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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2023; 17:794-825. [PMID: 34957864 PMCID: PMC10210100 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Sisse H. Laursen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University
College of Northern Denmark, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
- Department of Endocrinology, Aalborg
University Hospital, Aalborg, Denmark
- Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
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Al-Ozairi A, Taghadom E, Irshad M, Al-Ozairi E. Association Between Depression, Diabetes Self-Care Activity and Glycemic Control in an Arab Population with Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:321-329. [PMID: 36777315 PMCID: PMC9911899 DOI: 10.2147/dmso.s377166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Poor self-care behavior and depression are associated with worse glycemic control, but the relationship between these variables is poorly reported. The present study aimed to describe self-care behaviors and explore the association between depression, self-care and glycemic control in people with type 2 diabetes in an Arab population. PATIENTS AND METHODS This study recruited 446 patients with type-2 diabetes from an outpatient clinic in Kuwait and completed assessments of diabetes self-care using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and depression using the Patients Health Questionnaire-9 (PHQ-9) scales. Multiple linear regression models were used to determine the associations between depression, self-care behaviors and glycemic control. RESULTS Self-care behaviors were highest for medication taking (92.9%), an average for foot care (61.4%), blood glucose testing (60%) and healthy diet (55.7%), and lowest for exercise (27.1%). Depression, poor self-care activities and poor HbA1c levels were inter-correlated in univariate analysis (p< 0.03). In regression analysis, following healthful eating (B= -0.27, p< 0.001), general eating plan (B= -0.21, p= 0.01), more space carbohydrates evenly throughout the day (B= - 0.17, p= 0.03) and exercise at least 30 minutes (B= -0.17, p= 0.02) behaviors were associated with better HbA1c levels. However, depression was associated with poor scores of following a general eating plan (B= -0.20, p= 0.03), space carbohydrates evenly throughout the day (B= -0.21, p= 0.05), and exercising at least 30 minutes (B= -0.24, p= 0.03) behaviors. Depression scores were also associated with poor HbA1c levels (B= 0.32, p= 0.03). However, this association no longer persists after mutual adjustment with following a healthy diet (B= 0.14, p= 0.38) and exercise (B = 0.26, p = 0.08) behaviors. CONCLUSION Self-care activity was less than fifty percent in people with type 2 diabetes and higher activity was associated with better glycemic control. However, depression adversely affects self-care behaviors. To maintain and achieve glycemic control, diabetes educators might motivate people with type 2 diabetes to enhance their self-care activities, particularly those with depression symptoms and poor compliance with self-care activities.
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Affiliation(s)
- Abdullah Al-Ozairi
- Department of Psychiatry, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Etab Taghadom
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- Dasman Diabetes Institute, Dasman, Kuwait
| | | | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Correspondence: Ebaa Al-Ozairi, Dasman Diabetes Institute, PO Box 1180, Dasman, 15462, Kuwait, Email
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Systematic review and meta analysis of differential attrition between active and control arms in randomized controlled trials of lifestyle interventions in chronic disease. BMC Med Res Methodol 2021; 21:122. [PMID: 34126934 PMCID: PMC8204467 DOI: 10.1186/s12874-021-01313-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/30/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Attrition is a major obstacle for lifestyle interventions sustained for the medium-to-long term and can have significant consequences on the internal validity of a trial. When the degree of attrition differs between active and control arms this is termed differential attrition and is an important consideration during initial stages of trial planning. OBJECTIVES The primary research question of this study was: what is the differential attrition between treatment arms in lifestyle interventions for prevalent chronic diseases? METHODS We performed a systematic review and meta-analysis of 23 studies involving a lifestyle intervention component in cohorts with chronic diseases. The search accessed three databases: Scopus, Medline Ovid and Web of Science. Attrition between treatment arms was analysed using a random-effects model and examined the relationship between the relative attrition and potential moderators, such as time to final follow-up, time to first follow-up, type of disease, type of control, type of intervention and length of treatment. RESULTS The pooled risk ratio was 1.00 (95% CI 0.97 - 1.03) and only one study fell outside this range. A univariable association was described between the pooled risk ration and length (years) to final follow-up, which did not remain in the multivariable model. CONCLUSIONS Ultimately, we found no evidence of differential attrition in medium-to-long term lifestyle intervention studies for chronic disease, increasing confidence in conducting such studies with minimal potential of attrition bias. TRIAL REGISTRATION PROSPERO registration number CRD42018084495 .
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Warner MM, Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Reporting of Telehealth-Delivered Dietary Intervention Trials in Chronic Disease: Systematic Review. J Med Internet Res 2017; 19:e410. [PMID: 29229588 PMCID: PMC5742660 DOI: 10.2196/jmir.8193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/26/2017] [Accepted: 11/04/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Telehealth-delivered dietary interventions are effective for chronic disease management and are an emerging area of clinical practice. However, to apply interventions from the research setting in clinical practice, health professionals need details of each intervention component. OBJECTIVE The aim of this study was to evaluate the completeness of intervention reporting in published dietary chronic disease management trials that used telehealth delivery methods. METHODS Eligible randomized controlled trial publications were identified through a systematic review. The completeness of reporting of experimental and comparison interventions was assessed by two independent assessors using the Template for Intervention Description and Replication (TIDieR) checklist that consists of 12 items including intervention rationale, materials used, procedures, providers, delivery mode, location, when and how much intervention delivered, intervention tailoring, intervention modifications, and fidelity. Where reporting was incomplete, further information was sought from additional published material and through email correspondence with trial authors. RESULTS Within the 37 eligible trials, there were 49 experimental interventions and 37 comparison interventions. One trial reported every TIDieR item for their experimental intervention. No publications reported every item for the comparison intervention. For the experimental interventions, the most commonly reported items were location (96%), mode of delivery (98%), and rationale for the essential intervention elements (96%). Least reported items for experimental interventions were modifications (2%) and intervention material descriptions (39%) and where to access them (20%). Of the 37 authors, 14 responded with further information, and 8 could not be contacted. CONCLUSIONS Many details of the experimental and comparison interventions in telehealth-delivered dietary chronic disease management trials are incompletely reported. This prevents accurate interpretation of trial results and implementation of effective interventions in clinical practice.
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Affiliation(s)
- Molly M Warner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | | | - Tammy C Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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Mogre V, Abanga ZO, Tzelepis F, Johnson NA, Paul C. Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana. BMC Endocr Disord 2017; 17:20. [PMID: 28340613 PMCID: PMC5366118 DOI: 10.1186/s12902-017-0169-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/18/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care. METHODS Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours. RESULTS In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts. CONCLUSION Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana.
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Zakaria Osman Abanga
- Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, NSW, 2305, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, NSW, 2287, Australia
| | - Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, NSW, 2305, Australia
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Kangovi S, Mitra N, Smith RA, Kulkarni R, Turr L, Huo H, Glanz K, Grande D, Long JA. Decision-making and goal-setting in chronic disease management: Baseline findings of a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:449-455. [PMID: 27717532 PMCID: PMC5437864 DOI: 10.1016/j.pec.2016.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/01/2016] [Accepted: 09/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Growing interest in collaborative goal-setting has raised questions. First, are patients making the 'right choices' from a biomedical perspective? Second, are patients and providers setting goals of appropriate difficulty? Finally, what types of support will patients need to accomplish their goals? We analyzed goals and action plans from a trial of collaborative goal-setting among 302 residents of a high-poverty urban region who had multiple chronic conditions. METHODS Patients used a low-literacy aid to prioritize one of their chronic conditions and then set a goal for that condition with their primary care provider. Patients created patient-driven action plans for reaching these goals. RESULTS Patients chose to focus on conditions that were in poor control and set ambitious chronic disease management goals. The mean goal weight loss -16.8lbs (SD 19.5), goal HbA1C reduction was -1.3% (SD 1.7%) and goal blood pressure reduction was -9.8mmHg (SD 19.2mmHg). Patient-driven action plans spanned domains including health behavior (58.9%) and psychosocial (23.5%). CONCLUSIONS High-risk, low-SES patients identified high priority conditions, set ambitious goals and generate individualized action plans for chronic disease management. PRACTICE IMPLICATIONS Practices may require flexible personnel who can support patients using a blend of coaching, social support and navigation.
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Affiliation(s)
- Shreya Kangovi
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, PA 19104, United States.
| | - Nandita Mitra
- Perelman School of Medicine, University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA 19104, United States.
| | - Robyn A Smith
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, PA 19104, United States.
| | - Raina Kulkarni
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, PA 19104, United States.
| | - Lindsey Turr
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, PA 19104, United States.
| | - Hairong Huo
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, PA 19104, United States.
| | - Karen Glanz
- Perelman School of Medicine, University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA 19104, United States; Perelman School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - David Grande
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, PA 19104, United States.
| | - Judith A Long
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, PA 19104, United States; Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz, VA, Philadelphia, PA 19104, United States.
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Kangovi S, Mitra N, Turr L, Huo H, Grande D, Long JA. A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol. Contemp Clin Trials 2017; 53:115-121. [PMID: 27965180 PMCID: PMC5455773 DOI: 10.1016/j.cct.2016.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/02/2016] [Accepted: 12/03/2016] [Indexed: 11/16/2022]
Abstract
Upstream interventions - e.g. housing programs and community health worker interventions- address socioeconomic and behavioral factors that influence health outcomes across diseases. Studying these types of interventions in clinical trials raises a methodological challenge: how should researchers measure the effect of an upstream intervention in a sample of patients with different diseases? This paper addresses this question using an illustrative protocol of a randomized controlled trial of collaborative-goal setting versus goal-setting plus community health worker support among patients multiple chronic diseases: diabetes, obesity, hypertension and tobacco dependence. At study enrollment, patients met with their primary care providers to select one of their chronic diseases to focus on during the study, and to collaboratively set a goal for that disease. Patients randomly assigned to a community health worker also received six months of support to address socioeconomic and behavioral barriers to chronic disease control. The primary hypothesis was that there would be differences in patients' selected chronic disease control as measured by HbA1c, body mass index, systolic blood pressure and cigarettes per day, between the goal-setting alone and community health worker support arms. To test this hypothesis, we will conduct a stratum specific multivariate analysis of variance which allows all patients (regardless of their selected chronic disease) to be included in a single model for the primary outcome. Population health researchers can use this approach to measure clinical outcomes across diseases. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT01900470.
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Affiliation(s)
- Shreya Kangovi
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, PA, United States; Penn Center for Community Health Workers, Penn Medicine, Philadelphia 19104, PA, United States.
| | - Nandita Mitra
- Perelman School of Medicine, University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia 19104, PA, United States.
| | - Lindsey Turr
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, PA, United States.
| | - Hairong Huo
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, PA, United States.
| | - David Grande
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, PA, United States.
| | - Judith A Long
- Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, PA, United States; Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA, Philadelphia 19104, PA, United States.
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Kelly JT, Reidlinger DP, Hoffmann TC, Campbell KL. Telehealth methods to deliver dietary interventions in adults with chronic disease: a systematic review and meta-analysis. Am J Clin Nutr 2016; 104:1693-1702. [PMID: 27935523 DOI: 10.3945/ajcn.116.136333] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/04/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The long-term management of chronic disease requires the adoption of complex dietary recommendations, which can be facilitated by regular coaching to support behavioral changes. Telehealth interventions can overcome patient-centered barriers to accessing face-to-face programs and provide feasible delivery methods, accessible regardless of geographic location. OBJECTIVE This systematic review assessed the effectiveness of telehealth dietary interventions at facilitating dietary change in chronic disease. DESIGN A structured systematic search was conducted for all randomized controlled trials evaluating multifactorial dietary interventions in adults with chronic disease that provided diet education in an intervention longer than 4 wk. Meta-analyses that used the random-effects model were performed on diet quality, dietary adherence, fruit and vegetables, sodium intake, energy, and dietary fat intake. RESULTS A total of 25 studies were included, involving 7384 participants. The telehealth dietary intervention was effective at improving diet quality [standardized mean difference (SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and vegetable intake [mean difference (MD) 1.04 servings/d (95% CI: 0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake [SMD: -0.39 (-0.58, -0.20), P = 0.0001]. Single nutrients (total fat and energy consumption) were not improved by telehealth intervention; however, after a telehealth intervention, important clinical outcomes were improved, such as systolic blood pressure [MD: -2.97 mm Hg (95% CI: -5.72, -0.22 mm Hg), P = 0.05], total cholesterol [MD: -0.08 mmol/L (95% CI: -0.16, -0.00 mmol/L), P = 0.04], triglycerides [MD: -0.10 mmol/L (95% CI: -0.19, -0.01 mmol/L), P = 0.04], weight [MD: -0.80 kg (95% CI: -1.61, 0 kg), P = 0.05], and waist circumference [MD: -2.08 cm (95% CI: -3.97, -0.20 cm), P = 0.03]. CONCLUSIONS Telehealth-delivered dietary interventions targeting whole foods and/or dietary patterns can improve diet quality, fruit and vegetable intake, and dietary sodium intake. When applicable, they should be incorporated into health care services for people with chronic conditions. This review was registered at http://www.crd.york.ac.uk/PROSPERO/ as CRD42015026398.
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Affiliation(s)
| | | | - Tammy C Hoffmann
- Centre for Research in Evidence Based Practice, Bond University, Gold Coast, Australia; and
| | - Katrina L Campbell
- Faculty of Health Sciences and Medicine, .,Nutrition and Dietetics Department, Princess Alexandra Hospital, Brisbane, Australia
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Isaacs T, Hunt D, Ward D, Rooshenas L, Edwards L. The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review. J Med Internet Res 2016; 18:e256. [PMID: 27670360 PMCID: PMC5057063 DOI: 10.2196/jmir.6374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may underrecruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. OBJECTIVE This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes and the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. METHODS Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English-speaking countries were included. Ethnically targeted RCTs were excluded from the main review, but were included in a post hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. RESULTS Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5% patients (range 0%-97.7%). Fourteen studies (24%) that included at least 30% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Eight of these 14 studies (57%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant-screening criterion. Language proficiency was operationalized using nonstandardized measures (eg, having sufficient "verbal fluency"), with only three studies providing reasons for excluding patients on language grounds. CONCLUSIONS There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (eg, United States) than in those without such legislation (eg, United Kingdom). Less than 25% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters' impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024899 (Archived by WebCite at http://www.webcitation.org/6kQmI2bdF).
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Affiliation(s)
- Talia Isaacs
- University of Bristol, Graduate School of Education, Bristol, United Kingdom.
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Steed L, Lankester J, Barnard M, Earle K, Hurel S, Newman S. Evaluation of the UCL Diabetes Self-management Programme (UCL-DSMP): A Randomized Controlled Trial. J Health Psychol 2016; 10:261-76. [PMID: 15723895 DOI: 10.1177/1359105305049775] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-management has been described as the cornerstone of care for diabetes. Many self-management studies are limited by poor methodology and poor descriptions of the intervention. The current study developed a theoretically based self-management programme for patients with type 2 diabetes, which was evaluated via a randomized controlled trial. At immediate post-intervention and three-month follow-up the intervention group showed significant improvement relative to controls on self-management behaviours, quality of life and illness beliefs. A trend towards improved HbA1c was also observed. Documentation in a manual and development of a training programme for facilitators ensures the programme is replicable.
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Affiliation(s)
- Liz Steed
- Royal Free & University College Medical School, London, W1N 8AA, UK
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Strycker LA, Glasgow RE. Assessment and Enhancement of Social and Community Resources Utilization for Disease Self-Management. Health Promot Pract 2016. [DOI: 10.1177/152483990200300307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes an integrated intervention to encourage the use of community resources for dietary behavior change in older adults. Conducted as part of a randomized trial of Type 2 diabetes patients, the intervention components were designed to be broadly useful across chronic diseases and settings. A community resources guidebook, a survey and feedback procedure to assess and suggest resources for supporting chronic disease management at multiple levels (e.g., family, work, community), a newsletter, and postcards to document resource use were evaluated. All components were developed from a conceptual model of a pyramid of social and environmental support influences based on social-ecological theory. For each intervention component, the authors describe the rationale for development; present process and utilization, reach, and satisfaction data (when available); and discuss lessons learned. The authors conclude that such an intervention is promising, but the specific menu of intervention activities should be tailored to the participant, community, and resources available.
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Probst Y, Zammit G. Predictors for Reporting of Dietary Assessment Methods in Food-based Randomized Controlled Trials over a Ten-year Period. Crit Rev Food Sci Nutr 2015. [DOI: 10.1080/10408398.2013.816653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Levack WMM, Weatherall M, Hay‐Smith EJC, Dean SG, McPherson K, Siegert RJ. Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev 2015; 2015:CD009727. [PMID: 26189709 PMCID: PMC8941379 DOI: 10.1002/14651858.cd009727.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Goal setting is considered a key component of rehabilitation for adults with acquired disability, yet there is little consensus regarding the best strategies for undertaking goal setting and in which clinical contexts. It has also been unclear what effect, if any, goal setting has on health outcomes after rehabilitation. OBJECTIVES To assess the effects of goal setting and strategies to enhance the pursuit of goals (i.e. how goals and progress towards goals are communicated, used, or shared) on improving health outcomes in adults with acquired disability participating in rehabilitation. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trials registers to December 2013, together with reference checking, citation searching and contact with study authors to identify additional studies. We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs evaluating the effects of goal setting or strategies to enhance goal pursuit in the context of adult rehabilitation for acquired disability. DATA COLLECTION AND ANALYSIS Two authors independently reviewed search results for inclusion. Grey literature searches were conducted and reviewed by a single author. Two authors independently extracted data and assessed risk of bias for included studies. We contacted study authors for additional information. MAIN RESULTS We included 39 studies (27 RCTs, 6 cluster-RCTs, and 6 quasi-RCTs) involving 2846 participants in total. Studies ranged widely regarding clinical context and participants' primary health conditions. The most common health conditions included musculoskeletal disorders, brain injury, chronic pain, mental health conditions, and cardiovascular disease.Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. These studies provide very low quality evidence that including any type of goal setting in the practice of adult rehabilitation is better than no goal setting for health-related quality of life or self-reported emotional status (8 studies; 446 participants; standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.17 to 0.88, indicative of a moderate effect size) and self-efficacy (3 studies; 108 participants; SMD 1.07, 95% CI 0.64 to 1.49, indicative of a moderate to large effect size). The evidence is inconclusive regarding whether goal setting results in improvements in social participation or activity levels, body structure or function, or levels of patient engagement in the rehabilitation process. Insufficient data are available to determine whether or not goal setting is associated with more or fewer adverse events compared to no goal setting.Fourteen studies compared structured goal setting approaches, with or without strategies to enhance goal pursuit, to 'usual care' that may have involved some goal setting but where no structured approach was followed. These studies provide very low quality evidence that more structured goal setting results in higher patient self-efficacy (2 studies; 134 participants; SMD 0.37, 95% CI 0.02 to 0.71, indicative of a small effect size) and low quality evidence for greater satisfaction with service delivery (5 studies; 309 participants; SMD 0.33, 95% CI 0.10 to 0.56, indicative of a small effect size). The evidence was inconclusive regarding whether more structured goal setting approaches result in higher health-related quality of life or self-reported emotional status, social participation, activity levels, or improvements in body structure or function. Three studies in this group reported on adverse events (death, re-hospitalisation, or worsening symptoms), but insufficient data are available to determine whether structured goal setting is associated with more or fewer adverse events than usual care.A moderate degree of heterogeneity was observed in outcomes across all studies, but an insufficient number of studies was available to permit subgroup analysis to explore the reasons for this heterogeneity. The review also considers studies which investigate the effects of different approaches to enhancing goal pursuit, and studies which investigate different structured goal setting approaches. It also reports on secondary outcomes including goal attainment and healthcare utilisation. AUTHORS' CONCLUSIONS There is some very low quality evidence that goal setting may improve some outcomes for adults receiving rehabilitation for acquired disability. The best of this evidence appears to favour positive effects for psychosocial outcomes (i.e. health-related quality of life, emotional status, and self-efficacy) rather than physical ones. Due to study limitations, there is considerable uncertainty regarding these effects however, and further research is highly likely to change reported estimates of effect.
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Affiliation(s)
- William MM Levack
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Mark Weatherall
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - E. Jean C Hay‐Smith
- University of OtagoRehabilitation Teaching and Research Unit, Department of MedicineMein St, NewtownPO Box 7343WellingtonNew Zealand6242
| | - Sarah G Dean
- University of ExeterUniversity of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Kathryn McPherson
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
| | - Richard J Siegert
- Auckland University of TechnologySchool of Rehabilitation and Occupation StudiesPrivate Bag 92006AucklandNew Zealand1020
- Auckland University of TechnologySchool of Public Health and Psychosocial StudiesAucklandNew Zealand
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Heinrich E, Schaper NC, de Vries NK. Self-management interventions for type 2 diabetes: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.160] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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15
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Jalil S, Myers T, Atkinson I. A Meta-Synthesis of Behavioral Outcomes from Telemedicine Clinical Trials for Type 2 Diabetes and the Clinical User-Experience Evaluation (CUE). J Med Syst 2015; 39:28. [DOI: 10.1007/s10916-015-0191-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022]
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Abram JK, Hand RK, Parrott JS, Brown K, Ziegler PJ, Steiber AL. What Is Your Nutrition Program Missing? Finding Answers with the Guide for Effective Nutrition Interventions and Education (GENIE). J Acad Nutr Diet 2015; 115:122-30. [DOI: 10.1016/j.jand.2014.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 11/30/2022]
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Grooms KN, Ommerborn MJ, Pham DQ, Djoussé L, Clark CR. Dietary fiber intake and cardiometabolic risks among US adults, NHANES 1999-2010. Am J Med 2013; 126:1059-67.e1-4. [PMID: 24135514 PMCID: PMC3865784 DOI: 10.1016/j.amjmed.2013.07.023] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dietary fiber may decrease the risk of cardiovascular disease and associated risk factors. We examined trends in dietary fiber intake among diverse US adults between 1999 and 2010, and investigated associations between dietary fiber intake and cardiometabolic risks including metabolic syndrome, cardiovascular inflammation, and obesity. METHODS Our cross-sectional analysis included 23,168 men and nonpregnant women aged 20+ years from the 1999-2010 National Health and Nutrition Examination Survey. We used weighted multivariable logistic regression models to estimate predicted marginal risk ratios and 95% confidence intervals for the risks of having the metabolic syndrome, inflammation, and obesity associated with quintiles of dietary fiber intake. RESULTS Consistently, dietary fiber intake remained below recommended adequate intake levels for total fiber defined by the Institute of Medicine. Mean dietary fiber intake averaged 15.7-17.0 g. Mexican Americans (18.8 g) consumed more fiber than non-Hispanic whites (16.3 g) and non-Hispanic blacks (13.1 g). Comparing the highest with the lowest quintiles of dietary fiber intake, adjusted predicted marginal risk ratios (95% confidence interval) for the metabolic syndrome, inflammation, and obesity were 0.78 (0.69-0.88), 0.66 (0.61-0.72), and 0.77 (0.71-0.84), respectively. Dietary fiber was associated with lower levels of inflammation within each racial and ethnic group, although statistically significant associations between dietary fiber and either obesity or metabolic syndrome were seen only among whites. CONCLUSIONS Low dietary fiber intake from 1999-2010 in the US, and associations between higher dietary fiber and a lower prevalence of cardiometabolic risks suggest the need to develop new strategies and policies to increase dietary fiber intake.
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Affiliation(s)
- Kya N Grooms
- Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston, Mass
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van Vugt M, de Wit M, Hendriks SH, Roelofsen Y, Bilo HJG, Snoek FJ. Web-based self-management with and without coaching for type 2 diabetes patients in primary care: design of a randomized controlled trial. BMC Endocr Disord 2013; 13:53. [PMID: 24238104 PMCID: PMC3840688 DOI: 10.1186/1472-6823-13-53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online coaching could improve patient motivation and reduce program attrition. This study aims to test the hypothesis that a web-based self-management program with coaching will prove more effective on improving patient self-management behavior and clinical outcome measures than a web-based self-management program without coaching. METHODS The effects of a web-based self-management program with and without coaching will be tested with a nested randomized controlled trial within a healthcare group in the Netherlands. In one year 220 type 2 diabetes patients will be randomized into an intervention group (n = 110) or a control group (n = 110). The control group will receive only the online self-management program. The intervention group will receive the online self-management program and additional online coaching. Participants will be followed for one year, with follow-up measurements at 6 and 12 months. DISCUSSION The intervention being tested is set to support type 2 diabetes patients with their diabetes self-management and is expected to have beneficial effects on self-care activities, well being and clinical outcomes. When proven effective this self-management support program could be offered to other health care groups and their type 2 diabetes patients in the Netherlands. TRIAL REGISTRATION Nederlands Trial Register NTR4064.
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Affiliation(s)
- Michael van Vugt
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
- EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
- EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Henk JG Bilo
- Diabetes Centre, Isala Clinic Sophia, Zwolle, The Netherlands
- Department of internal medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
- EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Tao D, Or CK. Effects of self-management health information technology on glycaemic control for patients with diabetes: a meta-analysis of randomized controlled trials. J Telemed Telecare 2013; 19:133-143. [PMID: 23563018 DOI: 10.1177/1357633x13479701] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 11/16/2022]
Abstract
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) which had evaluated self-management health information technology (SMHIT) for glycaemic control in patients with diabetes. A total of 43 RCTs was identified, which reported on 52 control-intervention comparisons. The glycosylated haemoglobin (HbA1c) data were pooled using a random effects meta-analysis method, followed by a meta-regression and subgroup analyses to examine the effects of a set of moderators. The meta-analysis showed that use of SMHITs was associated with a significant reduction in HbA1c compared to usual care, with a pooled standardized mean difference of -0.30% (95% CI -0.39 to -0.21, P < 0.001). Sample size, age, study setting, type of application and method of data entry significantly moderated the effects of SMHIT use. The review supports the use of SMHITs as a self-management approach to improve glycaemic control. The effect of SMHIT use is significantly greater when the technology is a web-based application, when a mechanism for patients' health data entry is provided (manual or automatic) and when the technology is operated in the home or without location restrictions. Integrating these variables into the design of SMHITs may augment the effectiveness of the interventions.
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Affiliation(s)
- Da Tao
- Department of Industrial and Manufacturing Systems Engineering, Faculty of Engineering, University of Hong Kong, Hong Kong, China
| | - Calvin Kl Or
- Department of Industrial and Manufacturing Systems Engineering, Faculty of Engineering, University of Hong Kong, Hong Kong, China
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Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, Wood B, Inniss JD, Murray E. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2013; 2013:CD008776. [PMID: 23543567 PMCID: PMC6486319 DOI: 10.1002/14651858.cd008776.pub2] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Diabetes is one of the commonest chronic medical conditions, affecting around 347 million adults worldwide. Structured patient education programmes reduce the risk of diabetes-related complications four-fold. Internet-based self-management programmes have been shown to be effective for a number of long-term conditions, but it is unclear what are the essential or effective components of such programmes. If computer-based self-management interventions improve outcomes in type 2 diabetes, they could potentially provide a cost-effective option for reducing the burdens placed on patients and healthcare systems by this long-term condition. OBJECTIVES To assess the effects on health status and health-related quality of life of computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. SEARCH METHODS We searched six electronic bibliographic databases for published articles and conference proceedings and three online databases for theses (all up to November 2011). Reference lists of relevant reports and reviews were also screened. SELECTION CRITERIA Randomised controlled trials of computer-based self-management interventions for adults with type 2 diabetes, i.e. computer-based software applications that respond to user input and aim to generate tailored content to improve one or more self-management domains through feedback, tailored advice, reinforcement and rewards, patient decision support, goal setting or reminders. DATA COLLECTION AND ANALYSIS Two review authors independently screened the abstracts and extracted data. A taxonomy for behaviour change techniques was used to describe the active ingredients of the intervention. MAIN RESULTS We identified 16 randomised controlled trials with 3578 participants that fitted our inclusion criteria. These studies included a wide spectrum of interventions covering clinic-based brief interventions, Internet-based interventions that could be used from home and mobile phone-based interventions. The mean age of participants was between 46 to 67 years old and mean time since diagnosis was 6 to 13 years. The duration of the interventions varied between 1 to 12 months. There were three reported deaths out of 3578 participants.Computer-based diabetes self-management interventions currently have limited effectiveness. They appear to have small benefits on glycaemic control (pooled effect on glycosylated haemoglobin A1c (HbA1c): -2.3 mmol/mol or -0.2% (95% confidence interval (CI) -0.4 to -0.1; P = 0.009; 2637 participants; 11 trials). The effect size on HbA1c was larger in the mobile phone subgroup (subgroup analysis: mean difference in HbA1c -5.5 mmol/mol or -0.5% (95% CI -0.7 to -0.3); P < 0.00001; 280 participants; three trials). Current interventions do not show adequate evidence for improving depression, health-related quality of life or weight. Four (out of 10) interventions showed beneficial effects on lipid profile.One participant withdrew because of anxiety but there were no other documented adverse effects. Two studies provided limited cost-effectiveness data - with one study suggesting costs per patient of less than $140 (in 1997) or 105 EURO and another study showed no change in health behaviour and resource utilisation. AUTHORS' CONCLUSIONS Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control and the effect was larger in the mobile phone subgroup. There is no evidence to show benefits in other biological outcomes or any cognitive, behavioural or emotional outcomes.
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Affiliation(s)
- Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK.
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21
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Klein HA, Jackson SM, Street K, Whitacre JC, Klein G. Diabetes self-management education: miles to go. Nurs Res Pract 2013; 2013:581012. [PMID: 23577243 PMCID: PMC3616351 DOI: 10.1155/2013/581012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/19/2012] [Accepted: 12/29/2012] [Indexed: 11/17/2022] Open
Abstract
This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts.
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Affiliation(s)
- Helen Altman Klein
- Division of Research, MacroCognition LLC, P.O. Box 533, Yellow Springs, OH 45387, USA
| | - Sarah M. Jackson
- Department of Psychology, Wright State University, Dayton, OH 45435, USA
| | - Kenley Street
- Department of Psychology, Wright State University, Dayton, OH 45435, USA
| | - James C. Whitacre
- Division of Research, MacroCognition LLC, P.O. Box 533, Yellow Springs, OH 45387, USA
| | - Gary Klein
- Division of Research, MacroCognition LLC, P.O. Box 533, Yellow Springs, OH 45387, USA
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Khan MU. Lifestyle Modification in the Prevention of Type II Diabetes Mellitus. Oman Med J 2012; 27:170-1. [PMID: 22496947 DOI: 10.5001/omj.2012.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/21/2011] [Indexed: 11/03/2022] Open
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Jacob E, Duran J, Stinson J, Lewis MA, Zeltzer L. Remote monitoring of pain and symptoms using wireless technology in children and adolescents with sickle cell disease. J Am Assoc Nurse Pract 2012; 25:42-54. [PMID: 23279278 DOI: 10.1111/j.1745-7599.2012.00754.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to examine (a) symptoms, (b) pain characteristics (intensity, location, quality), (c) pain medications and nonpharmacological strategies used for pain, (d) thoughts and feelings, and (e) healthcare visits. We also examined the relationship between pain and sleep. DATA SOURCES Pain and symptoms were entered on an electronic e-Diary using a smartphone and were remotely monitored by an advanced practice registered nurse (APRN). Sixty-seven children and adolescents (10-17 years) reported mild to severe pain at home that did not require healthcare visits. Symptoms reported were (a) general symptoms such as tiredness/fatigue (34.7%), headache (20.8%), yellowing of the eyes (28.4%); (b) respiratory symptoms such as sniffling (32.9%), coughing (19.1%), changes in breathing (10.0%); and (c) musculoskeletal symptoms such as stiffness in joints (15.8%). A significant negative correlation was found between pain and sleep (r = -.387, p = .024). Factors that predict pain included previous history of sickle cell disease (SCD) related events, symptoms, and negative thoughts. CONCLUSION Pain and multiple symptoms entered on a web-based e-Diary were remotely monitored by an APRN and prompted communications, further evaluation, and recommendations. IMPLICATIONS FOR PRACTICE Remote monitoring using wireless technology may facilitate timely management of pain and symptoms and minimize negative consequences in SCD.
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Affiliation(s)
- Eufemia Jacob
- University of California Los Angeles School of Nursing, Los Angeles, California 90095, USA.
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Levack WMM, Siegert RJ, Dean SG, McPherson K, Hay-Smith EJC, Weatherall MM. Goal setting and activities to enhance goal pursuit for adults with acquired disabilities participating in rehabilitation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Egginton JS, Ridgeway JL, Shah ND, Balasubramaniam S, Emmanuel JR, Prokop LJ, Montori VM, Murad MH. Care management for Type 2 diabetes in the United States: a systematic review and meta-analysis. BMC Health Serv Res 2012; 12:72. [PMID: 22439920 PMCID: PMC3349574 DOI: 10.1186/1472-6963-12-72] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 03/22/2012] [Indexed: 01/15/2023] Open
Abstract
Background This systematic review and meta-analysis aims at assessing the composition and performance of care management models evaluated in the last decade and their impact on patient important outcomes. Methods A comprehensive literature search of electronic bibliographic databases was performed to identify care management trials in type 2 diabetes. Random effects meta-analysis was used when feasible to pool outcome measures. Results Fifty-two studies were eligible. Most commonly reported were surrogate outcomes (such as HbA1c and LDL), followed by process measures (clinic visit or testing frequency). Less frequently reported were quality of life, patient satisfaction, self-care, and healthcare utilization. Most care management modalities were carved out from primary care. Meta-analysis demonstrated a statistically significant but trivial reduction of HbA1c (weighted difference in means -0.21%, 95% confidence interval -0.40 to -0.03, p < .03) and LDL-cholesterol (weighted difference in means -3.38 mg/dL, 95% confidence interval -6.27 to -0.49, p < .02). Conclusions Most care management programs for patients with type 2 diabetes are 'carved-out', accomplish limited effects on metabolic outcomes, and have unknown effects on patient important outcomes. Comparative effectiveness research of different models of care management is needed to inform the design of medical homes for patients with chronic conditions.
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Affiliation(s)
- Jason S Egginton
- Division of Preventive Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Wei I, Pappas Y, Car J, Sheikh A, Majeed A. Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus. Cochrane Database Syst Rev 2011; 2011:CD008488. [PMID: 22161430 PMCID: PMC6486022 DOI: 10.1002/14651858.cd008488.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. OBJECTIVES To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus. SEARCH METHODS We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status. SELECTION CRITERIA Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus. DATA COLLECTION AND ANALYSIS Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently. MAIN RESULTS Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study. AUTHORS' CONCLUSIONS Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage.
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Affiliation(s)
- Igor Wei
- Imperial College LondonCentre for Patient Safety and Service QualitySt. Mary's CampusMedical School BuildingLondonUKW2 1PG
| | - Yannis Pappas
- Imperial College LondonDepartment of Primary Care and Public HealthSt Dunstan's RoadHammersmithLondonUKW6 8RP
| | - Josip Car
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthReynolds BuildingSt Dunstans RoadLondonUKW6 8RP
| | - Aziz Sheikh
- University of EdinburghCentre for Population Health SciencesMedical SchoolDoorway 3, Teviot PlaceEdinburghUKEH8 9AG
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthSt Dunstan's RoadHammersmithLondonUKW6 8RP
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Glasgow RE. Interactive media for diabetes self-management: issues in maximizing public health impact. Med Decis Making 2011; 30:745-58. [PMID: 21183760 DOI: 10.1177/0272989x10385845] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management. METHODS Following a brief review of the literature, the 5 As framework for enhancing the effectiveness of health behavior counseling and the RE-AIM model for estimating and enhancing public health impact are used to frame discussion of the strengths and limitations of IM for diabetes shared decision making and self-management support. RESULTS Data and lessons learned from a series of randomized trials of IM for diabetes self-management education are summarized around 2 key issues. The first is enhancing patient engagement in decision making and includes enhancing user experience and engagement, improving quality of care, and promoting collaborative action planning and follow-up. The second is getting such resources into place and sustaining them in real-world primary care settings and involves enhancing participation at patient, clinician, and health care system levels and enhancing the generalizability of results. CONCLUSIONS . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient's care, and collection of cost-effectiveness data is a key need for future research.
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Affiliation(s)
- Russell E Glasgow
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA.
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Vallis M, Dunbar P, Tay L, Nash A. Evaluation of a Nova Scotia Diabetes Assistance Program for People with Type 2 Diabetes. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)51009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dombrowski SU, Avenell A, Sniehott FF. Behavioural interventions for obese adults with additional risk factors for morbidity: systematic review of effects on behaviour, weight and disease risk factors. Obes Facts 2010; 3:377-96. [PMID: 21196792 PMCID: PMC6515855 DOI: 10.1159/000323076] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Reducing obesity through effective behaviour change interventions is of key importance to prevent disabling and life-threatening conditions, particularly in individuals already at risk for morbidity. PURPOSE To assess the effects of behavioural interventions for obese adults with additional risk factors for morbidity on behaviour, weight and disease risk factors. METHODS Systematic review of randomised controlled trials (RCTs). Three electronic databases and three journals were searched for behavioural interventions (aimed at changing dietary intake and/or physical activity (PA)) for adults (mean BMI ≥30 kg/m(2); mean age ≥40 years) with risk factors for morbidity, reporting follow-up data ≥12 weeks. RESULTS 44 RCTs met the inclusion criteria. Behavioural outcomes, weight loss, and cardiovascular disease risk factors showed consistent modest improvements over time, especially for interventions targeting both diet and PA. CONCLUSION Behavioural interventions in at-risk populations showed positive effect tendencies on behaviour, weight, and disease risk factors. However, there is still ample room for improvement, and future research should focus on identifying the most effective means of inducing dietary and PA behaviour change in this vulnerable population.
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Wu L, Forbes A, Griffiths P, Milligan P, While A. Telephone follow-up to improve glycaemic control in patients with Type 2 diabetes: systematic review and meta-analysis of controlled trials. Diabet Med 2010; 27:1217-25. [PMID: 20950378 DOI: 10.1111/j.1464-5491.2010.03113.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the impact of telephone follow-up interventions on glycaemic control in patients with Type 2 diabetes. METHODS This was a systematic review and meta-analysis of randomized controlled trials using The Cochrane Library, including the Cochrane central register of controlled trials; MEDLINE, EMBASE, PsycINFO and CINHAL, together with citation searching. The included studies were randomized controlled trials examining the effect of a telephone follow-up intervention on glycaemic control in patients with Type 2 diabetes. All the included trials were subject to critical appraisal. Data were extracted on study design, characteristics of patients, exact nature of the telephone intervention and details of comparison. Pooled standardized effects were calculated for the primary outcome. Glycaemic control was measured by HbA(1c) . RESULTS HbA(1c) levels reported in the reviewed studies were pooled using random effects models. The standardized effect of telephone follow-up was equivocal, with endpoint data showing weighted mean differences of -0.44 (95% CI -0.93 to 0.06) (Z = -1.72, P=0.08) in favour of the telephone follow-up intervention. Subgroup analysis of more intensive interventions (interactive follow-up with health professional plus automated follow-up or non-interactive follow-up) showed (n=1057) a significant benefit in favour of the treatment group, with a standardized mean difference of -0.84 (95% CI -1.67 to 0.0) (Z=1.97, P=0.05), indicating that more intensive (targeted) modes of follow-up may have better effects on glycaemic control. CONCLUSIONS The analysis suggested that telephone follow-up interventions following a more intensive targeted approach could have a positive impact on glycaemic control for Type 2 diabetes.
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Affiliation(s)
- L Wu
- King's College London, The Florence Nightingale School of Nursing and Midwifery, 57 Waterloo Road, London, UK
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Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, Kumanyika S, Kraus WE, Fleg JL, Redeker NS, Meininger JC, Banks J, Stuart-Shor EM, Fletcher BJ, Miller TD, Hughes S, Braun LT, Kopin LA, Berra K, Hayman LL, Ewing LJ, Ades PA, Durstine JL, Houston-Miller N, Burke LE. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 2010; 122:406-41. [PMID: 20625115 PMCID: PMC6893884 DOI: 10.1161/cir.0b013e3181e8edf1] [Citation(s) in RCA: 668] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jernigan VBB, Lorig K. The internet diabetes self-management workshop for American Indians and Alaska Natives. Health Promot Pract 2010; 12:261-70. [PMID: 20534807 DOI: 10.1177/1524839909335178] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Type 2 diabetes disproportionately affects American Indians and Alaska Natives (AI/ANs). In the larger population, patient self-management has become an increasing focus of the health care system to help reduce the impact of diabetes. However, little is known about patient self-management programs designed for AI/ANs. This study reports on the feasibility of implementing the Stanford Internet Diabetes Self-Management Workshop within the AI/AN population using a participatory research approach. This is a continuation of self-management studies to assist in meeting the needs of both patients and the health care system for health services that are effective (evidence based), efficient, and culturally appropriate. To our knowledge, this is the first study examining the effectiveness of an Internet-based diabetes patient self-management program among AI/ANs. This article reports on a pilot for a larger randomized study that is ongoing.
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Adams SY, Crawford AG, Rimal RN, Lee JS, Janneck LM, Sciamanna CN. The effects of a computer-tailored message on secondary prevention in type 2 diabetes: a randomized trial. Popul Health Manag 2009; 12:197-204. [PMID: 19663622 DOI: 10.1089/pop.2008.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to test the effect of computer-generated, tailored feedback on the quality of chronic disease management for type 2 diabetes when provided to a patient prior to a scheduled physician visit. A stand-alone computer application was developed to provide tailored feedback aimed at empowering patients to engage more actively in their diabetes management. Adults with type 2 diabetes (n = 203) were randomly assigned to groups receiving either efficacy (positive) messages (n = 68), risk (negative) messages (n = 67), or to a delayed treatment control group (n = 68). The intervention was delivered prior to a patient's visit with his or her physician so that patients would have the opportunity to discuss the messages at the clinical appointment. Although there were no significant differences in the percentage of participants who received intensified care or routine tests between the control and intervention groups, we learned that more directive messaging may be needed to help patients effectively manage their diabetes. Patients may benefit from directive feedback, providing them with specific questions to ask their physician that can lead to improved care, rather than receiving general and educational informational messages.
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Affiliation(s)
- Sandra Y Adams
- Jefferson School of Population Health, Philadelphia, PA, USA
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Dumrongpakapakorn P, Hopkins K, Sherwood P, Zorn K, Donovan H. Computer-mediated patient education: opportunities and challenges for supporting women with ovarian cancer. Nurs Clin North Am 2009; 44:339-54. [PMID: 19683095 DOI: 10.1016/j.cnur.2009.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A majority of women with ovarian cancer will face recurrent disease despite receiving aggressive chemotherapy at the time of diagnosis. Given the complex medical and psychosocial needs of women with ovarian cancer and the time constraints within busy clinical settings, providing women with the necessary education related to their disease and treatments can be challenging. The advent of computers and web-based technologies has created new opportunities for educating cancer patients and supporting them to better cope with their disease. This article reviews prior studies of computer-based patient education interventions to identify key intervention components and other factors associated with improved patient outcomes. Opportunities for using computer-based technologies to support women with ovarian cancer are discussed and WRITE Symptoms (a Written Representational Intervention To Ease Symptoms), a web-based, symptom management intervention for women with recurrent ovarian cancer, is introduced.
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Affiliation(s)
- Phensiri Dumrongpakapakorn
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA
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The effects of isolated telephone interventions on glycemic control in type 2 diabetes: a literature review. ANS Adv Nurs Sci 2009; 32:E28-41. [PMID: 19707085 DOI: 10.1097/ans.0b013e3181b0d6d6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A systematic literature review of studies published between 1990 and 2008 was conducted to evaluate the impact of isolated telephone interventions on glycemic control in adults with type 2 diabetes. Eight randomized controlled trials met the inclusion criteria. Overall, the interventions had mixed effects on glycemic control, suggesting further research is needed in this area. Current evidence does not support isolated telephone interventions to improve glycemic control in type 2 diabetes mellitus; well-designed studies to establish the effectiveness of this potentially cost-effective modality can be an important step in addressing the diabetes epidemic.
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Dale J, Caramlau I, Sturt J, Friede T, Walker R. Telephone peer-delivered intervention for diabetes motivation and support: the telecare exploratory RCT. PATIENT EDUCATION AND COUNSELING 2009; 75:91-8. [PMID: 19013741 DOI: 10.1016/j.pec.2008.09.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 08/25/2008] [Accepted: 09/17/2008] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To test trial design issues related to measuring the effectiveness of a peer telephone intervention to enhance self-efficacy in type 2 diabetes; evaluate the impact on self-efficacy and clinical outcome; and describe patient and peer experience. METHODS Eligible patients had raised HbA1c (initial threshold >8%, reduced to >7.4% mid-way through trial). Patients were recruited from 40 general practices and randomised (40:40:20 ratio) to receive routine care alone or, in addition, motivational telephone support from a peer supporter or a diabetes specialist nurse (9 peers and 12 DSNs) for a period of up to 6 months. The primary outcome measure was self-efficacy score, and secondary outcome measures included HbA1c. Patient and telecare supporter satisfaction and experience were evaluated. RESULTS In all, 231 patients participated. At 6 months there were no statistically significant differences in self-efficacy scores (p=0.68), HbA1c (p=0.87) or other secondary outcome measures. There was evidence of a high level of acceptability, but peer telecare support was less highly valued than that from a DSN. Some patients stated that they would have valued more information and advice. CONCLUSIONS Further consideration needs to be given to the targeting of the telecare peer support, its intensity, the training and ongoing supervision of peer supporters, and the extent to which information and advice should be incorporated. PRACTICE IMPLICATIONS While some patients with poorly controlled type 2 diabetes value peer telephone support, this approach appears not to suit all patients. Further intervention development and evaluation is required before widespread adoption can be recommended.
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Affiliation(s)
- Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK.
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Balamurugan A, Hall-Barrow J, Blevins MA, Brech D, Phillips M, Holley E, Bittle K. A pilot study of diabetes education via telemedicine in a rural underserved community--opportunities and challenges: a continuous quality improvement process. DIABETES EDUCATOR 2009; 35:147-54. [PMID: 19244570 DOI: 10.1177/0145721708326988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Telemedicine technology may offer an avenue to implement diabetes self-management education (DSME) for people with diabetes in underserved rural communities. The continuous quality improvement process was used to identify the problem, collect and analyze data, and develop and implement a DSME program via telemedicine (DSME-T) in an underserved rural community. METHODS A pilot study was conducted in 2006, implementing a DSME-T utilizing facilities at the University of Arkansas for Medical Sciences and a rural community hospital in Arkansas (Ozark Health, Inc). A total of 38 people were enrolled to receive DSME-T. Participant knowledge, self-efficacy, and self-care practices were assessed before participants began the education program and after they had completed it. Also, select clinical measures (glycosylated hemoglobin, lipid profile, and urine microalbumin) were collected. RESULTS A total of 66% of participants (n = 25) completed the DSME-T program. A significantly greater proportion of participants demonstrated improved knowledge (39% vs 83%; P = .012), endorsed greater self-efficacy (54% vs 86%; P = .016), and reported more frequent self-care practices to manage their diabetes at the conclusion of the study period. CONCLUSIONS The results of this pilot study suggest that DSME-T may offer opportunities for DSME among rural residents with diabetes. Plans are in place to explore the possibility of sustaining and expanding the program to other underserved rural communities.
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Affiliation(s)
- Appathurai Balamurugan
- The Epidemiology Branch at the Center for Public Health Practice, Arkansas Department of Health, Little Rock, Arkansas (Dr Balamurugan, Dr Phillips),The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
| | - Julie Hall-Barrow
- The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
| | - Mary Alice Blevins
- The Arkansas Diabetes Prevention and Control Program, Arkansas Department of Health, Little Rock, Arkansas (Ms Blevins)
| | - Detri Brech
- Ouachita Baptist University, Arkadelphia, Arkansas (Dr Brech)
| | - Martha Phillips
- The Epidemiology Branch at the Center for Public Health Practice, Arkansas Department of Health, Little Rock, Arkansas (Dr Balamurugan, Dr Phillips)
| | - Elizabeth Holley
- The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
| | - Kim Bittle
- Ozark Health, Inc, Clinton, Arkansas (Ms Bittle)
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Mosha TCE, Rashidi H. Evaluation of Self-Care Practices and Emotional Distress Among People with Type 2 Diabetes Mellitus in Dar Es Salaam, Tanzania. Ecol Food Nutr 2009; 48:89-111. [DOI: 10.1080/03670240802577457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Quinn CC, Gruber-Baldini AL, Shardell M, Weed K, Clough SS, Peeples M, Terrin M, Bronich-Hall L, Barr E, Lender D. Mobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control. Contemp Clin Trials 2009; 30:334-46. [PMID: 19250979 DOI: 10.1016/j.cct.2009.02.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 02/12/2009] [Accepted: 02/13/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND National data find glycemic control is within target (A1c<7.0%) for 37% of patients with diabetes, and only 7% meet recommended glycemic, lipid, and blood pressure goals. OBJECTIVES To compare active interventions and usual care for glucose control in a randomized clinical trial (RCT) among persons with diabetes cared for by primary care physicians (PCPs) over the course of 1 year. METHODS Physician practices (n=36) in 4 geographic areas are randomly assigned to 1 of 4 study groups. The intervention is a diabetes communication system, using mobile phones and patient/physician portals to allow patient-specific treatment and communication. All physicians receive American Diabetes Association (ADA) Guidelines for diabetes care. Patients with poor diabetes control (A1c> or =7.5%) at baseline (n=260) are enrolled in study groups based on PCP randomization. All study patients receive blood glucose (BG) meters and a year's supply of testing materials. Patients in three treatment groups select one of two mobile phone models, receive one-year unlimited mobile phone data and service plan, register on the web-based individual patient portal and receive study treatment phone software based on study assignment. Control group patients receive usual care from their PCP. The primary outcome is mean change in A1c over a 12-month intervention period. CONCLUSION Traditional methods of disease management have not achieved adequate control for BG and other conditions important to persons with diabetes. Tools to improve communication between patients and PCPs may improve patient outcomes and be satisfactory to patients and physicians. This RCT is ongoing.
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Affiliation(s)
- Charlene C Quinn
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD 21201, United States.
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Health coaching via an internet portal for primary care patients with chronic conditions: a randomized controlled trial. Med Care 2009; 47:41-7. [PMID: 19106729 DOI: 10.1097/mlr.0b013e3181844dd0] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efforts to enhance patient-physician communication may improve management of underdiagnosed chronic conditions. Patient internet portals offer an efficient venue for coaching patients to discuss chronic conditions with their primary care physicians (PCP). OBJECTIVES We sought to test the effectiveness of an internet portal-based coaching intervention to promote patient-PCP discussion about chronic conditions. RESEARCH DESIGN We conducted a randomized trial of a nurse coach intervention conducted entirely through a patient internet-portal. SUBJECTS Two hundred forty-one patients who were registered portal users with scheduled PCP appointments were screened through the portal for 3 target conditions, depression, chronic pain, mobility difficulty, and randomized to intervention and control groups. MEASURES One-week and 3-month patient surveys assessed visit experiences, target conditions, and quality of life; chart abstractions assessed diagnosis and management during PCP visit. RESULTS Similar high percentages of intervention (85%) and control (80%) participants reported discussing their screened condition during their PCP visit. More intervention than control patients reported their PCP gave them specific advice about their health (94% vs. 84%; P = 0.03) and referred them to a specialist (51% vs. 28%; P = 0.002). Intervention participants reported somewhat higher satisfaction than controls (P = 0.07). Results showed no differences in detection or management of screened conditions, symptom ratings, and quality of life between groups. CONCLUSIONS Internet portal-based coaching produced some possible benefits in care for chronic conditions but without significantly changing patient outcomes. Limited sample sizes may have contributed to insignificant findings. Further research should explore ways internet portals may improve patient outcomes in primary care. ClinicalTrials.gov registration NCT00130416.
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Clark M. Diabetes self-management education: a review of published studies. Prim Care Diabetes 2008; 2:113-120. [PMID: 18779034 DOI: 10.1016/j.pcd.2008.04.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 03/18/2008] [Accepted: 04/28/2008] [Indexed: 11/19/2022]
Abstract
Diabetes self-management is seen as the cornerstone of care for all individuals with diabetes who want to achieve successful health-related outcomes and is considered most effective when delivered by a multidisciplinary team with a comprehensive plan of care. There is a growing body of literature on both educational and psychosocial interventions, aimed at helping individuals to better manage their diabetes. However, the progress of this research and its implications for clinical practice remain unclear and sometimes controversial. This paper therefore aims to further clarify this literature by considering published evidence for the effectiveness of self-management education, including community-based peer support groups and ongoing home telephone support.
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Affiliation(s)
- Marie Clark
- Centre for Behavioural & Social Sciences in Medicine, Division of Medicine, UCL, Charles Bell House, 67-73 Riding House Street, London W1W 7EJ, UK.
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Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Assessing continuity of care in a community diabetes program: Initial questionnaire development and validation. J Clin Epidemiol 2008; 61:925-31. [DOI: 10.1016/j.jclinepi.2007.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 12/04/2007] [Accepted: 12/27/2007] [Indexed: 11/26/2022]
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Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev 2008:CD006424. [PMID: 18646153 DOI: 10.1002/14651858.cd006424.pub2] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ethnic minority groups in upper-middle and high income countries tend to be socio-economically disadvantaged and to have higher prevalence of type 2 diabetes than the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes. SEARCH STRATEGY We searched the The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, SIGLE and reference lists of articles. We also contacted authors in the field and handsearched commonly encountered journals. SELECTION CRITERIA RCTs of culturally appropriate diabetes health education for people over 16 years with type 2 diabetes mellitus from named ethnic minority groups resident in upper-middle or high income countries. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Where there were disagreements in selection of papers for inclusion, all four authors discussed the studies. We contacted study authors for additional information when data appeared to be missing or needed clarification. MAIN RESULTS Eleven trials involving 1603 people were included, with ten trials providing suitable data for entry into meta-analysis. Glycaemic control (HbA1c), showed an improvement following culturally appropriate health education at three months (weight mean difference (WMD) - 0.3%, 95% CI -0.6 to -0.01), and at six months (WMD -0.6%, 95% CI -0.9 to -0.4), compared with control groups who received 'usual care'. This effect was not significant at 12 months post intervention (WMD -0.1%, 95% CI -0.4 to 0.2). Knowledge scores also improved in the intervention groups at three months (standardised mean difference (SMD) 0.6, 95% CI 0.4 to 0.7), six months (SMD 0.5, 95% CI 0.3 to 0.7) and twelve months (SMD 0.4, 95% CI 0.1 to 0.6) post intervention. Other outcome measures both clinical (such as lipid levels, and blood pressure) and patient centred (quality of life measures, attitude scores and measures of patient empowerment and self-efficacy) showed no significant improvement compared with control groups. AUTHORS' CONCLUSIONS Culturally appropriate diabetes health education appears to have short term effects on glycaemic control and knowledge of diabetes and healthy lifestyles. None of the studies were long-term, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, standardised multi-centre RCTs that compare different types and intensities of culturally appropriate health education within defined ethnic minority groups.
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Affiliation(s)
- Kamila Hawthorne
- Department of Primary Care and Public Health, Cardiff University, 3rd Floor, Neuadd Meirionnydd Building. School of Medicine, Heath Park, Cardiff, UK, CF14 4XN
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Charron-Prochownik D, Zgibor JC, Peyrot M, Peeples M, McWilliams J, Koshinsky J, Noullet W, Siminerio LM. The Diabetes Self-management Assessment Report Tool (D-SMART): process evaluation and patient satisfaction. DIABETES EDUCATOR 2008; 33:833-8. [PMID: 17925587 DOI: 10.1177/0145721707307613] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this article is to present the results of the process evaluation and patient experience in completing the Diabetes Self-management Assessment Report Tool (D-SMART), an instrument within the AADE Outcome System to assist diabetes educators to assess, facilitate, and track behavior change in the provision of diabetes self-management education (DSME). METHODS The D-SMART was integrated into computer and telephonic systems at 5 sites within the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) network. Data were obtained from 290 patients with diabetes using the system at these programs via paper-and-pencil questionnaires following baseline D-SMART assessments and electronic system measurement of system performance. Process evaluation included time of completion, understanding content, usability of technology, and satisfaction with the system. Patients were 58% female and 85% Caucasian and had a mean age of 58 years. Fifty-six percent of patients had no more than a high school education, and 78% had Internet access at home. RESULTS Most patients reported completing the D-SMART at home (78%), in 1 attempt (86%) via the Internet (55%), and in less than 30 minutes. Seventy-six percent believed the questions were easy to understand, and 80% did not need assistance. Age was negatively associated with ease of use. Moreover, 76% of patients believed the D-SMART helped them think about their diabetes, with 67% indicating that it gave the diabetes educator good information about themselves and their diabetes. Most (94%) were satisfied with the D-SMART. Level of satisfaction was independent of the system being used. CONCLUSIONS The D-SMART was easily completed at home in 1 attempt, content was understandable, and patients were generally satisfied with the wording of questions and selection of answers. The D-SMART is easy to use and enhanced communication between the patient and clinician; however, elderly patients may need more assistance. Computer-based and telephonic D-SMARTs appear to be feasible and useful assessment methods for diabetes educators.
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Affiliation(s)
| | - Janice C Zgibor
- Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Zgibor, Mr Noullet)
| | - Mark Peyrot
- Sociology, Loyola College, Baltimore, Maryland (Dr Peyrot)
| | - Malinda Peeples
- American Association of Diabetes Educators, Chicago, Illinois (Ms Peeples)
| | - Janis McWilliams
- The University of Pittsburgh Medical Center and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms McWilliams, Ms Koshinsky, Dr Siminerio)
| | - Janice Koshinsky
- The University of Pittsburgh Medical Center and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms McWilliams, Ms Koshinsky, Dr Siminerio)
| | - William Noullet
- Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Zgibor, Mr Noullet)
| | - Linda M Siminerio
- The University of Pittsburgh Medical Center and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms McWilliams, Ms Koshinsky, Dr Siminerio)
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Povey RC, Clark-Carter D. Diabetes and healthy eating: a systematic review of the literature. DIABETES EDUCATOR 2008; 33:931-59; discussion 960-1. [PMID: 18057263 DOI: 10.1177/0145721707308408] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to review the literature on healthy eating interventions within diabetes care. DATA SOURCES The databases PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO were searched for the terms healthy eating or dietary and intervention and diabetes in the abstracts. In addition, electronic searches of the contents of Diabetes, Clinical Diabetes, Diabetes Care, Diabetes Spectrum, and Diabetic Medicine were conducted. STUDY SELECTION Articles were included in the review if the participants were diagnosed with type 1 or type 2 diabetes, results from an intervention to promote dietary change were reported, measurements were taken from 2 time points (preintervention and postintervention), at least 1 outcome measured eating behavior, and the articles had been published between 1990 and the present date. DATA EXTRACTION Data were extracted from the 23 studies found to be eligible. Studies were compared in terms of sample types and sizes, duration, and type and content of intervention. DATA SYNTHESIS Comparisons were made between the characteristics of those studies that produced a statistically significant result and those that did not, for the different outcome measures. CONCLUSIONS For studies measuring the outcomes of weight, fat intake, saturated fat intake, and carbohydrates, there was a tendency for successful interventions to include an exercise dimension and group work. Some outcomes had a tendency to show significant changes in studies of longer duration (eg, serum cholesterol), whereas others were more likely to show significant changes in studies of shorter duration (eg, weight, fiber), suggesting that certain outcomes may be more difficult to maintain. Future research would benefit by ensuring that sample sizes are adequate to give sufficient power, and interventions should be designed that focus on the maintenance in addition to the initiation of eating behavior change.
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Affiliation(s)
- Rachel Clare Povey
- The Center for Health Psychology, Faculty of Sciences, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - David Clark-Carter
- The Center for Health Psychology, Faculty of Sciences, Staffordshire University, Stoke-on-Trent, United Kingdom
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Boren SA, Gunlock TL, Peeples MM, Krishna S. Computerized learning technologies for diabetes: a systematic review. J Diabetes Sci Technol 2008; 2:139-46. [PMID: 19885190 PMCID: PMC2769717 DOI: 10.1177/193229680800200121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective of this study was to evaluate computerized learning technology interventions that can empower patients in the self-management of diabetes and support diabetes education over a distance. METHODS We searched Medline (1966-2006), CINAHL (1982-2006), and the Cochrane Central Register of Controlled Trials (first quarter 2007) databases. We also reviewed reference lists from included studies to identify additional studies. We included 25 articles representing 21 randomized controlled trials that evaluated a computerized learning technology and measured the outcome of patient care. We extracted patient sample, intervention, educational content topics, outcome measures, and statistical significance. RESULTS Of 21 eligible trials, 18 trials (85.7%) reported significant positive outcomes. Almost 44% (43.8%) of the outcomes demonstrated significant improvements (49 of 112 outcomes). CONCLUSIONS Patient self-management behaviors are important in chronic disease management, and initial evidence suggests that computerized learning technology interventions can play a significant role in the future.
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Affiliation(s)
- Suzanne Austin Boren
- Health Services Research and Development, Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri 65201, USA.
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Brown LL, Lustria MLA, Rankins J. A review of web-assisted interventions for diabetes management: maximizing the potential for improving health outcomes. J Diabetes Sci Technol 2007; 1:892-902. [PMID: 19885163 PMCID: PMC2769687 DOI: 10.1177/193229680700100615] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes.This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.
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Affiliation(s)
- Linda Lockett Brown
- College of Human Sciences, Florida State University, Tallahassee, Florida 32306-2100, USA.
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Norman GJ, Zabinski MF, Adams MA, Rosenberg DE, Yaroch AL, Atienza AA. A review of eHealth interventions for physical activity and dietary behavior change. Am J Prev Med 2007; 33:336-345. [PMID: 17888860 PMCID: PMC2180189 DOI: 10.1016/j.amepre.2007.05.007] [Citation(s) in RCA: 401] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 05/16/2007] [Accepted: 05/25/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review eHealth intervention studies for adults and children that targeted behavior change for physical activity, healthy eating, or both behaviors. DATA SOURCES Systematic literature searches were performed using five databases: MEDLINE, PsychInfo, CINAHL, ERIC, and the Cochrane Library to retrieve articles. STUDY INCLUSION AND EXCLUSION CRITERIA Articles published in scientific journals were included if they evaluated an intervention for physical activity and/or dietary behaviors, or focused on weight loss, used randomized or quasi-experimental designs, measured outcomes at baseline and a follow-up period, and included an intervention where participants interacted with some type of electronic technology either as the main intervention or an adjunct component. All studies were published between 2000 and 2005. RESULTS Eighty-six publications were initially identified, of which 49 met the inclusion criteria (13 physical activity publications, 16 dietary behaviors publications, and 20 weight loss or both physical activity and diet publications), and represented 47 different studies. Studies were described on multiple dimensions, including sample characteristics, design, intervention, measures, and results. eHealth interventions were superior to comparison groups for 21 of 41 (51%) studies (3 physical activity, 7 diet, 11 weight loss/physical activity and diet). Twenty-four studies had indeterminate results, and in four studies the comparison conditions outperformed eHealth interventions. CONCLUSIONS Published studies of eHealth interventions for physical activity and dietary behavior change are in their infancy. Results indicated mixed findings related to the effectiveness of eHealth interventions. Interventions that feature interactive technologies need to be refined and more rigorously evaluated to fully determine their potential as tools to facilitate health behavior change.
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Affiliation(s)
- Gregory J Norman
- Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, CA 92093, USA.
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49
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Nield L, Moore HJ, Hooper L, Cruickshank JK, Vyas A, Whittaker V, Summerbell CD. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2007; 2007:CD004097. [PMID: 17636747 PMCID: PMC9039967 DOI: 10.1002/14651858.cd004097.pub4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND While initial dietary management immediately after formal diagnosis is an 'accepted' cornerstone of treatment of type 2 diabetes mellitus, a formal and systematic overview of its efficacy and method of delivery is not currently available. OBJECTIVES To assess the effects of type and frequency of different types of dietary advice for adults with type 2 diabetes. SEARCH STRATEGY We carried out a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, bibliographies and contacted relevant experts. SELECTION CRITERIA All randomised controlled trials, of six months or longer, in which dietary advice was the main intervention. DATA COLLECTION AND ANALYSIS The lead investigator performed all data extraction and quality scoring with duplication being carried out by one of the other six investigators independently with discrepancies resolved by discussion and consensus. Authors were contacted for missing data. MAIN RESULTS Thirty-six articles reporting a total of eighteen trials following 1467 participants were included. Dietary approaches assessed in this review were low-fat/high-carbohydrate diets, high-fat/low-carbohydrate diets, low-calorie (1000 kcal per day) and very-low-calorie (500 kcal per day) diets and modified fat diets. Two trials compared the American Diabetes Association exchange diet with a standard reduced fat diet and five studies assessed low-fat diets versus moderate fat or low-carbohydrate diets. Two studies assessed the effect of a very-low-calorie diet versus a low-calorie diet. Six studies compared dietary advice with dietary advice plus exercise and three other studies assessed dietary advice versus dietary advice plus behavioural approaches. The studies all measured weight and measures of glycaemic control although not all studies reported these in the articles published. Other outcomes which were measured in these studies included mortality, blood pressure, serum cholesterol (including LDL and HDL cholesterol), serum triglycerides, maximal exercise capacity and compliance. The results suggest that adoption of regular exercise is a good way to promote better glycaemic control in type 2 diabetic patients, however all of these studies were at high risk of bias. AUTHORS' CONCLUSIONS There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway.
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Affiliation(s)
- L Nield
- University of Teesside, Parkside West Offices, Middlesbrough, U K, TS1 3BA.
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Dale J, Caramlau I, Docherty A, Sturt J, Hearnshaw H. Telecare motivational interviewing for diabetes patient education and support: a randomised controlled trial based in primary care comparing nurse and peer supporter delivery. Trials 2007; 8:18. [PMID: 17598895 PMCID: PMC1934921 DOI: 10.1186/1745-6215-8-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 06/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services. METHODS/DESIGN In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. DISCUSSION AND IMPLICATIONS OF THE RESEARCH: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications. TRIAL REGISTRATION Current Controlled Trials, ISRCTN63151946.
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Affiliation(s)
- Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jackie Sturt
- Warwick Medical School, University of Warwick, Coventry, UK
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