects of interventions delivered by mobile phone on adherence. METHODS We searched Cochrane, Medline, CINAHL, EMBASE and Global Health for randomised control trials (RCTs) of interventions delivered by mobile phones, designed to increase adherence to antiretroviral medication. Risk of bias was assessed using the Cochrane risk of bias tool. We calculated relative risk ratios (RR) or standardised mean difference (SMD) with 95% confidence interval (CI). Trials were analysed depending on delivery mechanism and intervention characteristics. We conducted meta-analysis for primary objective outcome measures. RESULTS We identified 19 trials. No trials were at low risk of bias. Interventions were delivered as follows; nine via text message, five via mobile phone call, one via mobile phone imagery and four via mixed interventions. There was no effect when interventions delivered by text message were pooled in the RR1.25 (CI 0.97 to 1.61) P = 0.08. The SMD 0.42 (0.03 to 0.81) p = 0.04 showed a moderate effect to improve adherence. There was mixed evidence of the effect of text messages delivered daily, weekly, at scheduled or triggered times, however, messages with link to support, interactivity and three or more behavior change techniques (BCTs) all improved adherence. Of the five trials delivered by mobile phone call, one reported a reduction in HIV viral load. One trial using mobile phone imagery reported a reduction in HIV viral load. Three trials that delivered interventions by text message and mobile phone counselling reported improved biological outcomes. CONCLUSION Specific interventions, of proven effectiveness should be considered for implementation, rather than mobile phone-based interventions in general. Interventions targeting a wider range of barriers to adherence may be more effective than existing interventions. The effects and cost-effectiveness of such interventions should be evaluated in a randomised controlled trial alongside long term objective and clinically important outcomes.
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Affiliation(s)
- Reshma Shah
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Julie Watson
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Caroline Free
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Morano JP, Clauson K, Zhou Z, Escobar-Viera CG, Lieb S, Chen IK, Kirk D, Carter WM, Ruppal M, Cook RL. Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study. JMIR Mhealth Uhealth 2019; 7:e12900. [PMID: 31271150 PMCID: PMC6636233 DOI: 10.2196/12900] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/31/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH. Objectives The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps. Methods A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform. Results Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a “flip-phone” model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical “daily” interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002). Conclusions This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.
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Affiliation(s)
- Jamie P Morano
- Department of Infectious Diseases and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Clinical Research Unit, University of South Florida, Florida Department of Health - Hillsborough, Tampa, FL, United States
| | - Kevin Clauson
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN, United States
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States.,Southern Alcohol HIV Research Consortium Center for Translational HIV Research, University of Florida, Gainesville, FL, United States
| | - César G Escobar-Viera
- Center for Research on Media, Technology, and Health - Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Spencer Lieb
- The AIDS Institute / Florida Consortium for HIV/AIDS Research, Tampa, FL, United States
| | - Irene K Chen
- Department of Infectious Diseases and International Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Clinical Research Unit, University of South Florida, Florida Department of Health - Hillsborough, Tampa, FL, United States
| | - David Kirk
- Clinical Research Unit, University of South Florida, Florida Department of Health - Hillsborough, Tampa, FL, United States
| | - Willie M Carter
- Immunology Clinical Research Unit, Florida Department of Health - Orange County, Orlando, FL, United States
| | - Michael Ruppal
- The AIDS Institute / Florida Consortium for HIV/AIDS Research, Tampa, FL, United States
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States.,Southern Alcohol HIV Research Consortium Center for Translational HIV Research, University of Florida, Gainesville, FL, United States
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Pérez-Jover V, Sala-González M, Guilabert M, Mira JJ. Mobile Apps for Increasing Treatment Adherence: Systematic Review. J Med Internet Res 2019; 21:e12505. [PMID: 31215517 PMCID: PMC6604503 DOI: 10.2196/12505] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/28/2019] [Accepted: 05/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated. OBJECTIVE This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients. METHODS We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017. RESULTS Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10. CONCLUSIONS The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home.
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Affiliation(s)
| | | | - Mercedes Guilabert
- Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
| | - José Joaquín Mira
- Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
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47
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Krasnoryadtseva A, Dalbeth N, Petrie K. Does seeing personal medical images change beliefs about illness and treatment in people with gout? A randomised controlled trial. Psychol Health 2019; 35:107-123. [PMID: 31184207 DOI: 10.1080/08870446.2019.1626396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: To explore the effects of an educational intervention with embedded personal medical images on illness perceptions, medication beliefs and treatment understanding in patients with gout. Design: Sixty people with gout were recruited into the study with three arms. The participants viewed a 12-min presentation about gout with either personalised medical scans, generic scans or medical illustrations from a standard educational booklet on gout. Main Outcome Measures: Illness perceptions about gout and beliefs about treatment for gout were assessed at baseline and immediately after the intervention. Results: There were no significant time by group interaction effects. All groups showed an increase in treatment control beliefs (p = .002), medication necessity (p < .001), improved understanding of medicines for gout (p < .001) and reduced their perceived gout stigma (p = .004). The personalised intervention was rated as more interesting compared to one with medical illustrations (p = .026). Personal scans were found more helpful than generic scans (p = .023) and medical illustrations (p = .048). Conclusion: The brief educational intervention yielded positive changes in illness perceptions, medication beliefs and treatment understanding in all groups. Personal scans did not induce specific changes but made the information more interesting.
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Affiliation(s)
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Keith Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Erguera XA, Johnson MO, Neilands TB, Ruel T, Berrean B, Thomas S, Saberi P. WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV. BMJ Open 2019; 9:e030473. [PMID: 31061063 PMCID: PMC6501960 DOI: 10.1136/bmjopen-2019-030473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Youth and young adults bear a disproportionate share of the HIV burden and there is a critical need for interventions to curb health disparities experienced among these age groups. The purpose of our research is to build on our theory-guided model and formative research to develop a mobile health application, called WYZ, for improved engagement in HIV care and antiretroviral therapy adherence, and pilot test it among youth and young adults living with HIV (YLWH). In this paper, we explain the design and development of WYZ for YLWH, describe the design of a forthcoming pilot trial for evaluating the feasibility and acceptability of WYZ and compare WYZ with other mobile health applications being developed to improve engagement in HIV care and antiretroviral medication adherence. METHODS AND ANALYSIS We used an agile methodology, shown to be useful in software development, and elicited feedback during beta testing to develop WYZ. WYZ is a modular, adaptive and personalised intervention delivered via a mobile phone. It is grounded in the information, motivation, behaviouralskills model which has been valuable for understanding and guiding the development of interventions for complex health behaviours. WYZ was created in collaboration with YLWH aged 18-29 years using a human-centred design approach that emphasises understanding the perspective of the users of the technology. WYZ is intended to improve engagement in HIV care by: (1) enhancing medication adherence self-efficacy, (2) increasing awareness and use of community resources, (3) reducing barriers to communication between youth and their healthcare team, and (4) providing a secure platform for the formation of a private online community of YLWH. We will conduct a 6-month single-arm pilot study to examine feasibility and acceptability of WYZ among 76 YLWH who live or receive care in the San Francisco Bay Area. All study activities, including recruitment, screening, enrolment, study assessments, provision of incentives and exit interviews, will be conducted remotely. We will explore feasibility and acceptability outcomes of the intervention using quantitative and qualitative methods. ETHICS AND DISSEMINATION Study staff will obtain written consent for study participation from all participants. This study and its protocols have been approved by the University of California San Francisco (UCSF) Institutional Review Board. Study staff will work with the UCSF Center for AIDS Prevention Studies' Community Engagement Core and the Youth Advisory Panel to disseminate results to the participants and the community using presentations, community forums, journal publications and/or social media. TRIAL REGISTRATION NUMBER NCT03587857; Pre-results.
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Affiliation(s)
- Xavier A. Erguera
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Theodore Ruel
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Beth Berrean
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sean Thomas
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Parya Saberi
- Medicine, University of California San Francisco, San Francisco, California, USA
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Marko KI, Ganju N, Krapf JM, Gaba ND, Brown JA, Benham JJ, Oh J, Richards LM, Meltzer AC. A Mobile Prenatal Care App to Reduce In-Person Visits: Prospective Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e10520. [PMID: 31042154 PMCID: PMC6658303 DOI: 10.2196/10520] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 01/07/2019] [Accepted: 01/26/2019] [Indexed: 01/02/2023] Open
Abstract
Background Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. Objective The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. Methods This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. Results A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. Conclusions The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction. Trial Registration ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517)
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Affiliation(s)
- Kathryn I Marko
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Nihar Ganju
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Jill M Krapf
- OB Hospitalist Group, Baylor All-Saints Medical Center, Fort Worth, TX, United States
| | - Nancy D Gaba
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - James A Brown
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Joshua J Benham
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Julia Oh
- The Jackson Laboratory, Farmington, CT, United States
| | - Lorna M Richards
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Jones ASK, Kleinstäuber M, Martin LR, Norton S, Fernandez J, Petrie KJ. Development and validation of the Health Visual Information Preference Scale. Br J Health Psychol 2019; 24:593-609. [PMID: 30955243 DOI: 10.1111/bjhp.12370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/18/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients are likely to have individual preferences for learning about health, which may influence their comprehension and utilization of health information. Some patients may prefer visual health information, which can make complex health information easier to understand. Aligning health information presentation with preferences may increase understanding and improve health outcomes, yet no scale measures preferences for visual health information. DESIGN Two studies examined the psychometric properties of the Health Visual Information Preference Scale (Health VIPS), a new measure designed to assess preferences for visual health information. METHODS In Study 1, 103 undergraduate students and 97 patients undergoing colorectal and gynaecological oncology surgery completed the Health VIPS. Exploratory factor analyses (EFA) were conducted for both samples. Internal consistency, test-retest reliability, and validity were assessed in the student sample. In Study 2, 196 outpatients completed the Health VIPS. Confirmatory factor analysis (CFA) was performed on this sample, in addition to measures of reliability and validity. RESULTS In Study 1, EFA analysis suggested a two-factor structure. The Health VIPS demonstrated good internal consistency in both the student sample (α = .70-.80) and patient sample (α = .80), and good test-retest reliability in the student sample (r = .63, p < .001). Convergent validity and discriminant validity were also established. In Study 2, the CFA confirmed a two-factor structure is the best model fit for the Health VIPS. The Health VIPS also demonstrated discriminant and convergent validity. Scale item means in all samples were positively skewed, suggesting a general preference for visual health information. CONCLUSIONS Initial evidence suggests the Health VIPS has good psychometric properties. This scale could identify patients who would benefit from additional visual aids when receiving health information. Statement of contribution What is already known on this subject? Poor comprehension of health information can lead to misunderstandings of illness and treatment, and potentially non-adherence. It is likely that patients have distinct preferences for how they would choose to receive health information, including information format. Visual health information is becoming more widely used to communicate information about health and illness to patients, although there is no measure to identify those who prefer this information format to standard written health materials. What does this study add? This study describes the first scale to assess preferences for visual health information. This scale could identify patients who would benefit from supplementary visual information in consultations.
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Affiliation(s)
- Annie S K Jones
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Leslie R Martin
- Department of Psychology, La Sierra University, Riverside, California, USA
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Justin Fernandez
- Department of Engineering Science, Faculty of Engineering, University of Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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