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Kangwal C, Thato R, Ua-Kit N, Visudtibhan A. Interventions to promote medication adherence among children with epilepsy: An integrative review. J Pediatr Nurs 2024:S0882-5963(24)00243-4. [PMID: 38944619 DOI: 10.1016/j.pedn.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 07/01/2024]
Abstract
PROBLEM Many children with epilepsy face challenges in adhering to their medication, leading to inadequate seizure control. However, the most effective intervention is still unclear. This integrative review's main goal was to examine and synthesize the existing literature on interventions for promoting medication adherence in children with epilepsy. ELIGIBILITY CRITERIA This integrative review followed Whittemore and Knafl's five-stage framework. Four electronic databases (PubMed, ScienceDirect, Scopus, and CINAHL Complete) were systematically searched from 2013 until 2024 to identify eligible studies published in the English language. The key search terms included "Children with epilepsy" AND "medication adherence" AND "intervention." Studies reporting on the implementation and evaluation of medication adherence interventions in children with epilepsy were eligible. Quality assessment and narrative synthesis were subsequently undertaken. SAMPLE A total of 17 studies were included in the review. RESULTS Five interventions were found, including educational, behavioral, and mixed intervention types, using technology and family involvement. Promoting medication adherence is crucial, but tailored interventions for different age groups and sustained support are needed. CONCLUSIONS Promoting medication adherence is of utmost importance to enhance the knowledge of children who have epilepsy and their families, and to increase medication adherence. However, there is still a need to develop interventions that are appropriate for children of different ages and their families, which should be suitable and sustainable during treatment. IMPLICATIONS Pediatric nurses should consider socioeconomic factors, ethnicity, family functioning, and parental distress. Strategies include monitoring adherence, continuous communication, and technology support for children with epilepsy during treatment.
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Affiliation(s)
- Chutimaporn Kangwal
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University, Thailand.
| | - Ratsiri Thato
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University, Thailand.
| | - Noraluk Ua-Kit
- Research Unit for Enhancing Well-being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University, Thailand
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Redfern J, Tu Q, Hyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, Chow CK. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 3:CD011851. [PMID: 38533994 PMCID: PMC10966941 DOI: 10.1002/14651858.cd011851.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for almost 18 million deaths annually. People with CVDs have a five times greater chance of suffering a recurrent cardiovascular event than people without known CVDs. Although drug interventions have been shown to be cost-effective in reducing the risk of recurrent cardiovascular events, adherence to medication remains suboptimal. As a scalable and cost-effective approach, mobile phone text messaging presents an opportunity to convey health information, deliver electronic reminders, and encourage behaviour change. However, it is uncertain whether text messaging can improve medication adherence and clinical outcomes. This is an update of a Cochrane review published in 2017. OBJECTIVES To evaluate the benefits and harms of mobile phone text messaging for improving medication adherence in people with CVDs compared to usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We also checked the reference lists of all primary included studies and relevant systematic reviews and meta-analyses. The date of the latest search was 30 August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim of improving adherence to medication for the secondary prevention of cardiovascular events. The comparator was usual care. We excluded cluster-RCTs and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were medication adherence, fatal cardiovascular events, non-fatal cardiovascular events, and combined CVD event. Secondary outcomes were low-density lipoprotein cholesterol for the effect of statins, blood pressure for antihypertensive drugs, heart rate for the effect of beta-blockers, urinary 11-dehydrothromboxane B2 for the antiplatelet effects of aspirin, adverse effects, and patient-reported experience. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 18 RCTs involving a total of 8136 participants with CVDs. We identified 11 new studies in the review update and seven studies in the previous version of the review. Participants had various CVDs including acute coronary syndrome, coronary heart disease, stroke, myocardial infarction, and angina. All studies were conducted in middle- and high-income countries, with no studies conducted in low-income countries. The mean age of participants was 53 to 64 years. Participants were recruited from hospitals or cardiac rehabilitation facilities. Follow-up ranged from one to 12 months. There was variation in the characteristics of text messages amongst studies (e.g. delivery method, frequency, theoretical grounding, content used, personalisation, and directionality). The content of text messages varied across studies, but generally included medication reminders and healthy lifestyle information such as diet, physical activity, and weight loss. Text messages offered advice, motivation, social support, and health education to promote behaviour changes and regular medication-taking. We assessed risk of bias for all studies as high, as all studies had at least one domain at unclear or high risk of bias. Medication adherence Due to different evaluation score systems and inconsistent definitions applied for the measurement of medication adherence, we did not conduct meta-analysis for medication adherence. Ten out of 18 studies showed a beneficial effect of mobile phone text messaging for medication adherence compared to usual care, whereas the other eight studies showed either a reduction or no difference in medication adherence with text messaging compared to usual care. Overall, the evidence is very uncertain about the effects of mobile phone text messaging for medication adherence when compared to usual care. Fatal cardiovascular events Text messaging may have little to no effect on fatal cardiovascular events compared to usual care (odds ratio 0.83, 95% confidence interval (CI) 0.47 to 1.45; 4 studies, 1654 participants; low-certainty evidence). Non-fatal cardiovascular events We found very low-certainty evidence that text messaging may have little to no effect on non-fatal cardiovascular events. Two studies reported non-fatal cardiovascular events, neither of which found evidence of a difference between groups. Combined CVD events We found very low-certainty evidence that text messaging may have little to no effect on combined CVD events. Only one study reported combined CVD events, and did not find evidence of a difference between groups. Low-density lipoprotein cholesterol Text messaging may have little to no effect on low-density lipoprotein cholesterol compared to usual care (mean difference (MD) -1.79 mg/dL, 95% CI -4.71 to 1.12; 8 studies, 4983 participants; very low-certainty evidence). Blood pressure Text messaging may have little to no effect on systolic blood pressure (MD -0.93 mmHg, 95% CI -3.55 to 1.69; 8 studies, 5173 participants; very low-certainty evidence) and diastolic blood pressure (MD -1.00 mmHg, 95% CI -2.49 to 0.50; 5 studies, 3137 participants; very low-certainty evidence) when compared to usual care. Heart rate Text messaging may have little to no effect on heart rate compared to usual care (MD -0.46 beats per minute, 95% CI -1.74 to 0.82; 4 studies, 2946 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Due to limited evidence, we are uncertain if text messaging reduces medication adherence, fatal and non-fatal cardiovascular events, and combined cardiovascular events in people with cardiovascular diseases when compared to usual care. Furthermore, text messaging may result in little or no effect on low-density lipoprotein cholesterol, blood pressure, and heart rate compared to usual care. The included studies were of low methodological quality, and no studies assessed the effects of text messaging in low-income countries or beyond the 12-month follow-up. Long-term and high-quality randomised trials are needed, particularly in low-income countries.
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Affiliation(s)
- Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney , Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Hospital, Sydney , Australia
| | - Matthew A Hollings
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clara Zwack
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
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O'Connor C, Leyritana K, Doyle AM, Lewis JJ, Salvaña EM. Changes in Adherence and Viral Load Suppression Among People with HIV in Manila: Outcomes of the Philippines Connect for Life Study. AIDS Behav 2024; 28:837-853. [PMID: 37794284 DOI: 10.1007/s10461-023-04190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
The Philippines HIV epidemic is among the fastest growing globally. Infections among men who have sex with men are rising at an alarming rate, necessitating targeted evidence-based interventions to retain people living with HIV in care, support adherence, and reach viral suppression. We conducted a 48-week prospective cohort study of 462 participants in which we provided a mobile health (mHealth) adherence support intervention using the Connect for Life platform. We observed an improvement in adherence, with the proportion of participants taking more than 95% of their antiretroviral therapy (ART) doses increasing from 78.6% at baseline to 90.3% at 48 weeks. Among treatment experienced participants, adherence improved significantly (McNemar's test = 21.88, P < 0.001). Viral load suppression did not change, with 92.6% suppression at baseline and 92.0% at 48 weeks. Illicit drug use was associated with reduced adherence (aOR = 0.56, 95%CI 0.31-1.00, P = 0.05) and being on second-line therapy was associated with poor viral load suppression (aOR = 0.33, 95%CI 0.14-0.78, P = 0.01). Quality of life improved following ART initiation, from a mean of 84.6 points (of a possible 120) at baseline to 91.01 at 48 weeks. Due to technical issues, fidelity to the intended intervention was low, with 22.1% (102/462) of participants receiving any voice calls and most others receiving a scaled-back SMS intervention. The mHealth intervention did not have any observed effect on adherence or on viral load suppression. While evidence of effectiveness of mHealth adherence interventions is mixed, these platforms should continue to be explored as part of differentiated treatment support services.
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Affiliation(s)
- Cara O'Connor
- Sustained Health Initiatives of the Philippines (SHIP), Mandaluyong, Philippines.
- The London School of Hygiene and Tropical Medicine, London, UK.
- Anova Health Institute, 12 Sherborne Ave. Parktown, Johannesburg, South Africa.
| | - Katerina Leyritana
- Sustained Health Initiatives of the Philippines (SHIP), Mandaluyong, Philippines
| | - Aoife M Doyle
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - James J Lewis
- Y Lab, the Public Services Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Edsel Maurice Salvaña
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila, Ermita, Manila, Philippines
- Section of Infectious Disease, Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Ermita, Manila, Philippines
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Hall K, Barry F, Thompson LR, Ravandi B, Hall JE, Chang TP, Halterman JS, Szilagyi PG, Okelo SO. Feasibility of text message follow-up for pediatric asthma care after an emergency department visit. J Asthma 2024; 61:140-147. [PMID: 37610221 DOI: 10.1080/02770903.2023.2248507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
Background: Many children seen in the Emergency Department (ED) for asthma do not follow-up with their primary care provider. Text messaging via short message service (SMS) is a ubiquitous, but untested means of providing post-ED asthma follow-up care.Objective: To evaluate responses to an asthma assessment survey via SMS following an ED visit and estimate the likelihood of response by sociodemographic and clinical characteristics. Methods: We recruited 173 parents of children 2-17 years-old presenting for ED asthma care to receive a follow-up text (participation rate: 85%). One month later, parents received via SMS a 22-item survey that assessed asthma morbidity. We assessed response rates overall and by various sociodemographic and clinical characteristics, including age, parental education, and indicators of asthma severity.Results: Overall, 55% of parents (n = 95) responded to the SMS survey. In multivariable logistic regression (MLR), parents who graduated high school had a four-fold higher response rate compared to parents with less than a high school degree (OR: 4.05 (1.62, 10.13)). More parents of children with oral steroid use in the prior 12 months responded to survey items (OR: 2.53 (1.2, 5.31)). Reported asthma characteristics included: 48% uncontrolled, 22% unimproved/worse, 21% with sleep disruption, and 10% who were hospitalized for asthma.Conclusions: Text messaging may be a viable strategy to improve post-ED asthma assessment and to identify children with persistent symptoms in need of enhanced care or modification of care plans.
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Affiliation(s)
- Kaitlin Hall
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Frances Barry
- Frances Barry Psychotherapy Practice, Santa Monica, CA, USA
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Bahareh Ravandi
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Jeanine E Hall
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CA, Los Angeles, CA, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sande O Okelo
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Park LG, Ng F, Handley MA. The use of the Capability-Opportunity- Motivation Behavior (COM-B) model to identify barriers to medication adherence and the application of mobile health technology in adults with coronary heart disease: A qualitative study. PEC INNOVATION 2023; 3:100209. [PMID: 37753273 PMCID: PMC10518702 DOI: 10.1016/j.pecinn.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/06/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
Objective Among patients with coronary heart disease, we sought to address the research questions of: 1) What is the acceptability of applying a technology-enabled approach to support medication adherence?; and 2) What are barriers to medication adherence using the Capability-Opportunity-Motivation Behavior (COM-B) model as a guiding framework? Methods Applying qualitative research methods, we employed a series of 3 focus groups per individual (total 9 sessions). Coded data from thematic analysis were mapped to the COM-B model components for meaningful associations. Results Fourteen participants were recruited (median age 69.5 ± 11, 50% female). Barriers to medication adherence were organized along these COM-B domains: psychological capability (forgetfulness, distractions, fear of side effects), physical opportunity (inaccessible medications, inability to renew prescriptions), reflective (burdening family members), and automatic motivation (medication fatigue, health decline). Conclusions Tailored text messaging and mobile phone apps were perceived as helpful tools for medication adherence. The COM-B model was useful to provide a comprehensive, theory-driven evaluation of patients' beliefs and motivations on whether to engage in medication adherence. Innovation To date, text messaging and mobile applications have not been widely implemented in the clinical setting and provide a major opportunity to innovate on approaches to address medication adherence.
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Affiliation(s)
- Linda G. Park
- University of California, San Francisco School of Nursing, Department of Community Health Systems, San Francisco Veterans Affair Medical Center, 2 Koret Way, Room 531A, San Francisco, CA 94143-0610, United States of America
| | - Fion Ng
- Department of Community Health Programs for Youth, San Francisco Department of Public Health, United States of America
| | - Margaret A. Handley
- Departments of Epidemiology and Biostatistics and Medicine, Division of General Internal Medicine, University of California, San Francisco, United States of America
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Zamanillo-Campos R, Fiol-deRoque MA, Serrano-Ripoll MJ, Mira-Martínez S, Ricci-Cabello I. Development and evaluation of DiabeText, a personalized mHealth intervention to support medication adherence and lifestyle change behaviour in patients with type 2 diabetes in Spain: A mixed-methods phase II pragmatic randomized controlled clinical trial. Int J Med Inform 2023; 176:105103. [PMID: 37267809 DOI: 10.1016/j.ijmedinf.2023.105103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Despite the increasing interest in text-messaging interventions to support healthcare delivery, the available evidence about their effectiveness is still limited. OBJECTIVES 1) to develop DiabeText, an intervention delivering automated, tailored brief text messages to support diabetes self-management; 2) to explore the potential impact of DiabeText on self-management behavior and glycaemic control, and; 3) to examine the feasibility of conducting a future phase III randomized clinical trial to evaluate the effectiveness of DiabeText. METHODS 3-month, two-arm, randomized feasibility trial (ClinicalTrials.gov: NCT04738591) with patients with type 2 diabetes (HbA1c > 8%). Participants were allocated to the control (usual care) or DiabeText group (usual care + five text messages per week). Outcomes were: recruitment rate; follow-up rate, missing data; medication adherence; adherence to Mediterranean diet; physical activity; and HbA1c. In addition, after delivering the intervention, we conducted a qualitative study involving 14 semi-structured interviews with participants allocated to the DiabeText group, to understand their views about the intervention. RESULTS From 444 screened people, we recruited 207 participants (recruitment rate = 47%), of which 179 completed the post-intervention interview (follow-up rate = 86%). We sent 7,355 SMS during the intervention period, of which 99% successfully reached the participants. At post-intervention, DiabeText was associated with non-statistically significant (p > 0.05) improvements in adherence to medication (OR = 2.0; 95%CI 1.0 to 4.2), Mediterranean diet (1.7; 0.9 to 3.2), and physical activity (1.7; 0.9 to 3.1). No between-group differences were observed in mean HbA1c (p = 0.670). The qualitative study indicated that participants perceived DiabeText as a helpful resource because it increased their awareness about the importance of adequate self-management and the sense of being cared for. CONCLUSIONS DiabeText is the first system in Spain to integrate patient-generated and routinely collected clinical data to deliver tailored text messages to support diabetes self-management. More robust trials are needed to determine its effectiveness and cost-efficacy.
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Affiliation(s)
- Rocío Zamanillo-Campos
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Maria Antonia Fiol-deRoque
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain.
| | - Maria Jesús Serrano-Ripoll
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS, RD21/0016/0005), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Sofía Mira-Martínez
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain
| | - Ignacio Ricci-Cabello
- Balearic Islands Health Research Institute (IdISBa) Carretera de Valldemossa, 79, Hospital Universitari Son Espases. Edifici S, 07120 Palma, Spain; Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Carrer de l'Escola Graduada, n° 3, 07002 Palma, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
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Modi AC, Patel AD, Mara CA, Schmidt M, Tenney JR, Stevens J. Pilot randomized controlled clinical trial of an adherence social norms intervention for adolescents with epilepsy. Epilepsy Behav 2023; 140:109082. [PMID: 36731289 PMCID: PMC9998352 DOI: 10.1016/j.yebeh.2022.109082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Non-adherence to anti-seizure medications (ASMs) is common for adolescents with epilepsy, with potentially devastating consequences. Existing adherence interventions in epilepsy do not meet the unique challenges faced by adolescents. Leveraging social norms capitalizes on the increased importance of peer influence while simultaneously targeting the low motivation levels of many adolescents. The current study examined the feasibility, acceptability, and satisfaction of a social norms adherence intervention in adolescents with epilepsy. METHODS A pilot RCT of a mHealth social norms intervention was conducted with adolescents with epilepsy who demonstrated non-adherence (≤95% adherence) during baseline. Adolescents were randomized to either (1) mHealth social norms (reminders, individualized and social norms adherence feedback) or (2) control (reminders and individualized adherence feedback). Primary outcomes included feasibility, acceptability, and satisfaction. Exploratory outcomes included electronically monitored adherence, seizure severity, and health-related quality of life (HRQOL). RESULTS One hundred four adolescents were recruited (53% female; Mage = 15.4 ± 1.4 years; 81% White: Non-Hispanic; 5% Black, 10% Bi/Multiracial; 2% White: Hispanic; 1% Other: Hispanic; 1% Bi/Multiracial-Hispanic). Forty-five percent screen-failed due to high adherence, 16% withdrew, and 38% were randomized to treatment (n = 19) or control (n = 21). Recruitment (75%), retention (78%), and treatment satisfaction were moderately high. Engagement with the intervention was moderate, with 64% of participants engaging with intervention notifications. Exploratory analyses revealed that after controlling for COVID-19 impact, the social norms intervention group maintained higher adherence over time compared to the control group. Small to moderate effect sizes were noted for seizure severity and HRQOL between groups. CONCLUSION This pilot intervention appeared feasible and acceptable. Increases in adherence in the treatment versus control group were modest, but a future larger more adequately powered study is needed to detect effects. Notably, it appeared the COVID pandemic influenced adherence behaviors during our trial.
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Affiliation(s)
- Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 3333 Burnet Ave., Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
| | - Anup D Patel
- Nationwide Children's Hospital, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States; The Ohio State, Department of Pediatrics, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States.
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 3333 Burnet Ave., Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
| | - Matthew Schmidt
- College of Education, University of Florida, 2423 Normal Hall, Gainesville, FL 32611, United States.
| | - Jeffrey R Tenney
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, 3333 Burnet Ave., Cincinnati, OH 45229, United States; University of Cincinnati, College of Medicine, Cincinnati, OH, United States.
| | - Jack Stevens
- Nationwide Children's Hospital, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States; The Ohio State, Department of Pediatrics, 700 Children's Drive, Near East Office Building, 3rd Floor, Columbus, OH 43205, United States.
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LaValley SA, Brady LA, Nguyen M, Jacobs D. Family Caregivers of Older Adults: Strategies, Tools, and Technologies for Medication Management. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:291-302. [PMID: 35850634 DOI: 10.1080/01634372.2022.2100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Susan A LaValley
- Department of Family Medicine, Primary Care Research Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, Primary Care Research Institute, University at Buffalo, Buffalo, New York, USA
| | - Melanie Nguyen
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York, USA
| | - David Jacobs
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York, USA
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Shin J, Jang J, Afaya A. Effectiveness of eHealth interventions targeted to improve medication adherence among older adults with mild cognitive impairment: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e060590. [PMID: 36323471 PMCID: PMC9639072 DOI: 10.1136/bmjopen-2021-060590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Medication adherence is a vital component of successful healthcare, yet poor adherence exists, especially in older adults with mild cognitive impairment. Therefore, this study seeks to conduct a systematic review of eHealth-based interventions aimed at improving medication adherence among older adults with mild cognitive impairment. METHODS AND ANALYSIS An open electronic database search will be conducted in PubMed, CINAHL, PsycINFO, EMBASE and Cochrane library to identify potential studies till 2022. Two authors will independently screen the titles and abstracts, after which studies that will be eligible for full-text review will be independently assessed by two reviewers for inclusion. Studies will be selected if they evaluate eHealth interventions aiming to improve medication adherence among older adults with mild cognitive impairment. Data will be analysed by using the Comprehensive Meta-Analysis software V.3 and Review Manager (RevMan) software V.5. The authors will separately analyse each outcome measure, compute intervention effects and present them as relative risks with 95% CIs for dichotomous data. Continuous data will be presented as mean differences and standardised mean differences (if required) with 95% CIs. If substantive statistical heterogeneity is identified, we will consider the use of random-effects models that can be incorporated into the statistical analysis. We envisage that this review will adduce evidence on eHealth interventions that will improve medication adherence among older adults with mild cognitive impairment. The findings can also inform health professionals and other relevant stakeholders on current eHealth-based interventions that are used to improve medication adherence among older adults with mild cognitive impairment. ETHICS AND DISSEMINATION Ethical approval is not required for systematic reviews. Findings will be disseminated widely through peer-reviewed publication and at conferences. PROSPERO REGISTRATION NUMBER CRD42021268665.
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Affiliation(s)
- Jinhee Shin
- College of Nursing, Woosuk University, Jeollabuk-do, South Korea
| | - Jiyoon Jang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Agani Afaya
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol 2022; 27:861-890. [PMID: 35080811 PMCID: PMC9541766 DOI: 10.1111/bjhp.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/28/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Around half of prescribed medications for long-term conditions are not taken as directed. Automated two-way digital communication, such as text messaging and interactive voice response technology, could deliver interventions to improve medication adherence, and subsequently health. However, exploration of how such interventions may improve medication adherence is limited. This review aimed to explore how automated two-way digital communication can improve medication taking with or without using non-digital intervention components, such as phone calls with healthcare professionals. METHODS A theory-informed narrative synthesis systematic review. Several databases were searched including CINAHL, Embase, Medline, and Web of Science using key words relating to 'medication adherence' and digital communication technologies. The Behavior Change Technique (BCT) coding using the BCT Taxonomy V1 and the Behavior Change Wheel were used to identify BCTs delivered within the included interventions. RESULTS A total of 3,018 records were screened with 43 study reports included in the review. Four medication-taking behaviors: taking medication, obtaining medication, self-testing, and asking for support were identified as targets for behavior change within the included interventions. Most BCTs within the digital communication component aimed to increase motivation for medication adherence, with non-digital intervention components included to address other medication taking barriers, such as physical and psychological capability. CONCLUSION Automated two-way digital communication can detect barriers to medication adherence by monitoring performance of the taking medication behavior. Monitoring outcomes from taking medication may increase reflective motivation to take medicines. Addressing physical opportunity to taking medication by facilitating the behavior obtaining medication may also increase adherence.
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Affiliation(s)
- Gemma Donovan
- Faculty of Health Sciences and WellbeingSchool of Pharmacy and Pharmaceutical SciencesUniversity of SunderlandUK
| | - Nicola Hall
- Faculty of Medical SciencesPopulation Health Sciences InstituteNewcastle UniversityUK
| | - Jonathan Ling
- Faculty of Health Sciences and WellbeingUniversity of SunderlandUK
| | | | - Scott Wilkes
- Faculty of Health Sciences and WellbeingSchool of MedicineUniversity of SunderlandUK
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11
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Ni R, Liu M, Huang S, Yang J. Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40090. [PMID: 35972792 PMCID: PMC9428777 DOI: 10.2196/40090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. OBJECTIVE The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. METHODS We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. CONCLUSIONS eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. TRIAL REGISTRATION PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.
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Affiliation(s)
- Ruping Ni
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Shunmin Huang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
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12
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O'Connor C, Leyritana K, Doyle AM, Birdthistle I, Lewis JJ, Gill R, Salvaña EM. Delivering an mHealth Adherence Support Intervention for Patients With HIV: Mixed Methods Process Evaluation of the Philippines Connect for Life Study. JMIR Form Res 2022; 6:e37163. [PMID: 35969425 PMCID: PMC9419042 DOI: 10.2196/37163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/05/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Philippines HIV epidemic is one of the fastest growing epidemics globally, and infections among men who have sex with men are increasing at an alarming rate. Connect for Life Philippines is a mobile health (mHealth) intervention that supports antiretroviral therapy (ART) adherence in this key population through individualized voice calls and SMS text messages. Objective The objective of this process evaluation is to assess the intervention reach, dose delivered and received, fidelity, and acceptability and to describe contextual factors affecting the implementation of an mHealth adherence support intervention for patients on ART in a clinic in Metro Manila, Philippines. Methods A mixed methods process evaluation approach was used in an observational cohort study. Quantitative data sources for the process evaluation were call and SMS text message logs obtained from the mHealth platform and questionnaires collected at 12-, 24-, and 48-week study visits. Qualitative data were collected from process reports and through a series of focus group discussions conducted with a subset of participants during the intervention development phase, after an initial 8-week pilot phase, and at the end of the study. Results The 462 study participants received 31,095 interactive voice calls and 8234 SMS text messages during the study. Owing to technical issues, intervention fidelity was low, with only 22.1% (102/462) of the participants receiving reminders via voice calls and others (360/462, 77.9%) receiving only SMS text messages during the intervention. After 48 weeks in the study, 63.5% (293/462) of the participants reported that they would be quite likely or very likely to recommend the program to a friend, and 53.8% (249/462) of the participants reported that they benefited quite a bit or very much from the intervention. Participants who were on ART for <6 months at the beginning of the study and those who received the daily or weekly pill reminders were more likely to report that they benefited from the intervention (P=.02 and P=.01, respectively). Conclusions The Connect for Life intervention had high participant satisfaction and acceptability, especially among those who received high dose of the intervention. However, poor reliability of local telecommunication networks had a large impact on the intervention’s usability, fidelity, and dose received.
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Affiliation(s)
- Cara O'Connor
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sustained Health Initiatives of the Philippines, Mandaluyong, Philippines
| | - Katerina Leyritana
- Sustained Health Initiatives of the Philippines, Mandaluyong, Philippines
| | - Aoife M Doyle
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James J Lewis
- Y Lab, the Public Services Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Randeep Gill
- Johnson & Johnson Global Public Health, London, United Kingdom
| | - Edsel Maurice Salvaña
- Institute of Molecular Biology and Biotechnology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
- Section of Infectious Disease, Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Manila, Philippines
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13
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Kokorelias KM, Nelson MLA, Tang T, Steele Gray C, Ellen M, Plett D, Jarach CM, Xin Nie J, Thavorn K, Singh H. Who is Included in Digital Health Technologies to Support Hospital to Home Transitions for Older Adults?: Secondary analysis of a rapid review and equity-informed recommendations (Preprint). JMIR Aging 2021; 5:e35925. [PMID: 35475971 PMCID: PMC9096639 DOI: 10.2196/35925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kristina Marie Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Sinai Health System/University Health Network, Toronto, ON, Canada
| | - Michelle LA Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Moriah Ellen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Eilat, Israel
| | - Donna Plett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carlotta Micaela Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Hardeep Singh
- March of Dimes Canada, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Mahoney DE, Russell CL. Women's Reports of Barriers to and Facilitators of Oral Medication Adherence During Ovarian Stimulation: A Mixed Methods Pilot Study. J Reprod Infertil 2021; 22:184-200. [PMID: 34900639 PMCID: PMC8607872 DOI: 10.18502/jri.v22i3.6719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Adherence to lifestyle modification recommendations remains problematic for women undergoing fertility treatment, raising concerns about the extent to which women adhere to prescribed medication regimens. Limited data have shown suboptimal oral medication adherence rates of 19% to 74%. The objective of this study was to explore what women perceive as barriers to and facilitators of oral medication adherence during fertility treatment cycles. Methods: An exploratory mixed methods pilot study was conducted among a sample of 30 women who were actively taking one to two cycles of letrozole or clomiphene citrate for ovarian stimulation in conjunction with intrauterine insemination cycles. Medication adherence barriers were measured using a 20-item survey. Medication adherence facilitators and personal experiences with fertility treatment were assessed with structured interviews. Medication adherence was assessed with electronic event monitoring. Results: The overall medication adherence median was 0.97 with a range of 0.75 to 1.00, and nine women (50%) demonstrated perfect adherence. The most commonly reported barriers were recently feeling sad, down, or blue (53%), and taking medication more than once per day (40%). Women with higher barrier scores had significantly lower medication adherence scores (p=0.02) compared to women with lower total barrier scores. Facilitators included using physical aides as reminders (60%) and establishing a daily routine (50%). No significant correlation was found between medication adherence scores and facilitators. Conclusion: The dynamic interplay between perceived barriers and facilitators and women’s medication-taking patterns could influence whether or not medication regimens are followed correctly.
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Affiliation(s)
- Diane E Mahoney
- School of Nursing, University of Kansas Medical Center, Kansas, US
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15
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Validation of a Virtual Assistant for Improving Medication Adherence in Patients with Comorbid Type 2 Diabetes Mellitus and Depressive Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212056. [PMID: 34831811 PMCID: PMC8620667 DOI: 10.3390/ijerph182212056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 12/30/2022]
Abstract
Virtual assistants are programs that interact with users through text or voice messages simulating a human-based conversation. The development of healthcare virtual assistants that use messaging platforms is rapidly increasing. Still, there is a lack of validation of these assistants. In particular, this work aimed to validate the effectiveness of a healthcare virtual assistant, integrated within messaging platforms, with the aim of improving medication adherence in patients with comorbid type 2 diabetes mellitus and depressive disorder. For this purpose, a nine-month pilot study was designed and subsequently conducted. The virtual assistant reminds patients about their medication and provides healthcare professionals with the ability to monitor their patients. We analyzed the medication possession ratio (MPR), measured the level of glycosylated hemoglobin (HbA1c), and obtained the patient health questionnaire (PHQ-9) score in the patients before and after the study. We also conducted interviews with all participants. A total of thirteen patients and five nurses used and evaluated the proposed virtual assistant using the messaging platform Signal. Results showed that on average, the medication adherence improved. In the final interview, 69% of the patients agreed with the idea of continuing to use the virtual assistant after the study.
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16
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van den Elshout MAM, Hoornenborg E, Achterbergh RCA, Coyer L, Anderson PL, Davidovich U, de Vries HJC, Prins M, van der Loeff MFS. Improving adherence to daily preexposure prophylaxis among MSM in Amsterdam by providing feedback via a mobile application. AIDS 2021; 35:1823-1834. [PMID: 34001705 DOI: 10.1097/qad.0000000000002949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Improving adherence to preexposure prophylaxis (PrEP) by providing automated feedback on self-reported PrEP use via a mobile application (app). DESIGN Randomized clinical trial among MSM participating in the Amsterdam PrEP demonstration project (AMPrEP). METHODS Eligible participants were randomized 1 : 1 to the control or intervention app. Both allowed daily reporting of sexual behaviour and medication intake; the intervention app also provided visual feedback. Dried blood spots collected at 12 and 24 months yielded intracellular tenofovir diphosphate concentrations (TFV-DP). We assessed proportions of participants with poor (TFV-DP <700 fmol/punch; primary outcome), good (TFV-DP ≥700 fmol/punch) and excellent (TFV-DP ≥1250 fmol/punch; secondary outcome) adherence at both time-points, and the association with the control or intervention app. RESULTS We randomized 229 participants, 118 to the intervention and 111 to the control arm. The primary, per-protocol, analysis included 83 participants per arm. In total, 22/166 (13%) of participants adhered poorly, 144/166 (87%) good and 66/166 (40%) excellently. App feedback did not result in a lower proportion of participants with poor adherence [control: 9 of 83 (11%); intervention: 13 of 83 (16%); P = 0.36]. App feedback did result in a larger proportion of participants with excellent adherence [control: 26/83 (31%); intervention: 40/83 (48%); P = 0.026]. CONCLUSION In this highly adherent population, app feedback did not improve the proportion of participants with poor adherence to PrEP.Clinical Trial Number Netherlands Trial Register: NL5413.
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Affiliation(s)
- Mark A M van den Elshout
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Roel C A Achterbergh
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Social Psychology, University of Amsterdam
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
- Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam institute for Infection & Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam
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17
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Gautier JF, Boitard C, Michiels Y, Raymond G, Vergez G, Guedon G. Impact of personalized text messages from pharmacists on medication adherence in type 2 diabetes in France: A real-world, randomized, comparative study. PATIENT EDUCATION AND COUNSELING 2021; 104:2250-2258. [PMID: 33750593 DOI: 10.1016/j.pec.2021.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A real-world, randomized study assessing the impact of a new, personalized, pharmacist-led text messaging service for managing type 2 diabetes (T2D). METHODS Messages were tailored to patient's needs based on their disease management habits, propensity for reactance, and physical activity levels at baseline. Treatment adherence (assed using the Morisky Medication Adherence Scale, MMAS-8, questionnaire), clinical factors (body mass index and physical activity) and biological markers for T2D were compared between patients who received a text message daily for 3 months in addition to standard care (SMS group) and those who received standard care alone (control group). RESULTS 114 pharmacies recruited 499 patients. Greater increases in global MMAS-8 scores were observed after 3 months for the SMS group than for the control group, however, this improvement was not sustained after the text messages stopped. Body mass index was found to improve with the text messaging service. CONCLUSION This study indicated that personalized text messages provided by community pharmacists can have an impact on adherence levels among T2D patients. PRACTICE IMPLICATIONS Pharmacy-led innovations, such as text messaging services, could be used to accompany patients in their treatment and to improve patient understanding of their illness between healthcare appointments.
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Affiliation(s)
| | | | - Yves Michiels
- Unisanté - Centre Universitaire de Médecine Générale et Santé Publique, Département des Policliniques - Secteur Pharmacie Recherche, rue du Bugnon 44, Bureau BU44/08.2133, CH-1011 Lausanne, Switzerland.
| | - Gerard Raymond
- Association Française des Diabétiques, 88 rue de la Roquette, Paris 75544, France.
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18
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Yerrapragada G, Siadimas A, Babaeian A, Sharma V, O'Neill TJ. Machine Learning to Predict Tamoxifen Nonadherence Among US Commercially Insured Patients With Metastatic Breast Cancer. JCO Clin Cancer Inform 2021; 5:814-825. [PMID: 34383580 DOI: 10.1200/cci.20.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Adherence to tamoxifen citrate among women diagnosed with metastatic breast cancer can improve survival and minimize recurrence. This study aimed to use real-world data and machine learning (ML) methods to classify tamoxifen nonadherence. METHODS A cohort of women diagnosed with metastatic breast cancer from 2012 to 2017 were identified from IBM MarketScan Commercial Claims and Encounters and Medicare claims databases. Patients with < 80% proportion of days coverage in the year following treatment initiation were classified as nonadherent. Training and internal validation cohorts were randomly generated (4:1 ratio). Clinical procedures, comorbidity, treatment, and health care encounter features in the year before tamoxifen initiation were used to train logistic regression, boosted logistic regression, random forest, and feedforward neural network models and were internally validated on the basis of area under receiver operating characteristic curve. The most predictive ML approach was evaluated to assess feature importance. RESULTS A total of 3,022 patients were included with 40% classified as nonadherent. All models had moderate predictive accuracy. Logistic regression (area under receiver operating characteristic 0.64) was interpreted with 94% sensitivity (95% CI, 89 to 92) and 0.31 specificity (95% CI, 29 to 33). The model accurately classified adherence (negative predictive value 89%) but was nondiscriminate for nonadherence (positive predictive value 48%). Variable importance identified top predictive factors, including age ≥ 55 years and pretreatment procedures (lymphatic nuclear medicine, radiation oncology, and arterial surgery). CONCLUSION ML using baseline administrative data predicts tamoxifen nonadherence. Screening at treatment initiation may support personalized care, improve health outcomes, and minimize cost. Baseline claims may not be sufficient to discriminate adherence. Further validation with enriched longitudinal data may improve model performance.
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Affiliation(s)
- Gayathri Yerrapragada
- School of Computing, Clemson University, Clemson, SC.,Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Athanasios Siadimas
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Amir Babaeian
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Vishakha Sharma
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Tyler J O'Neill
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
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Ramjan LM, Salamonson Y, Batt S, Kong A, McGrath B, Richards G, Roach D, Wall P, Crawford R. The negative impact of smartphone usage on nursing students: An integrative literature review. NURSE EDUCATION TODAY 2021; 102:104909. [PMID: 33894590 DOI: 10.1016/j.nedt.2021.104909] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Smartphones are ubiquitous, and for some, an indispensable companion. In nursing education curricula and clinical healthcare settings, smartphones have the potential to augment student learning. Nursing students report significant benefits to smartphone use, which extend beyond learning, to include enhanced communication, clinical decision making and evidence-based practice. Despite these benefits, little is known about the negative impact of smartphones on student learning. OBJECTIVES This integrative review aimed to synthesise findings from published research that referred to the detrimental direct or indirect effect of smartphone usage on nursing students. DESIGN The integrative review was guided by the five-stage approach as conceptualised by Whittemore and Knafl (2005). METHODS Seven electronic databases were systematically searched in consultation with a university librarian (CINAHL Plus, Ovid Medline ALL, Nursing and Allied Health Database, PsycINFO, PubMed, Scopus and ERIC) using a combination of key search terms and medical subject headings. A total of 646 articles were retrieved, and following removal of duplicates, screening of titles and abstracts, a final 27 articles met the inclusion criteria for this review. RESULTS Studies in the review originated from Korea (n = 7), Turkey (n = 6), India (n = 4), Spain (n = 3), USA (n = 2), Spain/Portugal (n = 1), Iran (n = 1), France (n = 1), Canada (n = 1) and Egypt (n = 1). Personal smartphone use was reported to be a distraction within clinical and classroom learning, and considered as uncivil, and compromised professionalism. Frequently, smartphones were used for entertainment (e.g. social networking) rather than professional purposes. The studies identified a concerning level of nomophobia and smartphone addiction among nursing students that caused stress and anxiety, and adversely affected sleep, learning and academic performance. Recommendations were proposed for smartphone policies. CONCLUSIONS Excessive smartphones use among nursing students may adversely affect physical and mental health and potentially impact on student learning within the classroom and clinical environment. Educators should consider the implementation of policies or guidance for the responsible use of smartphones by nursing students whilst in the classroom setting and during clinical placement, to mitigate the potential negative impact on health and academic performance.
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Affiliation(s)
- Lucie M Ramjan
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Yenna Salamonson
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Sharryn Batt
- College of Science, Health, Engineering and Education, Murdoch University, PO Box 1937, Mandurah, WA 6210, Australia.
| | - Ariana Kong
- Western Sydney University, South Western Sydney Local Health District, The Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
| | - Belinda McGrath
- School of Health and Social Services, Whitireia Polytechnic New Zealand, DX Box:SX33459, Porirua 5022, Wellington, New Zealand.
| | - Gina Richards
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
| | - David Roach
- 21(st) Century Curriculum Project, Western Sydney University, Office of the Pro-Vice Chancellor (Learning Transformations), Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Peter Wall
- College of Science, Health, Engineering and Education, Murdoch University, PO Box 1937, Mandurah, WA 6210, Australia.
| | - Ruth Crawford
- School of Nursing, Health and Wellness, Western Institute of Technology at Taranaki, Private Bag 2030, New Plymouth 4342, New Zealand.
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20
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Odukoya OO, Ohazurike C, Akanbi M, O'Dwyer LC, Isikekpei B, Kuteyi E, Ameh IO, Osadiaye O, Adebayo K, Usinoma A, Adewole A, Odunukwe N, Okuyemi K, Kengne AP. mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e20330. [PMID: 34106075 PMCID: PMC8409010 DOI: 10.2196/20330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/13/2020] [Accepted: 04/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. OBJECTIVE Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. METHODS A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. RESULTS Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. CONCLUSIONS Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940.
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Affiliation(s)
- Oluwakemi Ololade Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Chidumga Ohazurike
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maxwell Akanbi
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Linda C O'Dwyer
- Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Brenda Isikekpei
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ewemade Kuteyi
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Idaomeh O Ameh
- Division of Nephrology, Zenith Medical and Kidney Center, Abuja, Nigeria
| | - Olanlesi Osadiaye
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Khadijat Adebayo
- Department of Clinical Medicine, All Saints University School of Medicine, Roseau, Dominica
| | - Adewunmi Usinoma
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ajoke Adewole
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nkiruka Odunukwe
- Non-Communicable Disease Research Group, Nigeria Institute of Medical Research, Lagos, Nigeria
| | - Kola Okuyemi
- Department of Family and Preventive Medicine, University of Utah School Of Medicine, Salt Lake City, UT, United States
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, Medical Research Council, Cape Town, South Africa
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Atlas A, Muru-Lanning M, Moyes S, Kerse N, Jatrana S. Cell phone and technology use by octogenarians. J Prim Health Care 2021; 12:35-40. [PMID: 32223848 DOI: 10.1071/hc19042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Many countries, including New Zealand, have an aging population and new technologies such as cell phones may be useful for older people. AIM To examine cell phone and technology use by octogenarians. METHODS Te Puawaitanga O Nga Tapuwae Kia Ora Tonu- Life and Living in Advanced Age: A Cohort Study In New Zealand (LILACs NZ) cohort study data of Māori (aged 80-90 years, 11-year age band) and non-Māori (aged 85 years, 1-year age band) followed for 3 years was used to describe the prevalence among study participants of the use of the internet, cell phones and watching pay-per-view television. Association of these activities with living arrangement, congestive heart failure, chronic obstructive respiratory disease and participants' cognition were examined. RESULTS Technology use was relatively low among study octogenarians. Fewer Māori used cell phones and the internet (16% and 6%) than non-Māori (30% and 19%). Māori participants supported only by a pension were less likely to use cell phones than Māori with more income. More men watched pay-per-view television (e.g. SKY) than women. Living alone and having chronic lung disease were associated with not watching pay-per-view television. Participants who used the internet had higher cognition scores than others. Non-Māori women were less likely to watch pay-per-view television and non-Māori on a pension only were less likely to watch pay-per-view television than people on a higher income. Participants who lived alone were less likely to watch pay-per-view. CONCLUSION Relatively low use of technology may limit potential for health technology innovation for people of advanced age. Socioeconomic and ethnic disparities will amplify this.
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Affiliation(s)
- Astrid Atlas
- University of Auckland School of Population Health, General Practice and Primary Health Care, Auckland, New Zealand; and Corresponding author.
| | | | - Simon Moyes
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Ngaire Kerse
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Santosh Jatrana
- Swinburne University of Technology, Centre for Social Impact, Auckland, New Zealand
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22
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Ross ES, Sakakibara BM, Mackay MH, Whitehurst DGT, Singer J, Toma M, Corbett KK, Van Spall HGC, Rutherford K, Gheorghiu B, Code J, Lear SA. The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e24530. [PMID: 33988519 PMCID: PMC8164115 DOI: 10.2196/24530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/27/2021] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. OBJECTIVE This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. METHODS This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul's Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. RESULTS There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain-Health-directed activity: -0.13, 95% CI -0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI -0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI -0.22 to 0.29, P=.77; Self-monitoring and insight: -0.14, 95% CI -0.33 to 0.05, P=.15; Constructive attitudes and approaches: -0.10, 95% CI -0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI -0.18 to 0.27, P=.69; Social integration and support: -0.12, 95% CI -0.34 to 0.10, P=.27; and Health services navigation: -0.05, 95% CI -0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference -0.36, 95% CI -0.66 to -0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. CONCLUSIONS The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. TRIAL REGISTRATION ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.6968.
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Affiliation(s)
- Emily S Ross
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Brodie M Sakakibara
- Centre for Chronic Disease Prevention and Management, University of British Columbia Okanagan, Kelowna, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Martha H Mackay
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mustafa Toma
- Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
| | - Kitty K Corbett
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Kimberly Rutherford
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | | | - Jillianne Code
- Department of Curriculum and Pedagogy, University of British Columbia, Vancouver, BC, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Division of Cardiology, Providence Health Care, Healthy Heart Program St Paul's Hospital, Vancouver, BC, Canada
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Gomis-Pastor M, Mirabet Perez S, Roig Minguell E, Brossa Loidi V, Lopez Lopez L, Ros Abarca S, Galvez Tugas E, Mas-Malagarriga N, Mangues Bafalluy MA. Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial. Healthcare (Basel) 2021; 9:healthcare9040463. [PMID: 33919899 PMCID: PMC8070926 DOI: 10.3390/healthcare9040463] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08025 Barcelona, Catalonia, Spain
- Correspondence: ; Tel.: +34-667411996
| | - Sonia Mirabet Perez
- Cardiology Department, Hospital de la Santa Creu i Santa Pau and CIBER de Enfermedades Cardiovasculares (CIBER-CV), 08041 Barcelona, Catalonia, Spain;
| | - Eulalia Roig Minguell
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Vicenç Brossa Loidi
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Laura Lopez Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Sandra Ros Abarca
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Elisabeth Galvez Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Núria Mas-Malagarriga
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, 08025 Barcelona, Catalonia, Spain;
| | - Mª Antonia Mangues Bafalluy
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau and CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 08025 Barcelona, Catalonia, Spain;
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24
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Choi J, Chung C, Woo H. Diet-Related Mobile Apps to Promote Healthy Eating and Proper Nutrition: A Content Analysis and Quality Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073496. [PMID: 33800531 PMCID: PMC8037032 DOI: 10.3390/ijerph18073496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/31/2022]
Abstract
Dietary mobile applications (apps) continue to hold promise for facilitating a healthy diet and managing nutrition. However, few studies have objectively evaluated the content and quality of such apps in Korea. The present study assessed the content and quality of dietary mobile apps using the Mobile App Rating Scale (MARS). We selected 29 dietary apps based on keywords and eligibility criteria for inclusion in the analyses. We conducted regression analyses to examine the association between app content and MARS scores. Most of the apps featured a tracking tool, while few featured rewards or follow-up management. Our quality assessment revealed that the top-rated apps have distinct levels of quality in terms of MARS scores. The regression analyses showed that the ways in which the apps provide information and motivate the users are statistically significant predictors of app quality. Our findings may facilitate the selection of dietary apps in Korea and provide guidelines for app developers regarding potential improvements in terms of content and quality.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA;
| | - Chongwook Chung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan 44919, Korea;
| | - Hyekyung Woo
- Department of Health Administration, Kongju National University, Chungnam 32588, Korea
- Correspondence:
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Palmer MJ, Machiyama K, Woodd S, Gubijev A, Barnard S, Russell S, Perel P, Free C. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev 2021; 3:CD012675. [PMID: 33769555 PMCID: PMC8094419 DOI: 10.1002/14651858.cd012675.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors by lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor. Approximately 9% of CVD cases in the EU are attributed to poor adherence to vascular medications. Low-cost, scalable interventions to improve adherence to medications for the primary prevention of CVD have potential to reduce morbidity, mortality and healthcare costs associated with CVD. OBJECTIVES To establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two other databases on 7 January 2020. We also searched two clinical trials registers on 5 February 2020. We searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials investigating interventions delivered wholly or partly by mobile phones to improve adherence to cardiovascular medications prescribed for the primary prevention of CVD. We only included trials with a minimum of one-year follow-up in order that the outcome measures related to longer-term, sustained medication adherence behaviours and outcomes. Eligible comparators were usual care or control groups receiving no mobile phone-delivered component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The main outcomes of interest were objective measures of medication adherence (blood pressure (BP) and cholesterol), CVD events, and adverse events. We contacted study authors for further information when this was not reported. MAIN RESULTS We included 14 trials with 25,633 randomised participants. Participants were recruited from community-based primary and tertiary care or outpatient clinics. The interventions varied widely from those delivered solely through short messaging service (SMS) to those involving a combination of modes of delivery, such as SMS in addition to healthcare worker training, face-to-face counselling, electronic pillboxes, written materials, and home blood pressure monitors. Some interventions only targeted medication adherence, while others additionally targeted lifestyle changes such as diet and exercise. Due to heterogeneity in the nature and delivery of the interventions and study populations, we reported most results narratively, with the exception of two trials which were similar enough to meaningfully pool in meta-analyses. The body of evidence for the effect of mobile phone-based interventions on objective outcomes of adherence (BP and cholesterol) was of low certainty, due to most trials being at high risk of bias, and inconsistency in outcome effects. Two trials were at low risk of bias. Among five trials (total study enrolment: 5441 participants) recording low-density lipoprotein cholesterol (LDL-C), two studies found evidence for a small beneficial intervention effect on reducing LDL-C (-5.30 mg/dL, 95% confidence interval (CI) -8.30 to -2.30; and -9.20 mg/dL, 95% CI -17.70 to -0.70). The other three studies found results varying from a small reduction (-7.7 mg/dL) to a small increase in LDL-C (0.77 mg/dL). All of which had wide confidence intervals that included no effect. Across 13 studies (25,166 participants) measuring systolic blood pressure, effect estimates ranged from a large reduction (MD -12.45 mmHg, 95% CI -15.02 to -9.88) to a small increase (MD 2.80 mmHg, 95% CI 0.30 to 5.30). We found a similar range of effect estimates for diastolic BP, ranging from -12.23 mmHg (95% CI 14.03 to -10.43) to 1.64 mmHg (95% CI -0.55 to 3.83) (11 trials, 19,716 participants). Four trials showed intervention benefits for systolic and diastolic BP with confidence intervals excluding no effect, and among these were all three of the trials evaluating self-monitoring of blood pressure with mobile phone-based telemedicine. The fourth trial included SMS and provider support (with additional varied features). Seven studies (19,185 participants) reported 'controlled' BP as an outcome, and intervention effect estimates varied from negligible effects (odds ratio (OR) 1.01, 95% CI 0.76 to 1.34) to large improvements in BP control (OR 2.41, 95% CI: 1.57 to 3.68). The three trials of clinician training or decision support combined with SMS (with additional varied features) had confidence intervals encompassing benefits and harms, with point estimates close to zero. Pooled analyses of the two trials of interventions solely delivered through SMS were indicative of little or no beneficial intervention effect on systolic BP (MD -1.55 mmHg, 95% CI -3.36 to 0.25; I2 = 0%) and small increases in controlled BP (OR 1.32, 95% CI 1.06 to 1.65; I2 = 0%). Based on four studies (12,439 participants), there was very low-certainty evidence (downgraded twice for imprecision and once for risk of bias) relating to the intervention effect on combined (fatal and non-fatal) CVD events. Two studies (2535 participants) provided low-certainty evidence for the effect of the intervention on cognitive outcomes, with little or no difference between trial arms for perceived quality of care and satisfaction with treatment. There was moderate-certainty evidence (downgraded due to risk of bias) that the interventions did not cause harm, based on six studies (8285 participants). Three studies reported no adverse events attributable to the intervention. One study reported no difference between groups in experience of adverse effects of statins, and that no participants reported intervention-related adverse events. One study stated that potential side effects were similar between groups. One study reported a similar number of deaths in each arm, but did not provide further information relating to potential adverse events. AUTHORS' CONCLUSIONS There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted.
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Affiliation(s)
- Melissa J Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Susannah Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Mazzella Ebstein AM, Barton-Burke M, Anthony V, Smith A, Zhang Z, Robson M. Oral self-management of palbociclib (Ibrance®) using mobile technology protocol. J Adv Nurs 2021; 77:1556-1566. [PMID: 33245144 PMCID: PMC8454747 DOI: 10.1111/jan.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
AIM This study will test the feasibility and effectiveness of mobile technology intervention on the patients' self-management of oral anticancer medication. Secondary objectives include acceptability, the usefulness of text messages, and satisfaction by participants and nurses. METHODS This prospective two-arm study will recruit patients (N = 220) with metastatic breast cancer and initiating treatment with palbociclib (Ibrance ®). Allowing for attrition, patients will be randomized into the control (N = 100) or intervention (N = 100) group. Unidirectional text message reminders will be sent during the treatment cycle through a secure web application using the patient's smartphone. Self-reported survey responses will be collected at three time points; at consent, end of treatment cycles, and the follow-up clinic visit and include a demographic questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Post study questionnaire and the R-15 Patient Satisfaction Questionnaire. Nurses providing care for study patients will complete the Adaptation of Stamps Nurse Workload questionnaire. Data will be analysed an intent-to-treat analysis comparing the two arms. Study approval was obtained in December 2019 and funded in January 2020. DISCUSSION Smartphones are globally available and have text messaging capability which is increasingly being used as an intervention in healthcare studies. This study will test a low-cost, nurse-led intervention that enhances the patient's experience with oral anti-cancer medications, improves access to care, reduces costs, and improves the satisfaction of nurses caring for oncology patients. IMPACT Despite the ease of administering oral anti-cancer medications, oncology patients maynot take them as prescribed and consequently, these factors affect patient outcomes and disease control. Given the importance of taking oral anti-cancer medications and the difficulties patients experience in achieving it, the effective use of mobile technology interventions can actively engage patients in their care and improve medication self-management of anticancer treatment regimens.
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Affiliation(s)
| | - Margaret Barton-Burke
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venice Anthony
- Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Smith
- Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark Robson
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Psihogios AM, Li Y, Ahmed A, Huang J, Kersun LS, Schwartz LA, Barakat LP. Daily text message assessments of 6-mercaptopurine adherence and its proximal contexts in adolescents and young adults with leukemia: A pilot study. Pediatr Blood Cancer 2021; 68:e28767. [PMID: 33073479 DOI: 10.1002/pbc.28767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND This pilot study explored the feasibility and acceptability of implementing text-based assessments of oral chemotherapy adherence in adolescents and young adults (AYA) with leukemia. METHODS AYA prescribed maintenance 6-mercaptopurine (6MP) received daily text message surveys and utilized an electronic pill bottle for 28 days. Text surveys assessed 6MP adherence and contextual associates (eg, mood). Feasibility was defined by recruitment/retention rates, survey completion rates, cost, and technical issues. After the 28-day period, AYA completed an acceptability survey. Secondary analyses compared text survey and electronic pill bottle adherence rates, and explored the daily associations between contextual factors and 6MP nonadherence. RESULTS Eighteen AYA enrolled (M age = 18, range 15-22) and completed study procedures (100% recruitment and retention rates). Adherence survey completion rates were high (M = 88.9%), the technology cost was $204.00, and there were few technical issues. AYA reported high satisfaction with the surveys and perceived them as a helpful medication reminder. While not significantly correlated, survey and electronic pill bottle adherence data converged on the majority of days (>90%). Exploratory analyses showed that AYA were more likely to miss a dose of 6MP on weekends (OR = 2.33, P = .048) and on days when their adherence motivation (OR = 0.28, P = .047) and negative affect (OR = 3.92, P = .02) worsened from their own typical functioning. CONCLUSIONS For AYA with leukemia, daily text-based surveys are a feasible and acceptable method for delivering medication adherence assessments, and may operate as a short-term intervention. To develop personalized mobile health interventions, findings also highlighted the need to study time-varying predictors of 6MP nonadherence.
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Affiliation(s)
- Alexandra M Psihogios
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yimei Li
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Annisa Ahmed
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Leslie S Kersun
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Dasgupta D, Chaudhry B, Greeves K, Long J, Duarte M, Chawla N. A Tablet-based App for Successful Aging in Community-Dwelling Older Adults with Low Socioeconomic Status: A Feasibility Study (Preprint). JMIR Aging 2020. [DOI: 10.2196/26686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bashi N, Varnfield M, Karunanithi M. A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach. JMIR Form Res 2020; 4:e17542. [PMID: 33337339 PMCID: PMC7775820 DOI: 10.2196/17542] [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: 12/18/2019] [Revised: 05/27/2020] [Accepted: 10/03/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. OBJECTIVE The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. METHODS The content of Mobile Technology-Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists' survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. RESULTS The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients' data and provide support. CONCLUSIONS The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS.
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Affiliation(s)
- Nazli Bashi
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Marlien Varnfield
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Mohanraj Karunanithi
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
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Gomis-Pastor M, Mirabet S, Roig E, Lopez L, Brossa V, Galvez-Tugas E, Rodriguez-Murphy E, Feliu A, Ontiveros G, Garcia-Cuyàs F, Salazar A, Mangues MA. Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study. JMIR Cardio 2020; 4:e19065. [PMID: 33231557 PMCID: PMC7723747 DOI: 10.2196/19065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/05/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. Objective The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. Methods This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. Results An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. Conclusions The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory–based mHealth strategy.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabeth Galvez-Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerardo Ontiveros
- Information System Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Albert Salazar
- Director Manager, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Svingen J, Rosengren J, Turesson C, Arner M. A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial. Clin Rehabil 2020; 35:266-275. [PMID: 33040590 PMCID: PMC7874382 DOI: 10.1177/0269215520962287] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate the effect of a smartphone application on exercise adherence, range of motion and self-efficacy compared to standard rehabilitation after repair of the flexor digitorum profundus tendon. DESIGN Prospective multi-centre randomised controlled trial. SETTING Four hand surgery departments in Sweden. SUBJECTS A total of 101 patients (35 women) (mean age 37.5 ± 12.8) were randomised to control (n = 49) or intervention group (n = 52). INTERVENTION A smartphone application to facilitate rehabilitation. MAIN OUTCOME MEASURES Adherence assessed with the Sport Injury Rehabilitation Adherence Scale at two and six weeks (primary outcome). Secondary outcomes were self-reported adherence in three domains assessed at two and six weeks, self-efficacy assessed with Athlete Injury Self-Efficacy Questionnaire at baseline, two and six weeks. Range of motion and perceived satisfaction with rehabilitation and information were assessed at 12 weeks. RESULTS Twenty-five patients were lost to follow-up. There was no significant between group difference in Sport Injury Rehabilitation Adherence Scale at two or six weeks, mean scores (confidence interval, CI 95%) 12.5 (CI 11.8-13.3), 11.8 (CI 11.0-12.8) for the intervention group, and 13.3 (CI 12.6-14.0), 12.8 (CI 12.0-13.7) for the control group. Self-reported adherence for exercise frequency at six weeks was significantly better for the intervention group, 93.2 (CI 86.9-99.5) compared to the controls 82.9 (CI 76.9-88.8) (P = 0.02). There were no differences in range of motion, self-efficacy or satisfaction. CONCLUSION The smartphone application used in this study did not improve adherence, self-efficacy or range of motion compared to standard rehabilitation for flexor tendon injuries. Further research regarding smartphone applications is needed. LEVEL OF EVIDENCE I. Randomised controlled trial.
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Affiliation(s)
- Jonas Svingen
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Jenny Rosengren
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Experimental, Linköping University, Linkoping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marianne Arner
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
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Utility of Short Message Service (SMS) for Remote Data Collection for HIV in Low- and Middle-Income Countries. Curr HIV/AIDS Rep 2020; 17:654-662. [PMID: 33010003 PMCID: PMC7532340 DOI: 10.1007/s11904-020-00534-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Short message system (SMS) communication is widespread in low- and middle-income countries (LMICs), and may be a viable approach to address challenges with in-person data collection for HIV-related research and monitoring and evaluation. We reviewed the literature to characterize potential benefits and challenges with using SMS for remote data capture, including examples from HIV and sexual and reproductive health. RECENT FINDINGS In our review, we found that studies that have used SMS to capture sensitive, self-reported data found this was an acceptable and feasible strategy, and may reduce social desirability bias of self-reported data; but studies are limited. Shared phones and privacy concerns have been described as challenges, but can be addressed with enhanced security features. Response rates to SMS surveys varied significantly by topic, population, and setting. SMS may improve generalizability and precision of health and behavior data for HIV in research and programs, but use in LMICs is limited. SMS systems should be carefully designed to overcome potential implementation hurdles.
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Li A, Cunich M, Fuller N, Purcell K, Flynn A, Caterson I. Improving Adherence to Weight-Loss Medication (Liraglutide 3.0 mg) Using Mobile Phone Text Messaging and Healthcare Professional Support. Obesity (Silver Spring) 2020; 28:1889-1901. [PMID: 32902905 PMCID: PMC7589266 DOI: 10.1002/oby.22930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/01/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to weight-loss medication is suboptimal, leading to poor health outcomes. Short message service (SMS) can potentially improve adherence. METHODS A total of 3,994 participants with overweight or obesity in Australia receiving Saxenda® (liraglutide 3.0 mg) were enrolled from September 1, 2017, to February 28, 2018, through doctors, pharmacists, or websites and were randomly assigned to receive none, three, or five SMS per week. Participants were additionally offered a face-to-face consultation with a diabetes educator or a call from a dietitian. Medication adherence was measured as whether the total scripts claimed were at least as many as the total claims expected by March 31, 2018, and was modeled adjusting for age, sex, baseline BMI, residential region, enrolment channel, the total number of SMS, and additional patient support. RESULTS Participants receiving five SMS (OR, 6.25; 95% CI: 4.28-9.12) had greater adherence than those receiving three SMS (OR, 3.67; 95% CI: 2.67-5.03) or zero SMS per week. The effectiveness of SMS on adherence decreased as participants received more SMS over time. Moreover, the odds of adhering to liraglutide were higher for participants enrolled with pharmacists compared with those enrolled with doctors (OR, 2.28; 95% CI: 1.82-2.86) and for participants who received a face-to-face consultation (OR, 3.10; 95% CI: 1.82-5.29) or a call (OR, 1.31; 95% CI: 1.02-1.68) compared with those who received no extra support. CONCLUSIONS Integration of SMS into routine clinical practice should consider not only the frequency and content of reminders but also additional patient support to achieve higher and more sustained adherence to medication and health behavior changes.
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Affiliation(s)
- Ang Li
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating DisordersCentral Clinical SchoolCharles Perkins CentreThe University of SydneyCamperdownNew South WalesAustralia
- Sydney Health Economics CollaborativeSydney Local Health DistrictCamperdownNew South WalesAustralia
| | - Michelle Cunich
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating DisordersCentral Clinical SchoolCharles Perkins CentreThe University of SydneyCamperdownNew South WalesAustralia
- Sydney Health Economics CollaborativeSydney Local Health DistrictCamperdownNew South WalesAustralia
| | - Nicholas Fuller
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating DisordersCentral Clinical SchoolCharles Perkins CentreThe University of SydneyCamperdownNew South WalesAustralia
| | - Katrina Purcell
- Novo Nordisk Pharmaceuticals Pty. Ltd.Baulkham HillsNew South WalesAustralia
| | - Allanah Flynn
- Novo Nordisk Pharmaceuticals Pty. Ltd.Baulkham HillsNew South WalesAustralia
| | - Ian Caterson
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating DisordersCentral Clinical SchoolCharles Perkins CentreThe University of SydneyCamperdownNew South WalesAustralia
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Iterative Development of an mHealth Intervention to Support Antiretroviral Therapy Initiation and Adherence Among Female Sex Workers in Mombasa, Kenya. J Assoc Nurses AIDS Care 2020; 31:145-156. [PMID: 31868829 DOI: 10.1097/jnc.0000000000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nurses have an integral role to play in achieving the 95-95-95 goals to stem the HIV epidemic. We used the Information-Motivation-Behavioral Skills (IMB) theoretical model to develop a nurse-delivered, mHealth intervention to support antiretroviral therapy adherence among female sex workers living with HIV in Mombasa, Kenya. Twenty-three purposively sampled female sex workers living with HIV participated in 5 focus group discussions to iteratively develop the message content as well as the format and structure of the nurse-delivered, text-based intervention. Focus group discussion interview guides were developed in accordance with the IMB model. Transcripts were analyzed according to IMB themes, and findings were used to develop the intervention. Information-oriented texts addressed concerns and misconceptions; motivation-oriented texts reinforced women's desires to feel healthy enough to engage in activities; and behavioral skills-oriented texts included strategies to remember medication doses. The nurse-delivered, theory-based, culturally tailored intervention to support medication adherence was evaluated.
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Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial. Transplantation 2020; 104:640-651. [PMID: 31335759 DOI: 10.1097/tp.0000000000002872] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence. METHODS Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups' nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics' associations with nonadherence. RESULTS One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%-81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%-23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05). CONCLUSIONS Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.
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Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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Inan OT, Tenaerts P, Prindiville SA, Reynolds HR, Dizon DS, Cooper-Arnold K, Turakhia M, Pletcher MJ, Preston KL, Krumholz HM, Marlin BM, Mandl KD, Klasnja P, Spring B, Iturriaga E, Campo R, Desvigne-Nickens P, Rosenberg Y, Steinhubl SR, Califf RM. Digitizing clinical trials. NPJ Digit Med 2020; 3:101. [PMID: 32821856 PMCID: PMC7395804 DOI: 10.1038/s41746-020-0302-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/19/2020] [Indexed: 01/31/2023] Open
Abstract
Clinical trials are a fundamental tool used to evaluate the efficacy and safety of new drugs and medical devices and other health system interventions. The traditional clinical trials system acts as a quality funnel for the development and implementation of new drugs, devices and health system interventions. The concept of a "digital clinical trial" involves leveraging digital technology to improve participant access, engagement, trial-related measurements, and/or interventions, enable concealed randomized intervention allocation, and has the potential to transform clinical trials and to lower their cost. In April 2019, the US National Institutes of Health (NIH) and the National Science Foundation (NSF) held a workshop bringing together experts in clinical trials, digital technology, and digital analytics to discuss strategies to implement the use of digital technologies in clinical trials while considering potential challenges. This position paper builds on this workshop to describe the current state of the art for digital clinical trials including (1) defining and outlining the composition and elements of digital trials; (2) describing recruitment and retention using digital technology; (3) outlining data collection elements including mobile health, wearable technologies, application programming interfaces (APIs), digital transmission of data, and consideration of regulatory oversight and guidance for data security, privacy, and remotely provided informed consent; (4) elucidating digital analytics and data science approaches leveraging artificial intelligence and machine learning algorithms; and (5) setting future priorities and strategies that should be addressed to successfully harness digital methods and the myriad benefits of such technologies for clinical research.
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Affiliation(s)
- O. T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - P. Tenaerts
- Clinical Trials Transformation Initiative, Duke University, Durham, NC 27708 USA
| | - S. A. Prindiville
- Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - H. R. Reynolds
- School of Medicine, New York University, New York, NY 10003 USA
| | - D. S. Dizon
- The Lifespan Cancer Institute, Brown University, Providence, RI 02912 USA
| | - K. Cooper-Arnold
- National, Heart, Lung and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
- Present Address: Fortira at AstraZeneca, Gaithersburg, MD 20877 USA
| | - M. Turakhia
- VA Palo Alto Health Care System and the Center for Digital Health, Stanford University, Stanford, CA 94305 USA
| | - M. J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143 USA
| | - K. L. Preston
- Intramural Research Program of the National Institute on Drug Abuse at the National Institutes of Health, Baltimore, MD 21224 USA
| | - H. M. Krumholz
- The Center for Outcomes Research, Yale New Haven Hospital, Yale University, New Haven, CT 06510 USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510 USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06510 USA
| | - B. M. Marlin
- College of Information and Computer Sciences, University of Massachusetts at Amherst, Amherst, MA 01003 USA
| | - K. D. Mandl
- Computational Health Informatics Program at Boston Children’s Hospital, Departments of Biomedical Informatics and Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - P. Klasnja
- School of Information, University of Michigan, Ann Arbor, MI 48109 USA
| | - B. Spring
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - E. Iturriaga
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - R. Campo
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - P. Desvigne-Nickens
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - Y. Rosenberg
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - S. R. Steinhubl
- Scripps Research Translational Institute, La Jolla, CA 92037 USA
| | - R. M. Califf
- School of Medicine, Duke University, Durham, NC 27710 USA
- Verily Life Sciences and Google Health, South San Francisco, CA 94080 USA
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Health Promotion for Childhood Obesity: An Approach Based on Self-Tracking of Data. SENSORS 2020; 20:s20133778. [PMID: 32640540 PMCID: PMC7374452 DOI: 10.3390/s20133778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
At present, obesity and overweight are a global health epidemic. Traditional interventions for promoting healthy habits do not appear to be effective. However, emerging technological solutions based on wearables and mobile devices can be useful in promoting healthy habits. These applications generate a considerable amount of tracked activity data. Consequently, our approach is based on the quantified-self model for recommending healthy activities. Gamification can also be used as a mechanism to enhance personalization, increasing user motivation. This paper describes the quantified-self model and its data sources, the activity recommender system, and the PROVITAO App user experience model. Furthermore, it presents the results of a gamified program applied for three years in children with obesity and the process of evaluating the quantified-self model with experts. Positive outcomes were obtained in children’s medical parameters and health habits.
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Tan EH, Wong ALA, Tan CC, Wong P, Tan SH, Ang LEY, Lim SE, Chong WQ, Ho J, Lee SC, Tai BC. Improving medication adherence with adjuvant aromatase inhibitor in women with breast cancer: A randomised controlled trial to evaluate the effect of short message service (SMS) reminder. Breast 2020; 53:77-84. [PMID: 32652462 PMCID: PMC7375684 DOI: 10.1016/j.breast.2020.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023] Open
Abstract
Background Medication adherence is crucial for improving clinical outcomes in the treatment of patients. We evaluate the effect of short message service (SMS) reminder on medication adherence and serum hormones in patients with breast cancer on aromatase inhibitors. Methods An open-label, multi-centre, prospective randomised controlled trial of SMS versus Standard Care was conducted. Medication adherence was assessed via self-report using the Simplified Medication Adherence Questionnaire at baseline, 6 month, and 1 year. Androstenedione, estradiol, and estrone were measured at baseline and 1 year. The χ2 test and mixed effects logistic regression was performed to compare medication adherence between groups. Difference in androstenedione and estrone levels were assessed using analysis of covariance, whereas χ2 test and logistic regression was used for estradiol. Analysis was based on intention-to-treat. Results A total of 244 patients were randomised to receive weekly SMS reminder (n = 123) or Standard Care (n = 121) between May 2015 and December 2018. The odds of adherence was higher at 6-month in SMS (OR = 1.78, 95% CI 1.04–3.05, p = 0.034), and not significantly different at 1-year (OR = 1.15, 95% CI: 0.67–1.96 p = 0.617). Mixed effects logistic regression analysis showed higher odds of adherence in SMS over the 1-year period (OR = 2.35, 95% CI: 1.01–5.49, p = 0.048). There was no difference in serum hormone levels between groups. Conclusion SMS reminder improved medication adherence in the short-term but had no effect on serum hormones levels in the longer term. Future studies could investigate the use of tailored SMS intervention according to patient preference to improve its sustainability. Patients on aromatase inhibitors were randomised to SMS reminder or Standard Care. SMS reminder improved medication adherence in the short-term. There was no effect on serum hormones levels in the longer term.
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Affiliation(s)
- Eng Hooi Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-03F, 117549, Singapore
| | - Andrea Li Ann Wong
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Chuan Chien Tan
- Department of General Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Patrick Wong
- Division of Oncology Pharmacy, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Sing Huang Tan
- OncoCare Cancer Centre, 6 Napier Road, #02-17/18/19, Gleneagles Medical Centr, 258499, Singapore
| | - Li En Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Siew Eng Lim
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Wan Qin Chong
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Jingshan Ho
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, NUHS Tower Block Level 7, 1E Kent Ridge Road, 119228, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-03F, 117549, Singapore; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, 119228, Singapore.
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Assessing Parents' Needs in Using Phone Applications to Improve Medication Adherence in an Outpatient Pediatric Oncology Clinic. J Pediatr Hematol Oncol 2020; 42:e277-e280. [PMID: 31688633 DOI: 10.1097/mph.0000000000001621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor adherence in pediatric oncology leads to significant morbidity and mortality. Currently used medication reminder aids have shown little to no benefit in improving adherence. Phone applications (apps) have demonstrated improved adherence in recent studies involving the adult and pediatric patients. At this time, no pediatric oncology center is recommending a particular phone app. OBJECTIVE The objective of this study was to determine the proportion of parents of pediatric oncology patients interested in using a phone app for medication reminders and desired features. METHODS In this single-center observational trial, 45 questionnaires were completed by parents accompanying their child at a pediatric oncology center. See Supplemental Digital Content 1 (http://links.lww.com/JPHO/A327) for a copy of the questionnaire. Participants had a child on active cancer treatment and were able to read and write English. Primary outcomes included a number of parents currently using a phone app, the number of parents interested in using a phone app, main reasons for not using a phone app and desired phone app features. RESULTS Overall, 95.6% of parents had never used a phone app to aid in medication adherence. Over 85% of these parents were highly interested in using a phone app, but most were not aware of available phone apps to use (57.1%). Desired features included: refill notifications, tracking doses administered, personalizable medication schedule, free of charge, no advertisements, ability to input special instructions, use on multiple devices, unique alarms, tracking child's results, and privacy protection. CONCLUSIONS A majority of parents at an outpatient pediatric oncology clinic were interested in using a phone app to assist in medication adherence but were unaware of an available phone app. An ideal criteria list was created with 10 desired features to evaluate available phone apps that may be recommended for this population. Further studies are needed to evaluate if phone apps recommended by this tool improve adherence.
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White-Williams C, Rossi LP, Bittner VA, Driscoll A, Durant RW, Granger BB, Graven LJ, Kitko L, Newlin K, Shirey M. Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e841-e863. [DOI: 10.1161/cir.0000000000000767] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study (
Data Supplement
) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.
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Rowell-Cunsolo TL, Hu G. Barriers to optimal antiretroviral therapy adherence among HIV-infected formerly incarcerated individuals in New York City. PLoS One 2020; 15:e0233842. [PMID: 32479552 PMCID: PMC7263611 DOI: 10.1371/journal.pone.0233842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/13/2020] [Indexed: 01/26/2023] Open
Abstract
In the United States (U.S.), the HIV infection rate is disproportionately high among incarcerated individuals. HIV-infected individuals typically receive antiretroviral therapy (ART) to suppress HIV and reduce the threat of transmission. Although HIV-infected individuals are generally ART-adherent while incarcerated, the public health benefits experienced during incarceration are often lost as HIV-infected individuals struggle to maintain optimal adherence post-incarceration. While the importance of maintaining adherence in the post-incarceration period has been acknowledged, research on barriers to ART adherence during this period is limited. To better understand post-release barriers to ART adherence, we conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City; we also followed up with 18 (90%) participants after three months to explore whether their adherence challenges changed over time. Viral load testing results from their most recent physician visit were also recorded at each interview. Interviews were transcribed using transcription software and reviewed for accuracy by a researcher. Thematic coding based on discussion guide prompts were then used to identify commonly mentioned barriers to adherence. The results identified four overarching themes that affected study participants’ efforts to adhere to their ART regimen: medication burden, forgetfulness, mental health and emotional difficulties, and perceived conflict between substance use and medication adherence. These barriers were the most commonly cited and largely persisted at three-month follow-up. The results suggest that interventions addressing these challenges are essential for promoting ART adherence among HIV-infected formerly incarcerated individuals. Effective interventions may include mobile-based text messaging reminders and those that facilitate patient-provider communication. Additionally, interventions or programs that integrate substance use and mental health treatment into HIV-related care, along with other types of behavioral health support, may also be beneficial for this population. Such interventions should be a routine part of discharge planning and support for incarcerated individuals returning to the community.
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Affiliation(s)
- Tawandra L. Rowell-Cunsolo
- Assistant Professor of Social Welfare Science, School of Nursing, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Gloria Hu
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Feasibility and acceptability of an innovative adherence intervention for young adults with childhood-onset systemic Lupus Erythematosus. Pediatr Rheumatol Online J 2020; 18:36. [PMID: 32340616 PMCID: PMC7187497 DOI: 10.1186/s12969-020-00430-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In Childhood-Onset Systemic Lupus Erythematosus (cSLE), poor medication adherence rates are very high. Interventions targeting this problem in cSLE are limited thus effective interventions are needed. The objective of this study is to examine the feasibility and acceptability an intervention (automated digital reminders + personalized prescribed treatment plan (pPTP)) to improve medication adherence in young adults with cSLE over 3 months. METHOD This is a proof-of-concept randomized controlled study. All participants received SimpleMed+ pillboxes that track adherence. The treatment group received a pPTP, and in month 2, preselected digital reminders for missed doses. Reminders were discontinued after 30 days and adherence data collected. Data analysis was done using t-tests. RESULTS Twenty-one participants were approached and nineteen consented to participate, yielding a recruitment rate of 86%. Participants were on average 20.5 years, mostly black (58%) and female (84%). Of the nineteen consented, eleven were randomized to control (57%) and eight to treatment (42%) groups respectively. All participants in the treatment group rated the pillbox as easy to use, notably; none reported boredom with the pillbox or reminders. Also, 88% of participants in the treatment group rated the pillbox as helpful, however, only 50% reported the pPTP taught them new information about lupus or made them more interested in their lupus management. CONCLUSIONS This is the first use of an electronic pillbox to track adherence to multiple medications in cSLE. The high rating of the pillbox makes it an acceptable method of measuring adherence. Feasibility and acceptability ratings for the intervention were mixed suggesting a there is a subset of cSLE patients for whom this intervention would be beneficial. Future research should focus on a larger trial.
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Zárate-Bravo E, García-Vázquez JP, Torres-Cervantes E, Ponce G, Andrade ÁG, Valenzuela-Beltrán M, Rodríguez MD. Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14680. [PMID: 32130164 PMCID: PMC7076413 DOI: 10.2196/14680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users' attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. OBJECTIVE This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. METHODS A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. RESULTS The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD's external cues not only improved older adults' medication adherence but also mediated family caregivers' involvement. CONCLUSIONS The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. TRIAL REGISTRATION ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97.
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Affiliation(s)
- Ernesto Zárate-Bravo
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | | | - Gisela Ponce
- Facultad de Enfermería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - Ángel G Andrade
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Marcela D Rodríguez
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
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Erdil D, Koku Aksu AE, Falay Gür T, Gürel MS. Hand eczema treatment: Change behaviour with text messaging, a randomized trial. Contact Dermatitis 2020; 82:153-160. [DOI: 10.1111/cod.13448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Duygu Erdil
- Istanbul Training and Research Hospital, Department of Dermatology Istanbul Turkey
| | - Ayşe E. Koku Aksu
- Istanbul Training and Research Hospital, Department of Dermatology Istanbul Turkey
| | - Tuğba Falay Gür
- Sultan Abdulhamid Han Training and Research Hospital, Department of Dermatology Istanbul Turkey
| | - Mehmet S. Gürel
- Medeniyet University Goztepe Training and Research Hospital, Department of Dermatology Istanbul Turkey
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47
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Singh N, Varshney U. Medication adherence: A method for designing context-aware reminders. Int J Med Inform 2019; 132:103980. [PMID: 31586826 DOI: 10.1016/j.ijmedinf.2019.103980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/30/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Several interventions have been proposed to improve medication adherence including those using reminders. Context-aware reminders can be effective because they operate when the dose is due, has not been taken, and is still safe to take. Although very promising, we find that there is no method to design context-aware reminders. To address these, we focus on proposing a method to design context-aware reminders. METHODS We conducted a systematic review of context-aware reminders for medication adherence using PRISMA approach. The analysis of literature leads to several interesting observations including the need for a method to design context-aware reminders. In this study, we present Method to Design Context-Aware Reminders (MDCAR) that can also meet special requirements. We used domain experts reasoning to evaluate the designed Context-Aware Reminders for Medication Adherence (CARS-MA). Further, we used analytical model to evaluate reliability, side effects, and cost of intervention. RESULTS This is the first paper that addresses "how to" design context-aware reminders. The proposed design method can lead to range of context-aware reminders including CARS-MA. The verification, validation, and evaluation of CARS-MA indicate that the context-aware reminders perform better than simple reminders in improving medication adherence. CONCLUSIONS The proposed method for context-aware reminders will help healthcare professionals and researchers to implement and select a suitable intervention to improve medication adherence. Further, it can lead to decision support systems for patients, healthcare professionals, researchers and policy makers for medication adherence. The design method can be extended for complex scenarios of multiple medications, persistent-reminders, and composite interventions.
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Affiliation(s)
- Neetu Singh
- University of Illinois at Springfield, Springfield, IL, 62703, USA.
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Andrikopoulou E, Scott P, Herrera H, Good A. What are the important design features of personal health records to improve medication adherence for patients with long-term conditions? A systematic literature review. BMJ Open 2019; 9:e028628. [PMID: 31558449 PMCID: PMC6773318 DOI: 10.1136/bmjopen-2018-028628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions. DATA SOURCES PubMed (including MEDLINE), CINAHL, Science Direct (including EMBASE), BioMed Central, ACM digital, Emerald Insight, Google Scholar and Research Gate. METHODS Studies that were published between 1 January 2002 and 31 May 2018 in English were included if the participants were adults, with at least one long-term condition, were able to self-administer their medication and were treated in primary care settings. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the risk of bias was appraised using the Cochrane risk of bias tool. RESULTS From a total of 27 studies that matched the inclusion criteria, 12 were excluded due to low quality of evidence, 10 were rated moderate and 5 were rated high quality. All the included studies had low sample size and limited follow-up duration. Thirteen of the included studies found that the use of a PHR has increased medication adherence. The identified design features are reminders, education, personalisation and tailoring, feedback and alerts, gamification, medication management, medical appointment management, diary and self-monitoring, health condition management, set goals, patient's blog and tethered. It was impossible to draw conclusions as to which feature is important to what group of patients and why. The most frequently identified conditions were HIV and diabetes. This review did not identify any papers with negative results. It was not possible to numerically aggregate the PHR effect due to high heterogeneity of the medication adherence measurement, study type, participants and PHRs used. CONCLUSION Although we found recurrent evidence that PHRs can improve medication adherence, there is little evidence to date to indicate which design features facilitate this process. PROSPERO REGISTRATION NUMBER CRD42017060542.
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Affiliation(s)
- Elisavet Andrikopoulou
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
- School of Computing, Buckingham Building, Lion Terrace, Portsmouth, UK
| | - Philip Scott
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
| | - Helena Herrera
- School of Pharmacy and Biomedical Sciences, Faculty of Science, University of Portsmouth, Portsmouth, UK
| | - Alice Good
- School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth, UK
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Ramsey RR, Carmody JK, Holbein CE, Guilbert TW, Hommel KA. Examination of the uses, needs, and preferences for health technology use in adolescents with asthma. J Asthma 2019; 56:964-972. [PMID: 30207802 PMCID: PMC6414273 DOI: 10.1080/02770903.2018.1514048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Objective: To examine the health technology uses and preferences of adolescents with asthma using a qualitative descriptive individual interview approach. Methods: Twenty adolescents were recruited from regularly scheduled asthma clinic appointments from February to July 2016. Patients were interviewed about their technology use and ways in which health technology could improve their asthma management using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Results: Social media (e.g. Snapchat, Instagram) and general communication (e.g. messaging) were the most common uses of technology while medical reminders (e.g. appointment, refill, medication) were the most common use of health technology. Adolescents identified ways in which health technology could improve their asthma management including (1) tracking symptoms and medication, (2) medical reminders, and (3) asthma and self-management knowledge specifically related to medications and individual action plans. Other themes that emerged included a desire to customize health technology to fit with individual schedules and medical routines and use of health technology data with medical providers. Conclusions: Adolescents and parents experience a number of challenges related to managing asthma, and health technology interventions should focus on ways to improve adherence and self-management. Future research considerations and potential interventions including ways to integrate adolescent preferences with evidence-based interventions are discussed.
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Affiliation(s)
- Rachelle R Ramsey
- a Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
- b Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Julia K Carmody
- a Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Christina E Holbein
- a Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Theresa W Guilbert
- b Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati , OH , USA
- c Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
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Hansen WB, Scheier LM. Specialized Smartphone Intervention Apps: Review of 2014 to 2018 NIH Funded Grants. JMIR Mhealth Uhealth 2019; 7:e14655. [PMID: 31359866 PMCID: PMC6690163 DOI: 10.2196/14655] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background The widespread adoption of smartphones provides researchers with expanded opportunities for developing, testing and implementing interventions. National Institutes of Health (NIH) funds competitive, investigator-initiated grant applications. Funded grants represent the state of the science and therefore are expected to anticipate the progression of research in the near future. Objective The objective of this paper is to provide an analysis of the kinds of smartphone-based intervention apps funded in NIH research grants during the five-year period between 2014 and 2018. Methods We queried NIH Reporter to identify candidate funded grants that addressed mHealth and the use of smartphones. From 1524 potential grants, we identified 397 that met the requisites of including an intervention app. Each grant’s abstract was analyzed to understand the focus of intervention. The year of funding, type of activity (eg, R01, R34, and so on) and funding were noted. Results We identified 13 categories of strategies employed in funded smartphone intervention apps. Most grants included either one (35.0%) or two (39.0%) intervention approaches. These included artificial intelligence (57 apps), bionic adaptation (33 apps), cognitive and behavioral therapies (68 apps), contingency management (24 apps), education and information (85 apps), enhanced motivation (50 apps), facilitating, reminding and referring (60 apps), gaming and gamification (52 apps), mindfulness training (18 apps), monitoring and feedback (192 apps), norm setting (7 apps), skills training (85 apps) and social support and social networking (59 apps). The most frequently observed grant types included Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants (40.8%) and Research Project Grants (R01s) (26.2%). The number of grants funded increased through the five-year period from 60 in 2014 to 112 in 2018. Conclusions Smartphone intervention apps are increasingly competitive for NIH funding. They reflect a wide diversity of approaches that have significant potential for use in applied settings.
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