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Sun S, Simonsson O, McGarvey S, Torous J, Goldberg SB. Mobile phone interventions to improve health outcomes among patients with chronic diseases: an umbrella review and evidence synthesis from 34 meta-analyses. Lancet Digit Health 2024:S2589-7500(24)00119-5. [PMID: 39332937 DOI: 10.1016/s2589-7500(24)00119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/04/2024] [Accepted: 06/05/2024] [Indexed: 09/29/2024]
Abstract
This umbrella review of 34 meta-analyses, representing 235 randomised controlled trials done across 52 countries and 48 957 participants and ten chronic conditions, aimed to evaluate evidence on the efficacy of mobile phone interventions for populations with chronic diseases. We evaluated the strengths of evidence via the Fusar-Poli and Radua methodology. Compared with usual care, mobile apps had convincing effects on glycated haemoglobin reduction among adults with type 2 diabetes (d=0·44). Highly suggestive effects were found for both text messages and apps on various outcomes, including medication adherence (among patients with HIV in sub-Saharan Africa and people with cardiovascular disease), glucose management in type 2 diabetes, and blood pressure reduction in hypertension. Many effects (42%) were non-significant. Various gaps were identified, such as a scarcity of reporting on moderators and publication bias by meta-analyses, little research in low-income and lower-middle-income countries, and little reporting on adverse events.
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Affiliation(s)
- Shufang Sun
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA; International Health Institute, School of Public Health, Brown University, Providence, RI, USA; Mindfulness Center, School of Public Health, Brown University, Providence, RI, USA.
| | - Otto Simonsson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Stephen McGarvey
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; International Health Institute, School of Public Health, Brown University, Providence, RI, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simon B Goldberg
- Department of Counseling Psychology, School of Education, University of Wisconsin-Madison, Madison, WI, USA; Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
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Zhang S, Dieciuc M, Dilanchian A, Lustria MLA, Carr D, Charness N, He Z, Boot WR. Adherence Promotion With Tailored Motivational Messages: Proof of Concept and Message Preferences in Older Adults. Gerontol Geriatr Med 2024; 10:23337214231224571. [PMID: 38223550 PMCID: PMC10785722 DOI: 10.1177/23337214231224571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
This study examined the feasibility of using tailored text messages to promote adherence to longitudinal protocols and determined what facets of text message tone influence motivation. Forty-three older adults (Mage = 73.21, SD = 5.37) were recruited to engage in video-game-based cognitive training for 10 consecutive days. Participants received encouraging text messages each morning that matched their highest or lowest ranking reasons for participating in the study, after which they rated how effective each message was in motivating them to play the games that day. After 10 days, participants rated all possible messages and participated in semi-structured interviews to elicit their preferences for these messages. Results showed that messages matching participants' reasons for participating were more motivating than mismatched messages. Further, participants preferred messages that were personalized (i.e., use second person voice) and in formal tones. Messages consistent with these preferences were also rated as more motivating. These findings establish the feasibility of using message tailoring to promote adherence to longitudinal protocols and the relevance of tailoring messages to be personal and formal.
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Affiliation(s)
| | | | | | | | - Dawn Carr
- Florida State University, Tallahassee, USA
| | | | - Zhe He
- Florida State University, Tallahassee, USA
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Shim SY, Lee H. Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e44569. [PMID: 38039072 PMCID: PMC10724809 DOI: 10.2196/44569] [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: 11/24/2022] [Revised: 08/11/2023] [Accepted: 10/03/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults. OBJECTIVE We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults. METHODS The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life's Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable. RESULTS Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06). CONCLUSIONS Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance.
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Affiliation(s)
- Sun Young Shim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Tam HL, Wong EML, Cheung K. Educational Program with Text Messaging for Community-Dwelling Patients with Hypertension: A Pilot Randomized Controlled Trial. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:158-166. [PMID: 37295501 DOI: 10.1016/j.anr.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Controlling blood pressure minimizes the risk of cardiovascular events among patients with hypertension. Despite regular follow-ups, the hypertension management for patients aged ≥45 years is limited as evidenced from a decreased control rate. This pilot study aimed to test a theory-guided educational program for community-dwelling patients with hypertension. METHODS Sixty-nine patients with hypertension aged ≥45 years and having high blood pressure (>130/80 mmHg) were recruited in this two-arm pilot randomized controlled trial. Participants in the intervention group underwent a program guided by the Health Promotion Model, whereas those in the control group received usual care. Data were collected at baseline, week 8, and week 12 and used to assess the blood pressure, pulse pressure, self-efficacy, and adherence to hypertension management. Data were analyzed using a generalized estimating equation based on the intention-to-treat principle. Process evaluation was conducted to assess the feasibility and acceptability of the educational program. RESULTS The results obtained using the generalized estimating equation revealed that the educational program led to reduction in the systolic blood pressure (β = -7.12, p = .086) and pulse pressure (β = -8.20, p = .007) and to improve self-efficacy (β = 2.61, p = .269) at week 12. The program had a small-to-moderate effect on the reduction of systolic blood pressure (effect size = -0.45) and pulse pressure (effect size = -0.66) and self-efficacy (effect size = 0.23). The participants were highly satisfied with the educational program. CONCLUSIONS The educational program was found to be feasible and acceptable and may be incorporated into current hypertension management practices at the community level. TRIAL REGISTRATION ClinicalTrials.gov with identifier: NCT04565548.
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Affiliation(s)
- Hon Lon Tam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | | | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Widyakusuma NN, Suryawati S, Wiedyaningsih C, Probosuseno. What Do Seniors Believe About Medication Adherence? A Qualitative Study Among Seniors with Chronic Conditions in Yogyakarta, Indonesia. Patient Prefer Adherence 2023; 17:1381-1392. [PMID: 37312872 PMCID: PMC10259584 DOI: 10.2147/ppa.s412981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/25/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose This qualitative study elicited beliefs about medication adherence among hypertensive seniors with polypharmacy. Methods Twenty-one participants aged 60 or older with hypertension and other chronic conditions, with or without their family caregivers, residing surrounding Yogyakarta province, using five medicines or more routinely, were semi-structuredly interviewed by one researcher or one research assistant in January to April 2022. Behavioral, normative, and control beliefs were elicited using an interview guideline which was developed based on the Theory of Planned Behavior approach. Thematic analysis was applied. Results The participants believed that taking medicines routinely was advantageous because the medicines kept their body in good condition and prevented disease worsening. However, there were concerns about the medications' harmful effects on kidneys, gastric, and the whole body, and that the medicines would not be effective anymore. Prescribers, family, and friends would likely approve of medication adherence. However, non-prescriber doctors, family, and neighbors, mainly those with experience with complementary/alternative medicines, would likely disapprove of medication adherence. Good physical and cognitive function, help from family and technology, mealtime regularity, a simple regimen and easy-to-read medication labeling, and good communication with prescribers were among the facilitators of medication adherence. Physical and cognitive decline, mealtime irregularity, tablets that must be cut before taken, insurance that does not cover all medicines, change in dosage regimen, and hard-to-tear-off medication packaging were among the barriers to medication adherence. Conclusion Understanding these beliefs yields insights into the health communication approaches to improving seniors' medication adherence.
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Affiliation(s)
- Niken Nur Widyakusuma
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Suryawati
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Probosuseno
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Tam HL, Chair SY, Leung ISH, Leung LYL, Chan ASW. US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys. JMIR Public Health Surveill 2023; 9:e45697. [PMID: 36940169 PMCID: PMC10131672 DOI: 10.2196/45697] [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: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal. OBJECTIVE This study aimed to define individuals' lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys. METHODS US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported. RESULTS There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74). CONCLUSIONS A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted.
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Affiliation(s)
- Hon Lon Tam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Isaac Sze Him Leung
- Department of Statistics, The Chinese University of Hong Kong, Shatin, NT, China (Hong Kong)
| | - Leona Yuen Ling Leung
- The Ronin Institute, Montclair, NJ, United States
- Canadian Academy of Independent Scholars, Vancouver, BC, Canada
| | - Alex Siu Wing Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China (Hong Kong)
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Andersson U, Nilsson PM, Kjellgren K, Hoffmann M, Wennersten A, Midlöv P. PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care. J Hypertens 2023; 41:246-253. [PMID: 36394295 PMCID: PMC9799039 DOI: 10.1097/hjh.0000000000003322] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/16/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90 mmHg by improving the management of hypertension in daily life from a person-centred perspective. METHODS In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1 : 1 to either the intervention or usual care group. The intervention included daily measurement - via the participant's mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90 mmHg at 8 weeks and 12 months. Significance was tested by Pearson's chi 2 -test. RESULTS A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90 mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group ( P = 0.006). At 12 months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90 mmHg ( P = 0.071). CONCLUSION The proportion of participants with a controlled BP of less than 140/90 mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12 months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (NCT03554382).
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Affiliation(s)
- Ulrika Andersson
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University
| | | | - Karin Kjellgren
- University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
| | - Mikael Hoffmann
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping
| | - André Wennersten
- Department of Clinical Sciences Malmö, Lund University, Malmö
- Clinical Studies Sweden – Forum South, Skåne University Healthcare, Lund, Sweden
| | - Patrik Midlöv
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University
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Zhou C, Chen J, Tan F, Lai S, Li X, Pu K, Wu J, Dong Y, Zhao F. Relationship between self-care compliance, trust, and satisfaction among hypertensive patients in China. Front Public Health 2023; 10:1085047. [PMID: 36743158 PMCID: PMC9889937 DOI: 10.3389/fpubh.2022.1085047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Hypertension is a growing public health concern worldwide. It is a leading risk factor for all-cause mortality and may lead to complications such as cardiovascular disease, stroke, and kidney failure. Poor compliance of hypertensive patients is one of the major barriers to controlling high blood pressure. Compliance is not ideal among Chinese patients, and increasing patient self-care compliance with hypertension is necessary. Methods This article analyzes the status of self-care compliance, trust, and satisfaction among Chinese hypertensive patients using cross-sectional data from Zhejiang Province. We use a multi-group structural equation model (MGSEM) to compare the interrelationships across genders. Results The study's findings show that the average trust, satisfaction, and compliance scores are 3.92 ± 0.55, 3.98 ± 0.61, and 3.33 ± 0.41, respectively. Female patients exhibit higher average total scores for trust and compliance than male patients. The SEM results indicate that trust has a direct positive association with compliance [β = 0.242, 95% CI: (0.068, 0.402)] and satisfaction [β = 0.260, 95% CI: (0.145, 0.367)], while their satisfaction is not directly associated with compliance. The results of MGSEM show that trust has an indirect effect on compliance in the male group through satisfaction [β = 0.051, P < 0.05, 95% CI: (0.012, 0.116)]. In the female group, trust has a direct effect on satisfaction [β = 0.235, P < 0.05, 95% CI: (0.041, 0.406)] and compliance [β = 0.319, P < 0.01, 95% CI: (0.086, 0.574)]. Discussion This study reveals the mechanisms of self-care compliance, trust, and satisfaction among Chinese hypertensive patients. Its findings may serve as a reference for guiding primary healthcare providers to improve hypertension patients' compliance and implement gender-targeted health interventions.
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Affiliation(s)
- Chi Zhou
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China,*Correspondence: Chi Zhou ✉
| | - Jingchun Chen
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Fang Tan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sihong Lai
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xu Li
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Ke Pu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jiahui Wu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yin Dong
- Department of Hospital Office, The People's Hospital of Yuhuan, Taizhou, China,Yin Dong ✉
| | - Falin Zhao
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China,Falin Zhao ✉
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Calling S, Thulesius H. Randomised control trials using short messaging services (SMS) in hypertension treatment - convenient telemedicine interventions. Scand J Prim Health Care 2022; 40:415-416. [PMID: 36606469 PMCID: PMC9848306 DOI: 10.1080/02813432.2022.2159636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Region Skåne, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Lund, Sweden
- Research and Development Centre, Region Kronoberg, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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Leung LYL, Tam HL, Ho JKM. Effectiveness of Tai Chi on older adults: A systematic review of systematic reviews with re-meta-analysis. Arch Gerontol Geriatr 2022; 103:104796. [PMID: 36058045 DOI: 10.1016/j.archger.2022.104796] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
This overview study examined and synthesized the effect of Tai Chi (TC) on the physical conditions, psychological conditions, cognitive abilities, and quality of life (QoL) of older adults. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Using Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, PubMed, Scopus, and Web of Science, English-language systematic reviews (SRs) published within the latest decade (2010-2020) were included. SRs with meta-analysis were selected if TC was the examined intervention and older adults was the targeted population. A total of 16 SRs covering 89 original studies were included. A number of the pooled results of the included SRs were inconclusive. Taking into consideration of the new meta-analyses of this study, TC significantly improved most outcomes, including the mobility, pain level, physical function, psychological distress, depressive symptoms, anxiety, global cognitive function, mental speed and attention, learning ability, verbal fluency, executive function, and QoL of older adults. TC can be an effective intervention for older adults for improving physical and psychological conditions, cognitive abilities, and QoL. Additional high-quality studies with larger samples investigating the effectiveness of TC in older adults are warranted.
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Affiliation(s)
- Leona Yuen Ling Leung
- The Ronin Institute, Montclair, NJ 07043-2314, USA; Canadian Academy of Independent Scholar, Vancouver, Canada
| | - Hon Lon Tam
- Kiang Wu Nursing College of Macau, Macau; The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Jonathan Ka Ming Ho
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
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Peacock E, Craig LS, Krousel-Wood M. Electronic health strategies to improve medication adherence in patients with cardiometabolic disease: current status and future directions. Curr Opin Cardiol 2022; 37:307-316. [PMID: 35731675 PMCID: PMC9228772 DOI: 10.1097/hco.0000000000000971] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Enabled by widespread technological advancements, electronic health (eHealth) strategies have expanded rapidly over the last decade, presenting opportunities to support self-management including medication adherence for cardiometabolic disease control. eHealth can minimize access barriers to medications, enable timely assessment and shared decision-making, and provide medication reminders and health data feedback. This review summarizes current evidence for effectiveness of eHealth strategies for improving medication adherence in patients with hypertension, type 2 diabetes, and/or hyperlipidemia, and identifies priorities for future research. RECENT FINDINGS Current research supports the effectiveness of eHealth strategies to improve medication adherence and clinical outcomes for cardiometabolic disease. Although patient acceptability of eHealth strategies is generally high, engagement may decline over time. In addition, differences in effectiveness across intervention characteristics and sociodemographic groups are understudied, limiting generalizability and tailoring of interventions to local health system resources, culture, and patient needs or preferences. SUMMARY eHealth is a promising tool for addressing low medication adherence. Further work incorporating rigorous evaluation, assessment of patient engagement over time and effectiveness of intervention characteristics and components, and a health equity lens addressing eHealth use in vulnerable groups will increase understanding of the full potential of eHealth for improving medication adherence in diverse patients with cardiometabolic disease.
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Affiliation(s)
- Erin Peacock
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Leslie S. Craig
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, Louisiana
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Zhang Y, Leuk JSP, Teo WP. Domains, feasibility, effectiveness, cost, and acceptability of telehealth in aging care: a scoping review of systematic reviews (Preprint). JMIR Aging 2022; 6:e40460. [PMID: 37071459 PMCID: PMC10155091 DOI: 10.2196/40460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/02/2022] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. OBJECTIVE This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. METHODS Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. RESULTS A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. CONCLUSIONS Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
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Affiliation(s)
- Yichi Zhang
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Ageing Research Institute for Society and Education, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore
| | - Jessie Siew-Pin Leuk
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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