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Moll van Charante EP, Hoevenaar-Blom MP, Song M, Andrieu S, Barnes L, Birck C, Brooks R, Coley N, Eggink E, Georges J, Hafdi M, van Gool WA, Handels R, Hou H, Lyu J, Niu Y, Song L, Wang W, Wang Y, Wimo A, Yu Y, Zhang J, Zhang W, Brayne C, Wang W, Richard E. Prevention of dementia using mobile phone applications (PRODEMOS): a multinational, randomised, controlled effectiveness-implementation trial. THE LANCET. HEALTHY LONGEVITY 2024; 5:e431-e442. [PMID: 38763155 DOI: 10.1016/s2666-7568(24)00068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The expected increase of dementia prevalence in the coming decades will mainly be in low-income and middle-income countries and in people with low socioeconomic status in high-income countries. This study aims to reduce dementia risk factors in underserved populations at high-risk using a coach-supported mobile health (mHealth) intervention. METHODS This open-label, blinded endpoint, hybrid effectiveness-implementation randomised controlled trial (RCT) investigated whether a coach-supported mHealth intervention can reduce dementia risk in people aged 55-75 years of low socioeconomic status in the UK or from the general population in China with at least two dementia risk factors. The primary effectiveness outcome was change in cardiovascular risk factors, ageing, and incidence of dementia (CAIDE) risk score from baseline to after 12-18 months of intervention. Implementation outcomes were coverage, adoption, sustainability, appropriateness, acceptability, fidelity, feasibility, and costs assessed using a mixed-methods approach. All participants with complete data on the primary outcome, without imputation of missing outcomes were included in the analysis (intention-to-treat principle). This trial is registered with ISRCTN, ISRCTN15986016, and is completed. FINDINGS Between Jan 15, 2021, and April 18, 2023, 1488 people (601 male and 887 female) were randomly assigned (734 to intervention and 754 to control), with 1229 (83%) of 1488 available for analysis of the primary effectiveness outcome. After a mean follow-up of 16 months (SD 2·5), the mean CAIDE score improved 0·16 points in the intervention group versus 0·01 in the control group (mean difference -0·16, 95% CI -0·29 to -0·03). 1533 (10%) invited individuals responded; of the intervention participants, 593 (81%) of 734 adopted the intervention and 367 (50%) of 734 continued active participation throughout the study. Perceived appropriateness (85%), acceptability (81%), and fidelity (79%) were good, with fair overall feasibility (53% of intervention participants and 58% of coaches), at low cost. No differences in adverse events between study arms were found. INTERPRETATION A coach-supported mHealth intervention is modestly effective in reducing dementia risk factors in those with low socioeconomic status in the UK and any socioeconomic status in China. Implementation is challenging in these populations, but those reached actively participated. Whether this intervention will result in less cognitive decline and dementia requires a larger RCT with long follow-up. FUNDING EU Horizon 2020 Research and Innovation Programme and the National Key R&D Programmes of China. TRANSLATION For the Mandarin translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Marieke P Hoevenaar-Blom
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Sandrine Andrieu
- Aging Research Team, Centre for Epidemiology and Research in Population Health, INSERM-University of Toulouse UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Linda Barnes
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Rachael Brooks
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Nicola Coley
- Aging Research Team, Centre for Epidemiology and Research in Population Health, INSERM-University of Toulouse UPS, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Esmé Eggink
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Willem A van Gool
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ron Handels
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Faculty of Health, Medicine, and Life Sciences Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Haifeng Hou
- Centre for Precision Health, Edith Cowan University, Perth, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jihui Lyu
- Centre for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Yixuan Niu
- Department of Geriatrics, The Second Medical Centre & National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Libin Song
- Comvee Research Institute, Fuzhou Comvee Network & Technology, Fuzhou, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China; Centre for Precision Health, Edith Cowan University, Perth, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Yueyi Yu
- Innovation Centre for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinxia Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China; Centre for Precision Health, Edith Cowan University, Perth, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Wei Zhang
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Carol Brayne
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China; Centre for Precision Health, Edith Cowan University, Perth, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China; Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China; The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Ferraz LT, Santos AJT, Lorenzi LJ, Frohlich DM, Barley E, Castro PC. Design considerations for the migration from paper to screen-based media in current health education for older adults: a scoping review. BMJ Open 2024; 14:e078647. [PMID: 38604627 PMCID: PMC11015264 DOI: 10.1136/bmjopen-2023-078647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES To map the current use of paper-based and/or screen-based media for health education aimed at older people. DESIGN A scoping review was reported following the Preferred Reporting Items of Systematic Reviews and Meta-analyses for Scoping Reviews checklist. DATA SOURCES The search was carried out in seven databases (Scopus, Web of Science, Embase, Medline, CINAHL, ACM Guide to Computing Literature, PsycINFO), with studies available from 2012 to the date of the search in 2022, in English, Portuguese, Italian or Spanish. In addition, Google Scholar was searched to check the grey literature. The terms used in the search strategy were older adults, health education, paper and screen-based media, preferences, intervention and other related terms. ELIGIBILITY CRITERIA Studies included were those that carried out health education interventions for older individuals using paper and/or screen-based media and that described barriers and/or facilitators to using these media. DATA EXTRACTION AND SYNTHESIS The selection of studies was carried out by two reviewers. A data extraction form was developed with the aim of extracting and recording the main information from the studies. Data were analysed descriptively using Bardin's content analysis. RESULTS The review included 21 studies that carried out health education interventions with different purposes, the main ones being promotion of physical activity, hypertension prevention and psychological health. All 21 interventions involved screen-based media on computers, tablets, smartphones and laptops, while only 4 involved paper-based media such as booklets, brochures, diaries, flyers and drawings. This appears to reflect a transition from paper to screen-based media for health education for the older population, in research if not in practice. However, analysis of facilitators and barriers to using both media revealed 10 design factors that could improve or reduce their use, and complementarity in their application to each media type. For example, screen-based media could have multimedia content, additional functionality and interactivity through good interaction design, but have low accessibility and require additional learning due to complex interface design. Conversely, paper-based media had static content and low functionality but high accessibility and availability and a low learning cost. CONCLUSIONS We recommend having improved screen-based media design, continued use of paper-based media and the possible combination of both media through the new augmented paper technology. REGISTRATION NUMBER Open Science Framework (DOI: 10.17605/OSF.IO/GKEAH).
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Affiliation(s)
| | | | - Lorena Jorge Lorenzi
- Postgraduate Program in Bioengineering, University of São Paulo, São Carlos, Brazil
| | | | - Elizabeth Barley
- Mental Health Sciences and Nursing, University of Surrey, Guildford, UK
| | - Paula Costa Castro
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
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Turcotte S, Bouchard C, Rousseau J, DeBroux Leduc R, Bier N, Kairy D, Dang-Vu TT, Sarimanukoglu K, Dubé F, Bourgeois Racine C, Rioux C, Shea C, Filiatrault J. Factors influencing older adults' participation in telehealth interventions for primary prevention and health promotion: A rapid review. Australas J Ageing 2024; 43:11-30. [PMID: 38014903 DOI: 10.1111/ajag.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To identify facilitators and barriers to older adults' participation in telehealth interventions for primary prevention and health promotion. METHODS Relevant articles were searched using keywords in Embase and MEDLINE. Study characteristics, type of telehealth interventions and technology involved, as well as facilitators and barriers to their use, were extracted from selected articles. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was used to organise data. RESULTS A total of 24 articles (pertaining to 20 studies) were included. Nine facilitators and 11 barriers influencing the participation in telehealth interventions for primary prevention and health promotion among older adults were identified. The most recurrent facilitators were related to the individual's performance expectancy and effort expectancy, as well as the presence of a social dimension associated with the intervention (i.e. having a good relationship with the other participants in the program). The two most prevalent barriers were also related to effort expectancy and performance expectancy, followed by barriers related to the inherent characteristics of the technology and older adults' health condition. Experience, age and gender were also found to moderate technology use and acceptance. CONCLUSIONS This rapid review highlights the importance of adopting a holistic perspective when designing telehealth interventions aimed at preventive and health promotion purposes among older adults.
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Affiliation(s)
- Samuel Turcotte
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Camille Bouchard
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jacqueline Rousseau
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Roxane DeBroux Leduc
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie Bier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Dahlia Kairy
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Thien Thanh Dang-Vu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Concordia University, Montréal, Québec, Canada
| | - Kami Sarimanukoglu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - François Dubé
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
| | - Chanaelle Bourgeois Racine
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Camille Rioux
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Carolann Shea
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Johanne Filiatrault
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
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Lavoie A, Dubé V. Web-Based Interventions to Promote Healthy Lifestyles for Older Adults: Scoping Review. Interact J Med Res 2022; 11:e37315. [PMID: 35998024 PMCID: PMC9449830 DOI: 10.2196/37315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/14/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background With the aging of the population and rising rates of chronic diseases, web-based interventions could be considered to support older adults in adopting healthy lifestyles. To date, published knowledge syntheses have focused on quantitative studies among older adults aged ≥50 years. However, those aged ≥65 years may have different needs to be met by these interventions because of the biological and physiological changes associated with aging, and qualitative studies could help advance knowledge in this field. Objective The objective of this scoping review is to explore the extent of the literature on web-based interventions aimed at promoting healthy lifestyles among people aged ≥65 years. Methods A scoping review was conducted based on the framework proposed by Levac et al. Six databases (ie, MEDLINE, CINAHL, PsycINFO, Web of Science, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Library) and gray literature (ie, Google Scholar and OpenGrey) were searched. The final search was conducted on June 23, 2021. The studies were selected by 2 persons (AL and ML) independently. The included studies were systematic reviews and qualitative and quantitative studies focusing on web-based interventions to promote healthy lifestyles in people aged ≥65 years that were published in French or English between 1990 and 2021. Data were extracted in a table and synthesized based on the conceptualization of web-based interventions (ie, according to the use parameters, behavior change techniques, delivery modes, and theories). A thematic analysis was performed. Results In total, 20 articles were included in this review, which represents studies focused on 11 distinct interventions. All of the interventions (11/11, 100%) aimed to promote physical activity among older adults. The number of intervention sessions varied from 5 to 16, with a frequency from daily to once every 2 weeks. Diverse delivery modes such as electronic diary, video, and phone call were found. The most used behavior change techniques were instruction, feedback, and self-monitoring. Few interventions (6/11, 55%) were based on a theory. A favorable trend was observed in increasing physical activity, and 5 themes emerged that appeared to be central to behavior change among older adults: motivation, support, tailoring, barriers, and perceptions. Conclusions This scoping review provides a better understanding of the components of web-based interventions and their outcomes on the healthy lifestyles of people aged ≥65 years. These findings could provide important guidance for the design and development of future web-based interventions in this field. Further research is needed to continue the development and evaluation of innovative and accessible interventions to promote healthy lifestyles among older adults. International Registered Report Identifier (IRRID) RR2-10.2196/23207
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Affiliation(s)
- Audrey Lavoie
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Université de Montréal Marguerite-d'Youville Research Chair on Humanistic Nursing Interventions, Montreal, QC, Canada.,Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Véronique Dubé
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Université de Montréal Marguerite-d'Youville Research Chair on Humanistic Nursing Interventions, Montreal, QC, Canada.,Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Shvetz C, Gu F, Drodge J, Torous J, Guimond S. Validation of an ecological momentary assessment to measure processing speed and executive function in schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:64. [PMID: 34934063 PMCID: PMC8692600 DOI: 10.1038/s41537-021-00194-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022]
Abstract
Cognitive impairments are a core feature of schizophrenia that have negative impacts on functional outcomes. However, it remains challenging to assess these impairments in clinical settings. Smartphone apps provide the opportunity to measure cognitive impairments in an accessible way; however, more research is needed to validate these cognitive assessments in schizophrenia. We assessed the initial accessibility, validity, and reliability of a smartphone-based cognitive test to measure cognition in schizophrenia. A total of 29 individuals with schizophrenia and 34 controls were included in the analyses. Participants completed the standard pen-and-paper Trail Making Tests (TMT) A and B, and smartphone-based versions, Jewels Trail Tests (JTT) A and B, at the single in-lab visit. Participants were asked to complete the JTT remotely once per week for three months. We also investigated how subjective sleep quality and mood may affect cognitive performance longitudinally. In-lab and remote JTT scores moderately and positively correlated with in-lab TMT scores. Moderate test-retest reliability was observed across the in-lab, first remote, and last remote completion times of the JTT. Additionally, individuals with schizophrenia had significantly lower performance compared to controls on both the in-lab JTT and TMT. Self-reported mood had a significant effect on JTT A performance over time but no other significant relationships were found remotely. Our results support the initial accessibility, validity and reliability of using the JTT to measure cognition in schizophrenia. Future research to develop additional smartphone-based cognitive tests as well as with larger samples and in other psychiatric populations are warranted.
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Affiliation(s)
- Cecelia Shvetz
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Feng Gu
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Jessica Drodge
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Synthia Guimond
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
- Département de Psychoéducation et Psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada.
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6
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Hafdi M, Eggink E, Hoevenaar-Blom MP, Witvliet MP, Andrieu S, Barnes L, Brayne C, Brooks R, Coley N, Georges J, van der Groep A, van Marwijk H, van der Meijden M, Song L, Song M, Wang Y, Wang W, Wang W, Wimo A, Ye X, Moll van Charante EP, Richard E. Design and Development of a Mobile Health (mHealth) Platform for Dementia Prevention in the Prevention of Dementia by Mobile Phone Applications (PRODEMOS) Project. Front Neurol 2021; 12:733878. [PMID: 34975710 PMCID: PMC8716458 DOI: 10.3389/fneur.2021.733878] [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: 06/30/2021] [Accepted: 11/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Mobile health (mHealth) has the potential to bring preventive healthcare within reach of populations with limited access to preventive services, by delivering personalized support at low cost. Although numerous mHealth interventions are available, very few have been developed following an evidence-based rationale or have been tested for efficacy. This article describes the systematic development of a coach-supported mHealth application to improve healthy lifestyles for the prevention of dementia and cardiovascular disease in the United Kingdom (UK) and China. Methods: Development of the Prevention of Dementia by Mobile Phone applications (PRODEMOS) platform built upon the experiences with the Healthy Aging Through Internet Counseling in the Elderly (HATICE) eHealth platform. In the conceptualization phase, experiences from the HATICE trial and needs and wishes of the PRODEMOS target population were assessed through semi-structured interviews and focus group sessions. Initial technical development of the platform was based on these findings and took place in consecutive sprint sessions. Finally, during the evaluation and adaptation phase, functionality and usability of the platform were evaluated during pilot studies in UK and China. Results: The PRODEMOS mHealth platform facilitates self-management of a healthy lifestyle by goal setting, progress monitoring, and educational materials on healthy lifestyles. Participants receive remote coaching through a chat functionality. Based on lessons learned from the HATICE study and end-users, we made the intervention easy-to-use and included features to personalize the intervention. Following the pilot studies, in which in total 77 people used the mobile application for 6 weeks, the application was made more intuitive, and we improved its functionalities. Conclusion: Early involvement of end-users in the development process and during evaluation phases improved acceptability of the mHealth intervention. The actual use and usability of the PRODEMOS intervention will be assessed during the ongoing PRODEMOS randomized controlled trial, taking a dual focus on effectiveness and implementation outcomes.
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Affiliation(s)
- Melanie Hafdi
- Department of Neurology, Amsterdam University Medical Center (UMC) Location Academic Medical Center (AMC), Amsterdam, Netherlands,*Correspondence: Melanie Hafdi
| | - Esmé Eggink
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Marieke P. Hoevenaar-Blom
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - M. Patrick Witvliet
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sandrine Andrieu
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse-INSERM UMR1295, Toulouse, France,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Linda Barnes
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Rachael Brooks
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Nicola Coley
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse-INSERM UMR1295, Toulouse, France,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | | | | | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Libin Song
- Fuzhou Comvee Network &Technology Co., Ltd, Fuzhou, China
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia,School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China,Centre for Precision Health, Edith Cowan University, Perth, WA, Australia
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyan Ye
- Fuzhou Comvee Network &Technology Co., Ltd, Fuzhou, China
| | - Eric P. Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands,Department of Neurology, Radboud University Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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7
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Coley N, Andre L, Hoevenaar-Blom M, Ngandu T, Beishuizen C, Barbera M, van Wanrooij L, Kivipelto M, Soininen H, van Gool WA, Brayne C, Moll van Charante E, Richard E, Andrieu S. Factors predicting engagement of older adults with a coach-supported eHealth intervention promoting lifestyle change, and associations between engagement and changes in cardiovascular and dementia risk: secondary analysis of an 18-month multinational randomized controlled trial. J Med Internet Res 2021; 24:e32006. [PMID: 35385395 PMCID: PMC9127655 DOI: 10.2196/32006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/08/2021] [Accepted: 12/13/2021] [Indexed: 02/05/2023] Open
Abstract
Background Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective This study aimed to describe older adults’ engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ≥65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results Of the 1389 intervention group participants, 1194 (85.96%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was −0.08 (−0.12 to −0.03), −0.04 (−0.08 to 0.00), and 0.00 (−0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95% CI 2.66-10.95) or ≥7 hours per week (adjusted odds ratio 6.58, 95% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people.
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Affiliation(s)
- Nicola Coley
- Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse UPS, INSERM UMR1295, 37 allées Jules Guesde, Toulouse, FR.,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, FR
| | - Laurine Andre
- Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse UPS, INSERM UMR1295, 37 allées Jules Guesde, Toulouse, FR
| | - Marieke Hoevenaar-Blom
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, NL.,Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NL.,Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NL
| | - Tiia Ngandu
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, FI.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, SE
| | - Cathrien Beishuizen
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, NL
| | - Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, FI.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, GB
| | - Lennard van Wanrooij
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NL
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, SE.,Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, FI.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, GB.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, FI
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, FI.,Neurocenter, Neurology, Kuopio University Hospital, Kuopio, FI
| | - Willem A van Gool
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NL
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, GB
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, NL.,Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NL
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, NL.,Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, NL
| | - Sandrine Andrieu
- Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse UPS, INSERM UMR1295, 37 allées Jules Guesde, Toulouse, FR.,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, FR
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8
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Liu N, Yin J, Tan SSL, Ngiam KY, Teo HH. Mobile health applications for older adults: a systematic review of interface and persuasive feature design. J Am Med Inform Assoc 2021; 28:2483-2501. [PMID: 34472601 PMCID: PMC8510293 DOI: 10.1093/jamia/ocab151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes. MATERIALS AND METHODS We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort. RESULTS We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education. DISCUSSION Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously. CONCLUSIONS This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.
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Affiliation(s)
- Na Liu
- Discipline of Business Information Systems, The University of Sydney Business School, Sydney, Australia
| | - Jiamin Yin
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Sharon Swee-Lin Tan
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Kee Yuan Ngiam
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Hock Hai Teo
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
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9
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Eggink E, Hafdi M, Hoevenaar-Blom MP, Song M, Andrieu S, Barnes LE, Birck C, Brooks RL, Coley N, Ford E, Georges J, van der Groep A, van Gool WA, Handels R, Hou H, Li D, Liu H, Lyu J, van Marwijk H, van der Meijden M, Niu Y, Sadhwani S, Wang W, Wang Y, Wimo A, Ye X, Yu Y, Zeng Q, Zhang W, Wang W, Brayne C, Moll van Charante EP, Richard E. Prevention of dementia using mobile phone applications (PRODEMOS): protocol for an international randomised controlled trial. BMJ Open 2021; 11:e049762. [PMID: 34108173 PMCID: PMC8191602 DOI: 10.1136/bmjopen-2021-049762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/14/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Profiles of high risk for future dementia are well understood and are likely to concern mostly those in low-income and middle-income countries and people at greater disadvantage in high-income countries. Approximately 30%-40% of dementia cases have been estimated to be attributed to modifiable risk factors, including hypertension, smoking and sedentary lifestyle. Tailored interventions targeting these risk factors can potentially prevent or delay the onset of dementia. Mobile health (mHealth) improves accessibility of such prevention strategies in hard-to-reach populations while at the same time tailoring such approaches. In the current study, we will investigate the effectiveness and implementation of a coach-supported mHealth intervention, targeting dementia risk factors, to reduce dementia risk. METHODS AND ANALYSIS The prevention of dementia using mobile phone applications (PRODEMOS) randomised controlled trial will follow an effectiveness-implementation hybrid design, taking place in the UK and China. People are eligible if they are 55-75 years old, of low socioeconomic status (UK) or from the general population (China); have ≥2 dementia risk factors; and own a smartphone. 2400 participants will be randomised to either a coach-supported, interactive mHealth platform, facilitating self-management of dementia risk factors, or a static control platform. The intervention and follow-up period will be 18 months. The primary effectiveness outcome is change in the previously validated Cardiovascular Risk Factors, Ageing and Incidence of Dementia dementia risk score. The main secondary outcomes include improvement of individual risk factors and cost-effectiveness. Implementation outcomes include acceptability, adoption, feasibility and sustainability of the intervention. ETHICS AND DISSEMINATION The PRODEMOS trial is sponsored in the UK by the University of Cambridge and is granted ethical approval by the London-Brighton and Sussex Research Ethics Committee (reference: 20/LO/01440). In China, the trial is approved by the medical ethics committees of Capital Medical University, Beijing Tiantan Hospital, Beijing Geriatric Hospital, Chinese People's Liberation Army General Hospital, Taishan Medical University and Xuanwu Hospital. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN15986016.
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Affiliation(s)
- Esmé Eggink
- Department of General Practice, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Sandrine Andrieu
- INSERM-University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Linda E Barnes
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | | | | | - Nicola Coley
- INSERM-University of Toulouse UMR1027, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Willem A van Gool
- Department of Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ron Handels
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Haifeng Hou
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, China
| | - Dong Li
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, China
| | - Hongmei Liu
- Beijing Neurosurgical Institute, Beijing, China
| | - Jihui Lyu
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | - Yixuan Niu
- Department of Geriatrics, The Second Medical Centre and National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Shanu Sadhwani
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Wenzhi Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyan Ye
- Fuzhou Comvee Network & Technology Co., Ltd, Fuzhou, China
| | - Yueyi Yu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Centre and National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Centre for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University School of Public Health, Beijing, China
- Edith Cowan University School of Medical and Health Sciences, Joondalup, Western Australia, Australia
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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10
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Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer's Disease, and Dementia: From FINGER to World-Wide FINGERS. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2021; 7:29-36. [PMID: 32010923 PMCID: PMC7222931 DOI: 10.14283/jpad.2019.41] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alzheimer’s disease (AD) and dementia are a global public health priority, and prevention has been highlighted as a pivotal component in managing the dementia epidemic. Modifiable risk factors of dementia and AD include lifestyle-related factors, vascular and metabolic disorders, and psychosocial factors. Randomized controlled clinical trials (RCTs) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment and dementia in older adults. Given the complex, multifactorial, and heterogeneous nature of late-onset AD and dementia, interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia. To investigate the multidomain intervention in other populations and diverse cultural and geographical settings, the World-Wide FINGERS (WW-FINGERS) network was recently launched (https://alz.org/wwfingers). Within this network, new FINGER-type trials with shared core methodology, but local culture and context-specific adaptations, will be conducted in several countries. The WW-FINGERS initiative facilitates international collaborations, provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia, and aims at generating high-quality scientific evidence to support public health and clinical decision-making. Furthermore, the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice.
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Affiliation(s)
- A Rosenberg
- Miia Kivipelto, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, Phone: +46 (0)73 99 40 922,
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11
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McLean B, Hossain N, Donison V, Gray M, Durbano S, Haase K, Alibhai SMH, Puts M. Providing Medical Information to Older Adults in a Web-Based Environment: Systematic Review. JMIR Aging 2021; 4:e24092. [PMID: 33560228 PMCID: PMC8294635 DOI: 10.2196/24092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 01/16/2023] Open
Abstract
Background Cancer is a disease that predominantly affects older adults, and several organizations recommend the completion of a geriatric assessment to help with cancer treatment decision-making. Owing to a shortage of geriatric teams and the vast number of older adults diagnosed with cancer each year, a web-based geriatric assessment may improve access to geriatric assessment for older adults. We systematically reviewed the literature to obtain the latest evidence for the design of our web-based geriatric assessment tool Comprehensive Health Assessment for My Plan. Objective This review aimed to probe the following questions: what is the impact of providing health test results to older adults in a web-based environment without the presence of a health care provider for patient-centered outcomes, including satisfaction, perceived harm, empowerment, quality of life, and health care use (eg, hospitalization, physician visits, emergency room visits, and costs), and what recommendations do older adults and developers have for designing future apps or websites for older adults? Methods This systematic review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement. Studies were limited to publications in English that examined a web-based tool that provided test results to older adults (aged ≥65 years) without the presence of a health care provider. A health sciences librarian performed the search on November 29, 2019, on the following electronic databases: MEDLINE, Embase, CINAHL, PsycINFO, and the Cochrane Library. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool Version 2018. The findings are summarized narratively and in tabular format. Results A total of 26,898 titles and abstracts were screened by 2 independent reviewers, of which 94 studies were selected for a full-text review, and 9 studies were included in this review. There were only 2 randomized controlled trials of high quality that explored the effects of receiving health care results on the web via eHealth tools for older adults or provided evidence-based recommendations for designing such tools. Older adults were generally satisfied with receiving screening results via eHealth tools, and several studies suggested that receiving health screening results electronically improved participants’ quality of life. However, user interfaces that were not designed with older adults in mind and older adults’ lack of confidence in navigating eHealth tools proved challenging to eHealth uptake and use. All 9 studies included in this systematic review made recommendations on how to design eHealth tools that are intuitive and useful for older adults. Conclusions eHealth tools should incorporate specific elements to ensure usability for older adults. However, more research is required to fully elucidate the impact of receiving screening and results via eHealth tools without the presence of a health care provider for patient-centered outcomes in this target population.
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Affiliation(s)
- Bianca McLean
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nazia Hossain
- Department of Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Valentina Donison
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mikaela Gray
- Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada
| | | | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Shabbir Muhammad Husayn Alibhai
- Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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12
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Yatabe J, Yatabe MS, Ichihara A. The current state and future of internet technology-based hypertension management in Japan. Hypertens Res 2020; 44:276-285. [PMID: 33361825 PMCID: PMC7756130 DOI: 10.1038/s41440-020-00591-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
Abstract
Internet-based information and communication technology is altering our lives. Although medicine is traditionally conservative, it can benefit in many ways from adopting new technology and styles of care. Hypertension is a prime condition for the practical application of digital health management because it is prevalent and undercontrolled, and its primary index, home blood pressure, can be effectively telemonitored. Compared to other conditions that require laboratory measures or the use of drugs with frequent side effects, hypertension can be managed without actual office visits with sufficiently low risk. In this review of hypertension in Japan, we discuss the current and somewhat fragmented state of internet technology and the components and processes necessary for smooth, integrated, and multidisciplinary care in the future. Although further clinical trials are required to show the safety and efficacy of information and communication technology-based care for hypertension, the deployment of telemonitoring and telemedicine in daily practice should be expedited to solve the hypertension paradox. Challenges remain relating to cost, data integration, the redesigning of team-based care, and the improvement of user experience, but information and communication technology-based hypertension management is sure to become pivotal in improving public health.
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Affiliation(s)
- Junichi Yatabe
- General Incorporated Association TelemedEASE, Tokyo, Japan.
| | - Midori Sasaki Yatabe
- General Incorporated Association TelemedEASE, Tokyo, Japan.,Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, Tokyo, Japan
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13
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Sá GGDM, Santos AMRD, Galindo Neto NM, Carvalho KMD, Feitosa CDA, Mendes PN. Building and validating an educational video for elderly individuals about fall risks. Rev Bras Enferm 2020; 73:e20200010. [PMID: 33111805 DOI: 10.1590/0034-7167-2020-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/16/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to build and validate educational video for elderly individuals about fall risks. METHODS methodological study with video building. validated by 22 judges and assessed by 22 elderly individuals. Content was selected from the Fall Prevention Model and items from the Falls Risk Awareness Questionnaire. Items with an agreement greater than 0.80 were considered valid. verified through Content Validation Index (CVI) and binomial test. RESULTS building the video was guided by the Cognitive Theory of Multimedia Learning. Digital animation and audio narration were used. It lasted ten minutes and five seconds and included biological. socioeconomic. behavioral and environmental risks as well as precautions to avoid them. The CVI of judges had an average of 0.99. and of elderly individuals. an average of 1.0. CONCLUSION the video was built and validated for content and understanding and can be used to prevent falls in elderly individuals.
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14
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Akenine U, Barbera M, Beishuizen CR, Fallah Pour M, Guillemont J, Rosenberg A, Coley N, Mangialasche F, Salo L, Savy S, Pols AJ, Andrieu S, Richard E, Soininen H, Moll van Charante E, Kivipelto M. Attitudes of at-risk older adults about prevention of cardiovascular disease and dementia using eHealth: a qualitative study in a European context. BMJ Open 2020; 10:e037050. [PMID: 32764085 PMCID: PMC7412614 DOI: 10.1136/bmjopen-2020-037050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/27/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Prevention of cardiovascular disease (CVD) and dementia is a key health priority among older adults. Understanding individuals' attitudes to, the prevention of these conditions, particularly when delivered through novel eHealth tools, could help in designing effective prevention programmes. The aim of the study was to explore the attitudes of older adults at increased risk of CVD and dementia regarding engagement in eHealth self-management prevention programmes, and to describe the facilitators and barriers. DESIGN A qualitative research approach was used. Data were collected through eight focus groups in Finland, France and the Netherlands. Data were analysed following the principles of grounded theory. SETTING AND PARTICIPANTS Forty-four community-dwellers aged 65+ at risk of CVD were recruited from a previous trial cohort in Finland, and through general practices in France and the Netherlands. RESULTS The study identified three categories: access to reliable information, trust in the healthcare providers and burden and stigma of dementia. A core category was also identified: the interactive process of the three categories influencing engagement in self-management prevention programme. The categories were interconnected through an interactive process and influenced by the local healthcare culture and context which shaped them differently, becoming either facilitators or barriers to engage in eHealth self-management prevention programmes. CONCLUSIONS The study emphasises the importance of considering the interactions between the identified categories in this study, grounded in the local healthcare culture and context in further developments of eHealth self-management interventions that aim to prevent CVD and dementia. TRIAL REGISTRATION NUMBER ISRCTN48151589.
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Affiliation(s)
- Ulrika Akenine
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Mandana Fallah Pour
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Anna Rosenberg
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nicola Coley
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lotta Salo
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | | | - A Jeannette Pols
- Section of Medical Ethics, Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Andrieu
- INSERM, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Richard E, Moll van Charante EP, Hoevenaar-Blom MP, Coley N, Barbera M, van der Groep A, Meiller Y, Mangialasche F, Beishuizen CB, Jongstra S, van Middelaar T, Van Wanrooij LL, Ngandu T, Guillemont J, Andrieu S, Brayne C, Kivipelto M, Soininen H, Van Gool WA. Healthy ageing through internet counselling in the elderly (HATICE): a multinational, randomised controlled trial. LANCET DIGITAL HEALTH 2019; 1:e424-e434. [PMID: 33323224 DOI: 10.1016/s2589-7500(19)30153-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although web-based interventions have been promoted for cardiovascular risk management over the past decade, there is limited evidence for effectiveness of these interventions in people older than 65 years. The healthy ageing through internet counselling in the elderly (HATICE) trial aimed to determine whether a coach-supported internet intervention for self-management can reduce cardiovascular risk in community-dwelling older people. METHODS This prospective open-label, blinded endpoint clinical trial among people age 65 years or over at increased risk of cardiovascular disease randomly assigned participants in the Netherlands, Finland, and France to an interactive internet intervention stimulating coach-supported self-management or a control platform. Primary outcome was the difference from baseline to 18 months on a standardised composite score (Z score) of systolic blood pressure, LDL cholesterol, and body-mass index (BMI). Secondary outcomes included individual risk factors and cardiovascular endpoints. This trial is registered with the ISRCTN registry, 48151589, and is closed to accrual. FINDINGS Among 2724 participants, complete primary outcome data were available for 2398 (88%). After 18 months, the primary outcome improved in the intervention group versus the control group (0·09 vs 0·04, respectively; mean difference -0·05, 95% CI -0·08 to -0·01; p=0·008). For individual components of the primary outcome, mean differences (intervention vs control) were systolic blood pressure -1·79 mm Hg versus -0·67 mm Hg (-1·12, -2·51 to 0·27); BMI -0·23 kg/m2 versus -0·08 kg/m2 (-0·15, -0·28 to -0·01); and LDL -0·12 mmol/L versus -0·07 mmol/L (-0·05, -0·11 to 0·01). Cardiovascular disease occurred in 30 (2·2%) of 1382 patients in the intervention versus 32 (2·4%) of 1333 patients in the control group (hazard ratio 0·86, 95% CI 0·52 to 1·43). INTERPRETATION Coach-supported self-management of cardiovascular risk factors using an interactive internet intervention is feasible in an older population, and leads to a modest improvement of cardiovascular risk profile. When implemented on a large scale this could potentially reduce the burden of cardiovascular disease. FUNDING European Commission Seventh Framework Programme.
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Affiliation(s)
- Edo Richard
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Eric P Moll van Charante
- Department of Primary Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke P Hoevenaar-Blom
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nicola Coley
- INSERM, University of Toulouse UMR1027, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Mariagnese Barbera
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | | | - Yannick Meiller
- Department of Information and Operations Management, ESCP Europe, Paris, France
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Cathrien B Beishuizen
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Susan Jongstra
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tessa van Middelaar
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Lennard L Van Wanrooij
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Sandrine Andrieu
- INSERM, University of Toulouse UMR1027, Toulouse, France; Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, UK
| | - Miia Kivipelto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Neuroepidemiology and Aging Unit, School of Public Health, Imperial College London, UK
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Willem A Van Gool
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
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16
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Krysinska K, Roškar S, Sisask M. Older Age and New Technologies in Suicide Prevention. CRISIS 2019; 40:303-308. [PMID: 31510781 DOI: 10.1027/0227-5910/a000617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Karolina Krysinska
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Saška Roškar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Merike Sisask
- School of Governance, Law and Society (SOGOLAS), Tallinn University, Estonia.,Estonian-Swedish Mental Health and Suicidology Institute (ERSI), Tallin, Estonia
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17
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Beishuizen CR, Akenine U, Barbera M, Rosenberg A, Fallah Pour M, Richard E, Soininen H, Mangialasche F, Kivipelto M, Pols AJ, Moll van Charante E. Integrating nurses' experiences with supporting behaviour change for cardiovascular prevention into a self-management internet platform in Finland and the Netherlands: a qualitative study. BMJ Open 2019; 9:e023480. [PMID: 31175194 PMCID: PMC6577411 DOI: 10.1136/bmjopen-2018-023480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 03/13/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Global ageing is linked to an increased burden of cardiovascular disease and dementia, which calls for better prevention strategies. Self-management and eHealth applications are regarded as promising strategies to support prevention. The aim of this study was to explore nurses' best practices concerning behaviour change guidance for cardiovascular (CV) prevention in order to learn how to optimally integrate them into a coach-supported internet platform for CV self-management. DESIGN Qualitative focus group study in Finland and the Netherlands. Discussions were audiotaped and transcribed. Data were thematically analysed following principles of grounded theory. SETTING Dutch and Finnish primary care settings. PARTICIPANTS Six Finnish and seven Dutch primary care nurses with experience in CV prevention. RESULTS Similar best practices were found in both countries and comprised of (1) establishing a relationship of trust, (2) managing awareness and expectations and (3) appropriate timing and monitoring of the process of behaviour change. However, the Finnish and Dutch nurses used different approaches for accomplishment of these practices, which was reflected in their recommendations for online support. Both groups emphasised that online support should be combined with human support and integrated into regular care. Finnish nurses had more confidence in patient self-management and remote communication than Dutch nurses, who emphasised the importance of face-to-face contact and preferred to keep control of medical aspects of prevention. CONCLUSIONS Differences in Dutch and Finnish's nurses' practices for supporting CV prevention appear to reflect their local healthcare practices, which should be taken into account when designing internet platforms for health self-management. Including cognitive health as a goal of CV prevention might stimulate motivation for health behaviour change. TRIAL REGISTRATION NUMBER ISRCTN48151589; Pre-results.
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Affiliation(s)
- Cathrien Rl Beishuizen
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Ulrika Akenine
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mariagnese Barbera
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Anna Rosenberg
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Mandana Fallah Pour
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Edo Richard
- Department of Neurology, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | | | - Miia Kivipelto
- Department of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
- Division of Geriatric Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - A Jeannette Pols
- Department of General Practice, Section of Medical Ethics, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Moll van Charante
- Department of General Practice, Amsterdam UMC/University of Amsterdam, Amsterdam, The Netherlands
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18
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Wesselman LM, Hooghiemstra AM, Schoonmade LJ, de Wit MC, van der Flier WM, Sikkes SA. Web-Based Multidomain Lifestyle Programs for Brain Health: Comprehensive Overview and Meta-Analysis. JMIR Ment Health 2019; 6:e12104. [PMID: 30964438 PMCID: PMC6477576 DOI: 10.2196/12104] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/28/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The number of people living with dementia is increasing worldwide, mainly because of aging of the population. To date, there is no pharmaceutical intervention to delay or treat cognitive decline or dementia. As an estimated one-third of dementia cases might be attributable to modifiable lifestyle factors (such as cognitive and physical activity), multidomain lifestyle interventions are a promising way to maintain or improve brain health. Offering programs online would enable large-scale implementation. An overview of multidomain Web-based lifestyle programs for brain health would facilitate comparison and improvement of such programs to develop effective and sustainable interventions. OBJECTIVE This study aimed to (1) provide a comprehensive overview of Web-based multidomain lifestyle programs aimed at optimizing brain health in healthy adult populations and (2) describe the programs and targeted lifestyle factors, availability, and evaluation of adherence and user experience. In addition, a meta-analysis was performed to evaluate the effectiveness of these programs. METHODS Electronic databases (PubMed, EMBASE, and PsycINFO) were searched for Web-based lifestyle programs that were included when the program (1) aimed to optimize brain health, (2) focused on multiple lifestyle factors, (3) was completely Web-based (website, Web application or mobile app), (4) consisted of multiple sessions, and (5) focused on a healthy adult population. Program characteristics (target population, duration, frequency, tailoring, platform, and availability) and results of program evaluations (effectiveness, user evaluations, and adherence) were extracted and compared. Studies using a controlled design were included in a random-effects meta-analysis on the effectiveness on brain health outcomes. Study quality was assessed using the physiotherapy evidence database (PEDro) scale. RESULTS The electronic searches yielded 44 documents describing 14 Web-based lifestyle programs; physical and cognitive activities were targeted in all programs. Four programs (4/14, 29%) were publicly available and free of charge, whereas others were restricted to research settings (5/14, 36%), available after payment (1/14, 7%), or not available at all (2/14, 14%). User evaluations were reported for 8 (57%) of the 14 programs. Reported dropout of the intervention groups ranged from 2% to 52%. Overall, 3 studies evaluated the effectiveness of a program using a controlled design and were included in the meta-analysis (moderate-to-high quality). Pooled results showed a significant small-to-medium effect of the Web-based multidomain lifestyle interventions on outcome measures for brain health (global cognition score, subjective cognitive score, and lifestyle risk score; standard mean difference=0.45; 95% CI 0.12-0.78), with a high degree heterogeneity across studies (I2=75%; P=.02). CONCLUSIONS In total, 14 Web-based multidomain lifestyle programs aimed at optimizing brain health were found. The programs showed heterogeneity in both characteristics and effectiveness evaluation. Despite this heterogeneity, this meta-analysis suggests that Web-based lifestyle programs can positively influence brain health outcomes and have the potential to contribute to the prevention of dementia.
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Affiliation(s)
- Linda Mp Wesselman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Astrid M Hooghiemstra
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Medical Humanities, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Linda J Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein Cj de Wit
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Sietske Am Sikkes
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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19
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Moore G, Wilding H, Gray K, Castle D. Participatory Methods to Engage Health Service Users in the Development of Electronic Health Resources: Systematic Review. J Particip Med 2019; 11:e11474. [PMID: 33055069 PMCID: PMC7434099 DOI: 10.2196/11474] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/29/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
Background When health service providers (HSP) plan to develop electronic health (eHealth) resources for health service users (HSU), the latter’s involvement is essential. Typically, however, HSP, HSU, and technology developers engaged to produce the resources lack expertise in participatory design methodologies suited to the eHealth context. Furthermore, it can be difficult to identify an established method to use, or determine how to work stepwise through any particular process. Objective We sought to summarize the evidence about participatory methods and frameworks used to engage HSU in the development of eHealth resources from the beginning of the design process. Methods We searched for studies reporting participatory processes in initial development of eHealth resources from 2006 to 2016 in 9 bibliographic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Emcare, Cochrane Library, Web of Science, ACM Guide to Computing Literature, and IEEE Xplore. From 15,117 records initially screened on title and abstract for relevance to eHealth and early participatory design, 603 studies were assessed for eligibility on full text. The remaining 90 studies were rated by 2 reviewers using the Mixed Methods Appraisal Tool Version 2011 (Pluye et al; MMAT) and analyzed with respect to health area, purpose, technology type, and country of study. The 30 studies scoring 90% or higher on MMAT were included in a detailed qualitative synthesis. Results Of the 90 MMAT-rated studies, the highest reported (1) health areas were cancer and mental disorders, (2) eHealth technologies were websites and mobile apps, (3) targeted populations were youth and women, and (4) countries of study were the United States, the United Kingdom, and the Netherlands. Of the top 30 studies the highest reported participatory frameworks were User-Centered Design, Participatory Action Research Framework, and the Center for eHealth Research and Disease Management (CeHRes) Roadmap, and the highest reported model underpinning development and engagement was Social Cognitive Theory. Of the 30 studies, 4 reported on all the 5 stages of the CeHRes Roadmap. Conclusions The top 30 studies yielded 24 participatory frameworks. Many studies referred to using participatory design methods without reference to a framework. The application of a structured framework such as the CeHRes Roadmap and a model such as Social Cognitive Theory creates a foundation for a well-designed eHealth initiative that ensures clarity and enables replication across participatory design projects. The framework and model need to be clearly articulated and address issues that include resource availability, responsiveness to change, and the criteria for good practice. This review creates an information resource for future eHealth developers, to guide the design of their eHealth resource with a framework that can support further evaluation and development. Trial Registration PROSPERO CRD42017053838; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53838
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Affiliation(s)
- Gaye Moore
- Mental Health Executive Services, St Vincent's Hospital, Melbourne, Fitzroy, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Helen Wilding
- Mental Health Executive Services, St Vincent's Hospital, Melbourne, Fitzroy, Australia.,Library Service, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia
| | - David Castle
- Mental Health Executive Services, St Vincent's Hospital, Melbourne, Fitzroy, Australia.,Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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20
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Barbera M, Mangialasche F, Jongstra S, Guillemont J, Ngandu T, Beishuizen C, Coley N, Brayne C, Andrieu S, Richard E, Soininen H, Kivipelto M. Designing an Internet-Based Multidomain Intervention for the Prevention of Cardiovascular Disease and Cognitive Impairment in Older Adults: The HATICE Trial. J Alzheimers Dis 2019; 62:649-663. [PMID: 29480185 DOI: 10.3233/jad-170858] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Many dementia and cardiovascular disease (CVD) cases in older adults are attributable to modifiable vascular and lifestyle-related risk factors, providing opportunities for prevention. In the Healthy Aging Through Internet Counselling in the Elderly (HATICE) randomized controlled trial, an internet-based multidomain intervention is being tested to improve the cardiovascular risk (CVR) profile of older adults. OBJECTIVE To design a multidomain intervention to improve CVR, based on the guidelines for CVR management, and administered through a coach-supported, interactive, platform to over 2500 community-dwellers aged 65+ in three European countries. METHODS A comparative analysis of national and European guidelines for primary and secondary CVD prevention was performed. Results were used to define the content of the intervention. RESULTS The intervention design focused on promoting awareness and self-management of hypertension, dyslipidemia, diabetes mellitus, and overweight, and supporting smoking cessation, physical activity, and healthy diet. Overall, available guidelines lacked specific recommendations for CVR management in older adults. The comparative analysis of the guidelines showed general consistency for lifestyle-related recommendations. Key differences, identified mostly in methods used to assess the overall CVR, did not hamper the intervention design. Minor country-specific adaptations were implemented to maximize the intervention feasibility in each country. CONCLUSION Despite differences in CVR management within the countries considered, it was possible to design and implement the HATICE multidomain intervention. The study can help define preventative strategies for dementia and CVD that are applicable internationally.
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Affiliation(s)
- Mariagnese Barbera
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Francesca Mangialasche
- Department of Neurobiology, Aging Research Center, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Susan Jongstra
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Tiia Ngandu
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Cathrien Beishuizen
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Nicola Coley
- INSERM, University of Toulouse UMR 1027, Toulouse, France.,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | | | - Sandrine Andrieu
- INSERM, University of Toulouse UMR 1027, Toulouse, France.,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Miia Kivipelto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem, R&D unit, Stockholm Sweden
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Older Adults' Reasons for Participating in an eHealth Prevention Trial: A Cross-Country, Mixed-Methods Comparison. J Am Med Dir Assoc 2018; 20:843-849.e5. [PMID: 30541689 DOI: 10.1016/j.jamda.2018.10.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore older adults' reasons for participating in a multinational eHealth prevention trial, and compare motivations between countries. DESIGN Cross-sectional mixed methods research using quantitative and qualitative approaches (the ACCEPT-HATICE study). SETTING AND PARTICIPANTS Substudy conducted during the recruitment phase of an 18-month RCT testing the efficacy of an eHealth intervention for self-management of risk factors for cardiovascular disease (CVD) and cognitive decline in older adults in Finland, France, and the Netherlands. Participants were 343 dementia-free community dwellers aged 65+ with basic computer literacy and either ≥2 cardiovascular risk factors or a history of CVD/diabetes. MEASURES Online questionnaire (quantitative data) and semistructured interviews (qualitative data). RESULTS Contributing to scientific progress, wanting to improve one's lifestyle, and benefiting from additional medical monitoring were the predominant reasons for participating. Altruistic reasons were particularly relevant among the French, whereas Finnish and Dutch participants mainly emphasized the benefits of lifestyle changes and regular medical checkups. During interviews, preventing functional dependency emerged as a key underlying motivation. Although some trial design features influenced the decision to participate, the use of an eHealth intervention was not an important motivator in this population. CONCLUSIONS/IMPLICATIONS Altruism and personal benefits motivated older adults to participate in the trial; emphasizing such aspects could facilitate recruitment in future RCTs. Additional medical monitoring may be particularly appealing when access to public health care is considered limited. Furthermore, maintaining autonomy and preventing functional dependency emerged as a key concern in this population of young older adults.
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22
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Jin Z, Northridge ME, Metcalf SS. Modeling the Influence of Social Ties and Transportation Choice on Access to Oral Healthcare for Older Adults. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2018; 96:66-76. [PMID: 30008491 PMCID: PMC6039129 DOI: 10.1016/j.apgeog.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The current U.S. demographic shift toward an older population and the importance of intervening before conditions become severe warrant a concerted effort to ease the burden of access to healthcare for older adults. With regard to oral healthcare, more integrated services for older adults are needed to effectively serve their complex medical and dental needs. Using an agent-based simulation model, this paper examines the influence of social ties and transportation mode choices on opportunities for older adults to participate in community-based preventive screening events and access needed oral healthcare. This approach accounts for the heterogeneity of behavior that arises for a population exhibiting diversity in terms of social factors, including socioeconomic means and social support. In the context of older adults living in urban environments, the availability of different transportation modes ought to be taken into consideration. To explore alternative scenarios for the accessibility of preventive screening events offered at senior centers in northern Manhattan, an agent-based model (ABM) was created with a geographic information system (GIS) to simulate the influence of social ties and transportation choices on older adults seeking preventive screening services and oral healthcare. Results of simulation experiments indicate preferences for public transportation and inequities in accessibility that may be mitigated with social support. This simulation model offers a way to explore social support as an important factor in making transportation mode choices that mediate oral healthcare accessibility and thus oral health outcomes for older adults.
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Affiliation(s)
- Zhu Jin
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
| | - Mary E. Northridge
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY 10010, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032, USA
| | - Sara S. Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY 14261, USA
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23
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Kulmala J, Ngandu T, Kivipelto M. Prevention Matters: Time for Global Action and Effective Implementation. J Alzheimers Dis 2018; 64:S191-S198. [DOI: 10.3233/jad-179919] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jenni Kulmala
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Tiia Ngandu
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Department of Geriatrics, Karolinska University Hospital, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
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24
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Robbins TD, Lim Choi Keung SN, Arvanitis TN. E-health for active ageing; A systematic review. Maturitas 2018; 114:34-40. [PMID: 29907244 DOI: 10.1016/j.maturitas.2018.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
Enabling successful active ageing is an international priority to meet the challenges of increasing life expectancy. Digital strategies, such as telemedicine and e-health, offer the potential to deliver active ageing in a cost-effective manner at scale. This article aims to establish the extent to which the research literature considers e-health-based and telemedicine-based active ageing interventions. A systematic review was conducted according to PRISMA standards. Independently, two authors searched the Cochrane, EMBASE & CINAHL databases, with subsequent independent extraction and semi-quantitative analysis. We report a considerable breadth in digital active ageing research, which is truly international in its scope. There is a diverse range of both interventions and technologies, including a reassuring focus on community-based interventions. Whilst there are a number of quantitative studies, sample sizes are small, with a limited amount of statistical testing of the results. There is significant variation in the outcome measures reported and little consensus as to the most effective intervention strategies. Overall, whilst there is considerable breadth to the research published in the literature, there is a clear restriction in the depth of this research. There is little overall consensus. This lack of depth and consensus may be due to the need to recognize the important role of technical research elements alongside more traditional research methodologies, such as randomized controlled trials. Enabling both technical and clinical research methods to be recognized, in tandem, has enormous potential to support individuals, communities, clinicians and policy makers to make more informed decisions in relation to active ageing.
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Affiliation(s)
- Timothy David Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Sarah N Lim Choi Keung
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Theodoros N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom.
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Abstract
Nowadays, the Internet is the major source to obtain information about diseases and their treatments. The Internet is gaining relevance in the neurological setting, considering the possibility of timely social interaction, contributing to general public awareness on otherwise less-well-known neurological conditions, promoting health equity and improving the health-related coping. Neurological patients can easily find several online opportunities for peer interactions and learning. On the other hand, neurologist can analyze user-generated data to better understand patient needs and to run epidemiological studies. Indeed, analyses of queries from Internet search engines on certain neurological diseases have shown a strict temporal and spatial correlation with the "real world." In this narrative review, we will discuss how the Internet is radically affecting the healthcare of people with neurological disorders and, most importantly, is shifting the paradigm of care from the hands of those who deliver care, into the hands of those who receive it. Besides, we will review possible limitations, such as safety concerns, financial issues, and the need for easy-to-access platforms.
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van Middelaar T, Beishuizen CRL, Guillemont J, Barbera M, Richard E, Moll van Charante EP. Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants. BMJ Open 2018; 8:e019683. [PMID: 29358447 PMCID: PMC5781010 DOI: 10.1136/bmjopen-2017-019683] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To study older peoples' experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care. DESIGN Qualitative semistructured interview study, with thematic analysis. SETTING Primary care in the Netherlands. PARTICIPANTS People ≥65 years with an increased risk of cardiovascular disease who used the 'Healthy Ageing Through Internet Counselling in the Elderly' internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency. RESULTS We performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting. CONCLUSIONS Human support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption. TRIAL REGISTRATION NUMBER ISRCTN48151589; Pre-results.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mariagnese Barbera
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Edo Richard
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
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