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Willms A, Rhodes RE, Liu S. Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial. JMIR Form Res 2023; 7:e36562. [PMID: 36961486 PMCID: PMC10131910 DOI: 10.2196/36562] [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: 01/17/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. OBJECTIVE The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. METHODS In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. RESULTS Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η2p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η2p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η2p=0.01, Δmean SBP -0.4, SD 1.4 mm Hg; η2p=0.02, Δmean DBP -2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η2p=0.01; SFII: η2p=0.03). CONCLUSIONS The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted.
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Affiliation(s)
- Amanda Willms
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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Nuss K, Coulter R, DeSilva B, Buenafe J, Sheikhi R, Naylor PJ, Liu S. Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study. JMIR Pediatr Parent 2022; 5:e40431. [PMID: 36054663 PMCID: PMC9635440 DOI: 10.2196/40431] [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: 06/20/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. OBJECTIVE We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support-related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. METHODS This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children's physical activity, dietary and sedentary behaviors, and screen time, and the parent's support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. RESULTS Both the virtual and blended GH programs improved children's moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children's physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children's physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). CONCLUSIONS The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support-related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions.
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Affiliation(s)
- Kayla Nuss
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Rebecca Coulter
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | - Jeann Buenafe
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ronak Sheikhi
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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Perdew M, Liu S, Naylor PJ. Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review. Transl Behav Med 2021; 11:709-723. [PMID: 32893869 DOI: 10.1093/tbm/ibaa082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Effective evidence-informed family-based nutrition interventions for childhood obesity management are needed. (a) To assess the number and quality of published randomized controlled trials incorporating family-based nutrition interventions for childhood obesity (ages 5-18 years) management and (b) to identify intervention attributes (e.g., contact time, nutrition curricula, and behavior change strategies) used in successful interventions. Studies that met eligibility criteria were randomized controlled trials and family-based childhood obesity management interventions for children and adolescents ages 5-18 years old that included a healthy eating component and measured child dietary behaviors and/or parent dietary feeding practices. Six databases were searched: CINAHL complete, Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic Edition, MEDLINE with full text (PubMed), PsycINFO, SPORTDiscus, and ERIC (EBSCO Host). The validated Quality Assessment Tool for Quantitative Studies was used to assess study quality. Eight studies met eligibility criteria. Study quality analysis showed that blinding of the research teams (e.g., analysts, and those focused on data collection) and the use of age appropriate, valid, and reliable instruments were areas of concern. Successful nutrition interventions targeting children 5-18 years old, appear to include setting family-based goals, modifying home food environment, hands-on approaches to teaching nutrition (games, group-based activities), and fruit and vegetable vouchers. This review highlighted a limited amount of moderate to high quality evidence to suggest that family-based nutrition interventions can be successful in improving dietary behaviors and that interventions with positive outcomes had some components of nutrition curricula and strategies in common.
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Affiliation(s)
- Megan Perdew
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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O'Connor EA, Evans CV, Rushkin MC, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 324:2076-2094. [PMID: 33231669 DOI: 10.1001/jama.2020.17108] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020. STUDY SELECTION English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity. DATA EXTRACTION AND SYNTHESIS Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used. MAIN OUTCOMES AND MEASURES Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes). RESULTS Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events. CONCLUSIONS AND RELEVANCE Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Liu S, Tanaka R, Barr S, Nolan RP. Effects of self-guided e-counseling on health behaviors and blood pressure: Results of a randomized trial. PATIENT EDUCATION AND COUNSELING 2020; 103:635-641. [PMID: 31669047 DOI: 10.1016/j.pec.2019.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE 1) Evaluate the efficacy of e-Counseling vs. Control to promote lifestyle behaviors at 4 and 12-month follow-ups, 2) examine whether these behaviors changes were associated with lower blood pressure (BP), and Framingham Risk Index (FRI) at 12-month. METHODS Hypertensive patients (n = 264) were randomized to the e-Counseling or the Control group. Primary trial outcome was BP and secondary outcomes included exercise and diet behaviors. This study presented the results of secondary outcomes. Linear mixed models evaluated treatment effects at 4 and 12-month. Treatment-by-sex exploratory analyses were conducted if no main treatment effect was observed. RESULTS Daily steps significantly improved in e-Counseling vs. Controls at 12-month. Urinary sodium at 12-month did not significantly differ between the groups, but treatment-by-sex analysis showed that e-Counseling females lowered urinary sodium relative to Controls at 12 months. Improvements in steps and dietary sodium were significantly associated with improvements in BP and FRI at 12-month. CONCLUSION This hypertension e-Counseling protocol can promote long-term lifestyle behavior changes. Adherence to the lifestyle behavior change was associated with BP and FRI reduction at 12-month. PRACTICE IMPLICATIONS The hypertension e-counseling protocol has the potential to improve hypertension care and intervention reach.
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Affiliation(s)
- Sam Liu
- University of Victoria, School of Exercise Science, Physical and Health Education, Victoria, British Columbia, Canada.
| | - Rika Tanaka
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Susan Barr
- University of British Columbia, Department of Food, Nutrition & Health, British Columbia, Canada
| | - Robert P Nolan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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Sun GL, Lei L, Liu L, Liu J, He Y, Guo Z, Dai X, He L, Chen SQ, Liang Y, Ye J, Hu Y, Chen G, Chen JY, Liu Y. Rationale and design of the Web-basEd soCial media tecHnology to improvement in Adherence to dual anTiplatelet Therapy following Drug-Eluting Stent Implantation (WECHAT): protocol for a randomised controlled study. BMJ Open 2020; 10:e033017. [PMID: 31915170 PMCID: PMC6955490 DOI: 10.1136/bmjopen-2019-033017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) is frequently discontinued after drug-eluting stent (DES) implantation, which could increase the risk of major adverse cardiovascular events (MACEs). Few studies have attempted to improve DAPT adherence through web-based social media. OBJECTIVE To explore the effect of social media on DAPT adherence following DES implantation. METHODS/DESIGN The WeChat trial is a multicentre, single-blind, randomised study (1:1). It will recruit 760 patients with DES who require 12 months of DAPT. The control group will only receive usual care and general educational messages on medical knowledge. The intervention group will receive a personalised intervention, including interactive responses and medication and follow-up reminders beyond the general educational messages. The primary endpoint will be the discontinuation rate which is defined as the cessation of any dual antiplatelet drug owing to the participants' discretion within 1 year of DES implantation. The secondary endpoints will include medication adherence and MACEs. Both groups will receive messages or reminders four times a week with follow-ups over 12 months. ETHICS AND DISSEMINATION Ethical approval was granted by Ethics Committee of Guangdong Provincial People's Hospital (GDREC2018327H). Results will be disseminated via peer-reviewed publications and presentations at international conferences. TRIAL REGISTRATION NUMBER NCT03732066.
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Affiliation(s)
- Guo-Li Sun
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Li Lei
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liwei Liu
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Yibo He
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Zhaodong Guo
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Xiaohua Dai
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Lihao He
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shi-Qun Chen
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
| | - Yan Liang
- Department of Cardiology, Maoming General Hospital, Guangzhou, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan People's Hospital, Dongguan, China
| | - Yunzhao Hu
- Department of Cardiology, First People's Hospital, Shunde, China
| | - Guoqin Chen
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial People's Hospital affiliated with South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Asgari MR, Bouraghi H, Mohammadpour A, Haghighat M, Ghadiri R. The role of psychosocial determinants in predicting adherence to treatment in patient with hypertension. Interv Med Appl Sci 2019; 11:8-16. [PMID: 32148898 PMCID: PMC7044565 DOI: 10.1556/1646.10.2018.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Non-adherence in patients with hypertension directly exacerbates clinical outcomes. The purpose of the present research is to study the recognition of the relationships between the perceived social support and self-efficacy and the satisfaction of health care agents and the interaction of the patient with therapeutic personnel and access to health care and the behaviors of adherence to treatment in the patients who suffer hypertension. MATERIALS AND METHODS This descriptive cross-sectional correlation study recruited 250 patients from a specialized hypertension clinic in Semnan, who completed the following questionnaires: Multidimensional Scale of Perceived Social Support, self-efficacy, adherence to treatment, access to and satisfaction with health care, and the patient's interaction with treatment personnel. RESULTS An overall statistical description of the sample consists of 89 (35.6%) men and 161 (64.4%) women (SD = 10.41, range = 51.98). Regression coefficient of previous variables (three steps) shows that self-efficacy share, consent form civil services, and job could demonstrate with 99% certainty in the changes of treatment conformity in a meaningful way. CONCLUSIONS High self-efficacy, satisfaction with health care, and a favorable job have a high direct effect on adherence to treatment in patients with hypertension and controlling hypertension. Social support and education do not have a significant impact on adherence to treatment.
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Affiliation(s)
- Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamid Bouraghi
- Department of Health Information Technology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Mohammadpour
- Department of Health Information Technology, School of Paramedical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mina Haghighat
- Unit of Psychology Consultation, Semnan University, Semnan, Iran
| | - Raheleh Ghadiri
- Jahadieh Health Center, Semnan University of Medical Sciences, Semnan, Iran
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Liu S, Husband C, La H, Juba M, Loucks R, Harrison A, Rhodes RE. Development of a self-guided web-based intervention to promote physical activity using the multi-process action control framework. Internet Interv 2018; 15:35-42. [PMID: 30568879 PMCID: PMC6290280 DOI: 10.1016/j.invent.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Physical activity promotion has mostly focused on theories of intention-formation, with the assumption that positive intentions will lead to behaviour. Though necessary, exercise intentions alone are often not sufficient to improve physical activity behaviour. The Multi-Process Action Control (M-PAC) framework builds on previous intention-based theories by including both determinants of intention formation and its translation into behaviour. The purpose of this study was to describe the process of developing a self-guided web-based intervention to promote physical activity among adults using the M-PAC model. PROCEDURES The development process consisted of the following three phases: 1) Intervention planning: determine intervention needs and requirements; 2) Intervention development: use an iterative process to design a web-based physical activity intervention based on the M-PAC framework; 3) Pilot testing: conduct usability and acceptability assessment on the web-based intervention to further enhance user experience. PRINCIPAL RESULTS The intervention planning phase suggested that there is a need for web-based physical activity interventions and there is currently no web-based intervention designed using the M-PAC model. In phase two, we adopted an iterative process to develop a 10-week self-guided web-based intervention to help adults (>18 years of age) to meet 150 min of moderate to vigorous physical activity per week. The pilot testing phase yielded valuable feedback on usability, content, and design of the web-based intervention. MAJOR CONCLUSIONS The development of a web-based physical activity intervention using the M-PAC model could further enhance the effectiveness of web-based interventions and have a significant impact on extending the reach of existing physical activity promotion programs. This study has reinforced the importance of an iterative development process that involves a multi-disciplinary team to design a web-based intervention to promote physical activity. The process enabled the team to clarify the needs for an intervention for our target users, and provided valuable feedback on the design and content of the web-based intervention. Future studies are now needed to evaluate the effectiveness of our web-based intervention.
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Affiliation(s)
- Sam Liu
- Corresponding author at: School of Exercise Science, Physical and Health Education, University of Victoria, McKinnon Building 124, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Casandra Husband
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Henry La
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Madeline Juba
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Raven Loucks
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Aimee Harrison
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Ryan E. Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
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Lakshminarayan K, Westberg S, Northuis C, Fuller CC, Ikramuddin F, Ezzeddine M, Scherber J, Speedie S. A mHealth-based care model for improving hypertension control in stroke survivors: Pilot RCT. Contemp Clin Trials 2018; 70:24-34. [PMID: 29763657 PMCID: PMC6317360 DOI: 10.1016/j.cct.2018.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794). METHODS We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses. RESULTS Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, "I thought the system was easy to use" mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5-6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50% in IA and CA. At study completion, HTN was controlled in 82% (23/28) of IA and 64% (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89% (23/26) of IA and 58% (14/24) of CA, (p = 0.015). CONCLUSION A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors. CLINICAL TRIAL gov: NCT01875094.
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Affiliation(s)
- Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, University of Minnesota, School of Public Health, United States.
| | - Sarah Westberg
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, College of Pharmacy, United States
| | - Carin Northuis
- Division of Epidemiology & Community Health, University of Minnesota, School of Public Health, United States
| | - Candace C Fuller
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, United States
| | - Farah Ikramuddin
- Department of Rehabilitation Medicine, University of Minnesota, United States
| | | | - Julie Scherber
- Department of Medicine, University of Minnesota, United States
| | - Stuart Speedie
- Institute for Health Informatics, University of Minnesota, United States
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Tanaka R, Banerjee A, Surikova J, Tracey J, Payne A, Ross H, Nolan R. A Moderated e-Forum for Adults With Cardiovascular Disease: Usability Study. JMIR Hum Factors 2018; 5:e20. [PMID: 29776901 PMCID: PMC5984275 DOI: 10.2196/humanfactors.8820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/07/2018] [Accepted: 02/27/2018] [Indexed: 11/23/2022] Open
Abstract
Background Self-care behaviors are commonly prescribed to manage both cardiovascular disease and hypertension to reduce modifiable risk factors and improve quality of life. Nevertheless, long-term adherence to self-care recommendations for cardiac patients has been problematic. In cardiac patients, moderated online forums have been found to be particularly useful in supporting maintenance of heart-healthy diet and fewer hospital visits. As such, we developed the e-Forum, a Web-based moderated forum designed to promote continued user engagement and long-term self-care adherence. Objective The objective of this study was to assess the usability of the user interface for the newly designed e-Forum. In addition to overall user satisfaction, we obtained feedback from our target users on the key features of this newly developed interface. Methods An iterative design tested the usability of the e-Forum. On the basis of the user feedback, adjustments were made to the design of our e-Forum, and these changes were then tested in the succeeding group. Participants were recruited from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network. After consenting to participate in our study, patients were asked to complete a set of goal-oriented tasks and a feedback interview for the e-Forum. A content analysis of the transcripts from the set of goal-oriented tasks and feedback interviews identified several themes, including general feedback and comments regarding 3 key areas of the e-Forum: layout, navigation, and content. Results Overall, 13 cardiac patients (aged 32-81 years) participated in 3 rounds of testing. Participants across all 3 rounds were highly satisfied with our e-Forum and indicated that they would find such a forum useful in managing their health. Expressions of overall satisfaction with the e-Forum and positive comments regarding layout increased between the initial and the final round. As improvements were made to the e-Forum based on participant feedback, potential barriers, negative comments related to the content, and the number of navigation errors decreased between rounds 1 and 3. Conclusions We found evidence to support the usability of the user interface for our e-Forum. These results indicate that the e-Forum will likely be a successful tool to support an online community of cardiac patients in their efforts to sustain long-term lifestyle behavior change.
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Affiliation(s)
- Rika Tanaka
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Anita Banerjee
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Jelena Surikova
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Jacqueline Tracey
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Ada Payne
- Models of Care, Clinical Programs and Quality Initiatives, Cancer Care Ontario, Toronto, ON, Canada
| | - Heather Ross
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Robert Nolan
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Tanaka R, Nolan RP. Psychobehavioral Profiles to Assist Tailoring of Interventions for Patients With Hypertension: Latent Profile Analysis. J Med Internet Res 2018; 20:e149. [PMID: 29752248 PMCID: PMC5970280 DOI: 10.2196/jmir.8757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Practice guidelines advocate combining pharmacotherapy with lifestyle counseling for patients with hypertension. To allow for appropriate tailoring of interventions to meet individual patient needs, a comprehensive understanding of baseline patient characteristics is essential. However, few studies have empirically assessed behavioral profiles of hypertensive patients in Web-based lifestyle counseling programs. Objective The objectives of this study were to (1) specify baseline psychobehavioral profiles of patients with hypertension who were enrolled in a Web-based lifestyle counseling trial, and (2) examine mean differences among the identified profile groups in demographics, psychological distress, self-reported self-care behaviors, physiological outcomes, and program engagement to determine prognostic implications. Methods Participants (N=264; mean age 57.5 years; 154/264, 58.3% female; 193/264, 73.1% white) were recruited into a longitudinal, double-blind, randomized controlled trial, designed to evaluate an online lifestyle intervention for hypertensive patients. A series of latent profile analyses identified psychobehavioral profiles, indicated by baseline measures of mood, motivation, and health behaviors. Mean differences between profile groups were then explored. Results A 2-class solution provided the best model fit (the Bayesian information criterion (BIC) is 10,133.11; sample-size adjusted BIC is 10,006.54; Lo-Mendell-Rubin likelihood ratio test is 65.56, P=.001). The 2 profile groups were (1) adaptive adjustment, marked by low distress, high motivation, and somewhat satisfactory engagement in health behaviors and (2) affectively distressed, marked by clinically significant distress. At baseline, on average, affectively distressed patients had lower income, higher body mass index, and endorsed higher stress compared with their adaptive adjustment counterparts. At 12-months post intervention, treatment effects were sustained for systolic blood pressure and Framingham risk index in the adaptive adjustment group, and those in the adaptive adjustment group were 2.4 times more likely to complete the 12-month intervention study, compared with their affectively distressed counterparts. Conclusions Interventions for patients who are adaptively adjusted may differ in focus from those designed for the affectively distressed patients. As such, this study underscores the importance of identifying psychobehavioral profiles, as they allow for evidence-based tailoring of lifestyle counseling programs for patients with hypertension. Trial Registration ClinicalTrials.gov NCT01541540; https://clinicaltrials.gov/ct2/show/NCT01541540 (Archived by WebCite at http://www.webcitation.org/6yzZYZcWF)
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Affiliation(s)
- Rika Tanaka
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Robert P Nolan
- Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Department of Psychiatry and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Fang J, Moore L, Loustalot F, Yang Q, Ayala C. Reporting of adherence to healthy lifestyle behaviors among hypertensive adults in the 50 states and the District of Columbia, 2013. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2016; 10:252-262.e3. [PMID: 26851000 PMCID: PMC4992982 DOI: 10.1016/j.jash.2016.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Achieving and maintaining a healthy lifestyle is an important part of hypertension management. The purpose of this study was to assess US state-level prevalence of adherence to healthy lifestyle behaviors among those with self-reported hypertension. Using 2013 data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey, we examined the adherence to five healthy lifestyle behaviors related to hypertension management: having a "normal" weight, not smoking, avoiding or limiting alcohol intake, consuming the recommended amount of fruits and vegetables, and engaging in the recommended amount of physical activity. We estimated age-standardized percentages of each healthy lifestyle behavior overall and by state, as well as prevalence of all five healthy lifestyle behaviors. Overall, the prevalence of healthy lifestyle behaviors varied widely among those with self-reported hypertension: 20.5% had a normal weight, 82.3% did not smoke, 94.1% reported no or limited alcohol intake, 14.1% consumed the recommended amounts of fruits or vegetables, and 46.6% engaged in the recommended amount of physical activity. Overall, only 1.7% of adults with self-reported hypertension reported all five healthy lifestyle behaviors, with significant variation by state. Age-standardized prevalence of individuals reporting all five healthy lifestyle behaviors ranged from 0.3% in Louisiana to 3.8% in the District of Columbia. In conclusion, adherence to healthy lifestyle behaviors varied among those with hypertension; fewer than 2% reported meeting current recommendations and standards when assessed collectively. Disparities were observed by demographic and descriptive characteristics, including geography.
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Affiliation(s)
- Jing Fang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Latetia Moore
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carma Ayala
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Barley EA, Clifton A, Lee G, Norman IJ, O'Callaghan D, Tierney K, Richards D. The Space From Heart Disease Intervention for People With Cardiovascular Disease and Distress: A Mixed-Methods Study. JMIR Res Protoc 2015; 4:e81. [PMID: 26133739 PMCID: PMC4526970 DOI: 10.2196/resprot.4280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background Poor self-management of symptoms and psychological distress leads to worse outcomes and excess health service use in cardiovascular disease (CVD). Online-delivered therapy is effective, but generic interventions lack relevance for people with specific long-term conditions, such as cardiovascular disease. Objective To develop a comprehensive online CVD-specific intervention to improve both self-management and well-being, and to test acceptability and feasibility. Methods Informed by the Medical Research Council (MRC) guidance for the development of complex interventions, we adapted an existing evidence-based generic intervention for depression and anxiety for people with CVD. Content was informed by a literature review of existing resources and trial evidence, and the findings of a focus group study. Think-aloud usability testing was conducted to identify improvements to design and content. Acceptability and feasibility were tested in a cross-sectional study. Results Focus group participants (n=10) agreed that no existing resource met all their needs. Improvements such as "collapse and expand" features were added based on findings that participants’ information needs varied, and specific information, such as detecting heart attacks and when to seek help, was added. Think-aloud testing (n=2) led to changes in font size and design changes around navigation. All participants of the cross-sectional study (10/10, 100%) were able to access and use the intervention. Reported satisfaction was good, although the intervention was perceived to lack relevance for people without comorbid psychological distress. Conclusions We have developed an evidence-based, theory-informed, user-led online intervention for improving self-management and well-being in CVD. The use of multiple evaluation tests informed improvements to content and usability. Preliminary acceptability and feasibility has been demonstrated. The Space from Heart Disease intervention is now ready to be tested for effectiveness. This work has also identified that people with CVD symptoms and comorbid distress would be the most appropriate sample for a future randomized controlled trial to evaluate its effectiveness.
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Affiliation(s)
- Elizabeth Alexandra Barley
- Post Graduate Research Department, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
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Payne AY, Surikova J, Liu S, Ross H, Mechetiuc T, Nolan RP. Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure. JMIR Hum Factors 2015; 2:e7. [PMID: 27026267 PMCID: PMC4797699 DOI: 10.2196/humanfactors.4125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/06/2015] [Accepted: 03/22/2015] [Indexed: 11/13/2022] Open
Abstract
Background Chronic heart failure (CHF) is a major cause of hospitalization and mortality. In order to maintain heart function and quality of life, patients with CHF need to follow recommended self-care guidelines (ie, eating a heart healthy diet, exercising regularly, taking medications as prescribed, monitoring their symptoms, and living a smoke-free life). Yet, adherence to self-care is poor. We have developed an Internet-based e-Counseling platform, Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT), that aims to improve self-care adherence and quality of life in people with CHF. Before assessing the efficacy of this e-platform in a multisite, double-blind, randomized controlled trial, we evaluated the usability of the prototype website. Objective The objective of the study was to assess the usability of the CHF-CePPORT e-Counseling platform in terms of navigation, content, and layout. Methods CHF patients were purposively sampled from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network, to participate in this study. We asked the consented participants to perform specific tasks on the website. These tasks included watching self-help videos and reviewing content as directed. Their interactions with the website were captured using the “think aloud” protocol. After completing the tasks, research personnel conducted a semi-structured interview with each participant to assess their experience with the website. Content analysis of the transcripts from the “think aloud” sessions and the interviews was conducted to identify themes related to navigation, content, and layout of the website. Descriptive statistics were used to summarize the satisfaction data. Results A total of 7 men and women (ages 39-77) participated in 2 iterative rounds of testing. Overall, all participants were very satisfied with the content and layout of the website. They reported that the content was helpful to their management of CHF and that it reflected their experiences in coping with CHF. The layout was professional and friendly. The use of videos made the learning process entertaining. However, they experienced many navigation errors in the first round of testing. For example, some participants were not sure how to navigate across a series of Web pages. Based on the experiences that were reported in the first round, we made several changes to the navigation structure. This included using large navigation buttons to direct users to each section and providing tutorial videos to familiarize users with our website. We assessed whether these changes improved user navigation in the second round of testing. The major finding is that participants made fewer navigation errors and they did not identify any new problems. Conclusions We found evidence to support the usability of our CHF-CePPORT e-Counseling platform. Our findings highlight the importance of a clear and easy-to-follow navigation structure on user experience.
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Affiliation(s)
- Ada Ym Payne
- Cardiac eHealth, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
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