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Pajalic Z, Olsen SEG, Hamre A, Strøm BS, Clausen C, Saplacan D, Kulla G. Home living older adults' subjective perceptions, evaluation, and interpretations of various welfare technology: A systematic review of qualitative studies. PUBLIC HEALTH IN PRACTICE 2024; 7:100470. [PMID: 38314397 PMCID: PMC10834993 DOI: 10.1016/j.puhip.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/27/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives This paper aims to map home-living older adults' subjective perceptions, evaluations, and interpretations of various welfare technologies. Study design Systematic literature review. Methods The study was designed as a systematic literature review of qualitative studies. This systematic literature review was carried out according to the PRISMA statement and was prospectively registered in PROSPERO registration number CRD42020190206. The international electronic bibliographic databases included AMED, Academic, CINAHL, Cochrane Reviews, EMBASE, Google Scholar, MEDLINE via PubMed, Scopus, and Web of Science. The scientific evidence was synthesized using qualitative analysis. All aspects of the study method followed COREQ guidelines. Results Following a detailed systematic search and screening of 1405 studies, 10 were included in the systematic review. The study shows that implementing Welfare Technology seems to prolong older adults' independent living in their own homes and was perceived as a complement to face-to-face contact with health care providers. Conclusions This study indicated that older adults consider accepting Welfare Technology as it contributes to a sense of security and empowerment in their everyday lives.
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Affiliation(s)
- Zada Pajalic
- Faculty of Health Sciences Sustainable Healthcare and Welfare Technology (SHWT) VID Specialized University, Oslo, Norway
| | - Sofia Elisabeth G Olsen
- Faculty of Health Sciences Sustainable Healthcare and Welfare Technology (SHWT) VID Specialized University, Oslo, Norway
| | - Annabel Hamre
- Faculty of Health Sciences Sustainable Healthcare and Welfare Technology (SHWT) VID Specialized University, Oslo, Norway
| | | | | | - Diana Saplacan
- Robotics and Intelligent Systems (ROBIN) Research Group, University of Oslo, Norway
| | - Gunilla Kulla
- Faculty of Health Sciences, Western Norway University of Applied Sciences, Forde, Norway
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Creber A, Leo DG, Buckley BJR, Chowdhury M, Harrison SL, Isanejad M, Lane DA. Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis. BMC Cardiovasc Disord 2023; 23:469. [PMID: 37726655 PMCID: PMC10510185 DOI: 10.1186/s12872-023-03486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology. METHOD A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease). RESULTS Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used. CONCLUSION Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.
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Affiliation(s)
- Anna Creber
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Mahin Chowdhury
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Stephanie L Harrison
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Masoud Isanejad
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Musculoskeletal Ageing, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Farooqi MH, Abdelmannan DK, Al buflasa MM, Abbas Hamed MA, Xavier M, Santos Cadiz TJ, Nawaz FA. The Impact of Telemonitoring on Improving Glycemic and Metabolic Control in Previously Lost-to-Follow-Up Patients with Type 2 Diabetes Mellitus: A Single-Center Interventional Study in the United Arab Emirates. Int J Clin Pract 2022; 2022:6286574. [PMID: 35685530 PMCID: PMC9159213 DOI: 10.1155/2022/6286574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/28/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Telemonitoring (TM), mobile-phone technology for health, and bluetooth-enabled self-monitoring devices represent innovative solutions for proper glycemic control, compliance and monitoring, and access to providers. OBJECTIVE In this study, we evaluated the impact of TM devices on glycemic control and the compliance of 38 previously lost-to-follow-up (LTFU) patients with type 2 diabetes mellitus (T2DM). METHODS This was an interventional single-center study that randomly recruited LTFU patients from the Dubai Diabetes Center (DDC), UAE. After contact and recruitment by phone, patients had an initial visit at which they were provided with home-based TM devices. A follow-up visit was conducted three months later. RESULTS The mean HbA1c decreased significantly from 10.3 ± 1.9% at baseline to 7.4 ± 1.5% at the end of follow-up, with a mean difference (MD) of -2.9% [95% CI: -3.6 to -2.2]. The percentage of patients with HbA1c <7% was 50% after three months. Home-based blood sugar monitor devices showed a significant reduction in fasting blood glucose (FBG) after three months (MD = -40.1 mg/dL, 95% CI: -70.8 to -9.3). A significant reduction was observed in terms of body weight after three months (MD = -1.3 kg, 95% CI: -2.5 to -0.08). The mean number of days the participants used a device was the highest for portable pill dispensers (86.5 ± 22.8 days), followed by a OneTouch® blood glucose monitor (72.9 ± 23.5 days). CONCLUSIONS TM led to significant improvements in overall diabetes outcomes, including glycemic control and body weight, indicating its effectiveness in a challenging population of T2DM patients who had previously been lost to follow-up.
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Affiliation(s)
| | | | | | | | - Maxon Xavier
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
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Pereira PDF, Santos JCD, Cortez DN, Reis IA, Torres HDC. Evaluation of group education strategies and telephone intervention for type 2 diabetes. Rev Esc Enferm USP 2021; 55:e03746. [PMID: 34105688 DOI: 10.1590/s1980-220x2020002603746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate group education strategies and telephone intervention regarding the variables empowerment, self-care practices, and glycemic control of people with diabetes. METHOD Clinical trial with eight randomized clusters, conducted between 2015 and 2016, with 208 users with type 2 diabetes mellitus allocated for group education, telephone intervention, or control group. Sociodemographic data, glycated hemoglobin, empowerment, and self-care practices were collected. RESULTS The user mean age was of 63.5 years (SD = 8.9 years), with the participation of 124 women, which amounts to 59.6% of these users. The strategies led to a statistically significant reduction in the levels of glycated hemoglobin (p < 0.001). The telephone intervention was also observed to present statistically significant results regarding self-care practices (p < 0.001) and empowerment in diabetes (p < 0.001) when compared to group education. CONCLUSION The telephone intervention presented statistically significant results for empowerment and practices of self-care when compared to group education. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-7gb4wm.
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Affiliation(s)
- Priscila de Faria Pereira
- Secretaria de Estado de Saúde de Minas Gerais, Subsecretaria de Políticas e Ações de Saúde, Superintendência de Atenção Primária à Saúde, Belo Horizonte, MG, Brasil
| | | | | | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais, Instituto de Ciências Exatas, Departamento de Estatística, Belo Horizonte, MG, Brasil
| | - Heloisa de Carvalho Torres
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Aplicada, Belo Horizonte, MG, Brasil
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Weller SC, Vickers BN. Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings. BMJ Open Diabetes Res Care 2021; 9:e002103. [PMID: 33888546 PMCID: PMC8070853 DOI: 10.1136/bmjdrc-2020-002103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Diabetes self-care practices are less effective outside of controlled research settings, and almost half of patients do not achieve good glycemic control. Qualitative studies suggest some lifestyle strategies may be linked to good control, but those strategies have not been validated. This study provides population-based evidence that dietary strategies identified in qualitative studies are associated with glycemic control in US patients with diabetes. RESEARCH DESIGN AND METHODS In a cross-sectional sample of the National Health and Nutrition Examination Survey (NHANES), qualitative self-management themes were matched to survey questions and used to predict good glycemic control (hemoglobin A1c <7.0% (53 mmol/mol)). Patients were limited to those 50 years of age and older with a diagnosis of diabetes for at least 1 year (N=465). RESULTS Patients averaged 65 years of age with a body mass index of 32.56 kg/m2 and 42% reported no physical activity. In logistic regression models controlling for sociodemographic and medical history variables, self-monitoring of blood glucose, weight loss, and physical activity were not significantly associated with glycemic control. Instead, dietary practices such as consuming low-calorie foods (OR=4.05, 95% CI 1.64 to 10.01), eating less fat (OR=2.15, 95% CI 1.03 to 4.47), and reducing sodium (OR=1.94, 95% CI 1.18 to 3.17) were significantly associated with good glycemic control, as was diabetes education or consultation with a dietitian (OR=3.48, 95% CI 1.28 to 9.45). Non-adherence to medications (OR=0.27, 95% CI 0.11 to 0.68) and general dietary descriptions, such as following a 'diabetic diet' (OR=0.32, 95% CI 0.17 to 0.57) and 'changing eating habits for weight loss' (OR=0.34, 95% CI 0.15 to 0.77), were associated with poorer glycemic control. CONCLUSIONS The NHANES validation of lifestyle management strategies suggests practices that may be sustainable. In a population that tends to be obese with low physical activity, successful self-care might emphasize specific dietary practices offering concrete touchpoints for patient communication and guidance. These strategies might help maintain glycemic control.
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Affiliation(s)
- Susan C Weller
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Benjamin N Vickers
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Chan CB, Popeski N, Hassanabad MF, Sigal RJ, O'Connell P, Sargious P. Use of Virtual Care for Glycemic Management in People With Types 1 and 2 Diabetes and Diabetes in Pregnancy: A Rapid Review. Can J Diabetes 2021; 45:677-688.e2. [PMID: 34045146 DOI: 10.1016/j.jcjd.2021.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/28/2021] [Indexed: 11/26/2022]
Abstract
Our objective in this study was to answer the main research question: In patients with diabetes, does virtual care vs face-to-face care provide different clinical, patient and practitioner experience or quality outcomes? Articles (2012 to 2020) describing interventions using virtual care with the capability for 2-way, individualized interactions compared with usual care were included. Studies involving any patients with diabetes and outcomes of glycated hemoglobin (A1C), quality of care and/or patient or health-care practitioner experience were included. Systematic reviews, randomized controlled studies, quasi-experimental trials, implementation trials, observational studies and qualitative analyses were reviewed. MEDLINE and McMaster Health Evidence databases searched in June 2020 identified 59 articles. Virtual care, in particular telemonitoring, combined with a means of 2-way communications provided improvement in A1C similar or superior to usual care, with the strongest evidence for type 2 diabetes. Virtual care was generally acceptable to patients, who expressed satisfaction with their care. Health-care providers recognized benefits but raised issues of technical support, workflow and compensation.
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Affiliation(s)
- Catherine B Chan
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Agricultural, Food and Nutritional Sciences, Li Ka Shing Centre for Health Innovation Research, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mortaza Fatehi Hassanabad
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Sargious
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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Beks H, King O, Clapham R, Alston L, Glenister K, McKinstry C, Quilliam C, Wellwood I, Williams C, Wong Shee A. Community health programs delivered through information and communications technology in high-income countries: a scoping review (Preprint). J Med Internet Res 2020; 24:e26515. [PMID: 35262498 PMCID: PMC8943572 DOI: 10.2196/26515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/15/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods The Joanna Briggs Institute’s scoping review methodology guided the review of the literature. Results The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Renee Clapham
- St Vincents Health Australia, Melbourne, Australia
- Ballarat Health Services, Ballarat, Australia
| | - Laura Alston
- School of Medicine, Deakin University, Geelong, Australia
- Colac Area Health, Colac, Australia
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
- Department of Rural Health, University of Melbourne, Shepparton, Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Claire Quilliam
- Department of Rural Health, University of Melbourne, Wangaratta, Australia
| | - Ian Wellwood
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | | | - Anna Wong Shee
- School of Medicine, Deakin University, Geelong, Australia
- Ballarat Health Services, Ballarat, Australia
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Hirst JA, Farmer AJ, Williams V. How point-of-care HbA 1c testing changes the behaviour of people with diabetes and clinicians - a qualitative study. Diabet Med 2020; 37:1008-1015. [PMID: 31876039 PMCID: PMC7318570 DOI: 10.1111/dme.14219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
AIM To explore adults with diabetes and clinician views of point-of-care HbA1c testing. METHODS Adults with diabetes and HbA1c ≥ 58 mmol/mol (7.5%) receiving HbA1c point-of-care testing in primary care were invited to individual interviews. Participants were interviewed twice, once prior to point-of-care testing and once after 6 months follow-up. Clinicians were interviewed once. A thematic framework based on an a priori framework was used to analyse the data. RESULTS Fifteen participants (eight women, age range 30-70 years, two Asians, 13 white Europeans) were interviewed. They liked point-of-care testing and found the single appointment more convenient than usual care. Receiving the test result at the appointment helped some people understand how some lifestyle behaviours affected their control of diabetes and motivated them to change behaviours. Receiving an immediate test result reduced the anxiety some people experience when waiting for a result. People thought there was little value in using point-of-care testing for their annual review. Clinicians liked the point-of-care testing but expressed concerns about costs. CONCLUSIONS This work suggests that several features of point-of-care testing may encourage behavioural change. It helped some people to link their HbA1c result to recent lifestyle behaviours, thereby motivating behavioural change and reinforcing healthy lifestyle choices.
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Affiliation(s)
- J. A. Hirst
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - A. J. Farmer
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - V. Williams
- School of NursingNipissing UniversityNorth BayONUSA
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Miele F, Clementi S, Gennaro R, Nicolao I, Romanelli T, Speese K, Piras EM. Text Messaging and Type 1 Diabetes Management: Qualitative Study Exploring Interactions Among Patients and Health Care Professionals. JMIR Diabetes 2019; 4:e11343. [PMID: 31094332 PMCID: PMC6533872 DOI: 10.2196/11343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/16/2018] [Accepted: 03/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients' perceptions about strengths and weaknesses of this technology. OBJECTIVE In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals' interactions in text messaging. METHODS The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. RESULTS The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. CONCLUSIONS The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals.
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Affiliation(s)
- Francesco Miele
- e-Health Research Unit, Bruno Kessler Foundation, Trento, Italy
| | - Silvia Clementi
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Trento, Italy
| | - Renzo Gennaro
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Rovereto, Italy
| | - Ilaria Nicolao
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Trento, Italy
| | - Tiziana Romanelli
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Trento, Italy
| | - Katja Speese
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Rovereto, Italy
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Buysse H, Coremans P, Pouwer F, Ruige J. Sustainable improvement of HbA 1c and satisfaction with diabetes care after adding telemedicine in patients on adaptable insulin regimens: Results of the TeleDiabetes randomized controlled trial. Health Informatics J 2019; 26:628-641. [PMID: 31046527 DOI: 10.1177/1460458219844369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This 2-year study evaluates whether tele-education adds to improvement and maintenance of good glycemic control and patient satisfaction. Adult patients were randomly assigned to study, getting immediate access to tele-education, or control group, getting this surplus education after 3 months. At several moments, clinical data were retrieved and patients completed questionnaires. Multivariate analyses of covariance and repeated measures analysis of variance were conducted. Implementation of tele-education in between face-to-face contacts improved glycemic control for both groups, which was maintained over a 2-year period. Tele-education did not have an influence on glucose measurements or on hypoglycemic events. Patients were satisfied with this tele-educational tool and appreciated use of personal messages. Further research should focus on the possible influence of "life changes" and influence on "need for more tele-educational feedback," and consequently on the provision of (mobile) platforms adaptable to patient's (changing life) situations.
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Walker RC, Tong A, Howard K, Palmer SC. Patient expectations and experiences of remote monitoring for chronic diseases: Systematic review and thematic synthesis of qualitative studies. Int J Med Inform 2019; 124:78-85. [PMID: 30784430 DOI: 10.1016/j.ijmedinf.2019.01.013] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/13/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the range of patients' beliefs, attitudes, expectations, and experiences of remote monitoring for chronic conditions across different healthcare contexts and populations. DESIGN We searched MEDLINE, Embase, PsychINFO, and CINAHL, Google Scholar, and reference lists of related studies through to July 2017. Thematic synthesis was used to analyse the findings of the primary studies. Study characteristics were examined to explain differences in findings. SETTING All healthcare settings PARTICIPANTS: Adults with chronic diseases OUTCOMES: Patient beliefs, attitudes, expectations and experiences of remote monitoring RESULTS: We included 16 studies involving 307 participants with chronic obstructive pulmonary disease, heart failure, diabetes, hypertension, and end stage kidney disease. The studies were conducted in 8 countries. We identified four themes: gaining knowledge and triggering actions (tracking and responding to change, prompting timely and accessible care, supporting self-management and shared decision-making); reassurance and security (safety in being alone, peace of mind); concern about additional burden (reluctance to learn something new, lack of trust in technology, avoiding additional out-of-pocket costs), and jeopardising interpersonal connections (fear of being lost in data, losing face to face contact). CONCLUSIONS For patients with chronic disease, remote monitoring increased their disease-specific knowledge, triggered earlier clinical assessment and treatment, improved self-management and shared decision-making. However, these potential benefits were balanced against concerns about losing interpersonal contact, and the additional personal responsibility of remote monitoring.
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Affiliation(s)
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, 8140, New Zealand; Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand
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Hui CY, McKinstry B, Walton R, Pinnock H. A mixed method observational study of strategies to promote adoption and usage of an application to support asthma self-management. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2019; 25:243-253. [PMID: 30672405 DOI: 10.14236/jhi.v25i4.1056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/05/2018] [Accepted: 08/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Apps can potentially support asthma self-management, however attracting downloads and encouraging on-going adherence is challenging. OBJECTIVES We observed the impact of different recruitment strategies and app features on adoption and continued use. METHODS Practice nurses in five practices in Lothian/Oxford approached adults with active asthma to try out a prototype app. We also advertised the app via social media (Asthma UK; AUK Centre for Applied Research). We observed patients' download and retention rates and sent pre- and post-trial questionnaires. We sampled 15 patients for interviews before and after using our app for one month to explore motivations, triggers and barriers to adoption and usage. Interviews were transcribed and analysed thematically with reference to the Fogg behaviour model. RESULTS Social media attracted 87 users, but only 15 (17%) used the app for 30 days. Practices recruited 24 patients, 13 (54%) continued for 30 days. Successful adoption was dependent on ease of downloading and sufficient motivation. Some patients needed technological assistance with downloading the app and starting to use the features. Adherence was dependent on motivation derived from a sense that the healthcare professional and/or researcher was interested in the results, and that using an app to support their self-management could improve their asthma control. CONCLUSION Social media attracted more downloads in a short time. However, most patients stopped using the app within a month. Practices recruited fewer patients, but patents adhered longer to the app. Dual promotion strategies (social media with practice support) may be the optimal approach to encourage adoption and adherence to telehealth.
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Affiliation(s)
- Chi Yan Hui
- Usher Institute of Population Health Sciences and Informatics, Asthma UK Centre for Applied Research, The University of Edinburgh.
| | - Brian McKinstry
- Professor of Primary Care eHealth, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh.
| | - Robert Walton
- Professor of Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London.
| | - Hilary Pinnock
- Professor of Primary Care Respiratory Medicine, Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh.
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Implementing telemonitoring in primary care: learning from a large qualitative dataset gathered during a series of studies. BMC FAMILY PRACTICE 2018; 19:118. [PMID: 30021535 PMCID: PMC6052602 DOI: 10.1186/s12875-018-0814-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/29/2018] [Indexed: 01/09/2023]
Abstract
Background Telemonitoring for long term conditions such as hypertension and diabetes has not been widely adopted despite evidence of efficacy in trials and policy support. The Telescot programme comprised a series of seven trials and observational studies of telemonitoring for long term conditions in primary care, all with an explanatory qualitative component which had been analysed and published separately. There were changes to the models of care within and between studies and combining datasets would provide a longitudinal view of the evolution of primary care based telemonitoring services that was not available in the individual studies, as well as allowing comparison across the different conditions monitored. We aimed to explore what drove changes to the way telemonitoring was implemented, compare experience of telemonitoring across the range of long term conditions, and identify what issues, in the experience of the participants, need to be considered in implementing new telemonitoring systems. Method Synthesis and thematic reanalysis of transcribed qualitative interview and focus group data from the Telescot programme adopting an interpretive description approach. All transcribed and coded text was re-read and data relating to the experience of the telemonitoring services, perceptions of future use and strategies for implementation were recoded into one consistent system. This was analysed thematically. Results The combined dataset contained transcribed qualitative interview and focus group data from 181 patients and 109 professionals. Four major themes were identified, using data, empowering patients, adjusting the model of care and system design. Conclusion Telemonitoring was valued by patients who found it empowering and convenient. This, combined with initial professional concern that increased surveillance may create dependency led to the development of a more patient led service. However, despite a number of initial concerns being addressed as the service evolved, primary care professionals identified a number of barriers to widespread routine adoption of telemonitoring, many of which could be addressed by improved system design.
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14
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Lee PA, Greenfield G, Pappas Y. Patients' perception of using telehealth for type 2 diabetes management: a phenomenological study. BMC Health Serv Res 2018; 18:549. [PMID: 30005696 PMCID: PMC6045870 DOI: 10.1186/s12913-018-3353-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a growing body of evidence that supports the uses of telehealth to monitor and manage people with diabetes at a distance. Despite this, the uptake of telehealth has been low. The objective of this study is to explore patients’ perceptions of using telehealth for type 2 diabetes management. Methods Semi-structured interviews were undertaken with 10 patients from the NHS Newham area in London, UK. Data were collected using recorded semi-structured interviews. The interviews were transcribed verbatim and the analysis was guided by the phenomenological analysis approach. Results We identified three main themes for facilitating positive patient experience or acceptance of telehealth and these included: technology consideration, service perceptions and empowerment. All patients asserted that they were pleased with the technology and many also proclaimed that they could not see themselves being without it. Moreover, very few negative views were reported with respect to the use of telehealth. Conclusion The patients’ perceived telehealth as a potential to enhance their quality of life, allow them to live independently at home as well as help them take and be in more control over their own health state. The findings of this study therefore supports the use of telehealth for the routine care of people with type 2 diabetes. However, one must interpret the results with caution due to limitations identified in the sample.
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Affiliation(s)
- Puikwan A Lee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Nguyen KT, Olgin JE, Pletcher MJ, Ng M, Kaye L, Moturu S, Gladstone RA, Malladi C, Fann AH, Maguire C, Bettencourt L, Christensen MA, Marcus GM. Smartphone-Based Geofencing to Ascertain Hospitalizations. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003326. [PMID: 28325751 DOI: 10.1161/circoutcomes.116.003326] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geolocators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based geofencing to track hospitalizations. METHODS AND RESULTS Participants aged ≥18 years installed a mobile application programmed to geofence all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥4 hours. An in-person study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A remote arm invited Health eHeart Study participants who consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible in-person patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval, 55%-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53; P=0.03). In the remote arm, the application was downloaded by 3443 participants residing in all 50 US states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% confidence interval, 57%-72%). CONCLUSIONS Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to geofencing other types of prespecified locations to facilitate healthcare research and patient care.
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Affiliation(s)
- Kaylin T Nguyen
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Jeffrey E Olgin
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Mark J Pletcher
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Madelena Ng
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Leanne Kaye
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Sai Moturu
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Rachel A Gladstone
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Chaitanya Malladi
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Amy H Fann
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Carol Maguire
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Laura Bettencourt
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Matthew A Christensen
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Gregory M Marcus
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.).
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Rho MJ, Kim HS, Sun C, Wang G, Yoon KH, Choi IY. Comparison of the Acceptance of Telemonitoring for Glucose Management Between South Korea and China. Telemed J E Health 2017; 23:881-890. [PMID: 28598260 DOI: 10.1089/tmj.2016.0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Telemonitoring is used for glucose management and support in many countries. A better understanding of the differences in telemonitoring acceptance based on regional characteristics is needed. Therefore, we compared the acceptance of telemonitoring for glucose management among patients in South Korea and China. MATERIALS AND METHODS This study used data from Korean (n = 81) and Chinese (n = 92) subjects with type 2 diabetes. We used two independent sample t-tests to compare patients' perceptions of telemonitoring and multiple regression analysis to determine the factors that affected their behavioral intentions to use telemonitoring. We conducted Wilcoxon signed rank tests to assess the differences in hemoglobin A1c (HbA1c) levels from baseline to follow-up. RESULTS Although Korean and Chinese patients had positive perceptions of the services, different factors influenced their behavioral intentions to use them. In South Korea, performance expectations and social influences were significantly associated with intention to use telemonitoring. Patients younger than 50 years showed a significant decrease in HbA1c levels at month 6 (p < 0.05). In China, effort expectancy and facilitating conditions were significantly associated with intention to use. In addition, subjects in all age groups exhibited a significant decrease in HbA1c levels at all follow-up points (p < 0.001). CONCLUSION Telemonitoring was a supportive intervention in improving blood sugar levels among patients with diabetes in South Korea and China, but the factors influencing its use varied. We provide practical guidance for developing telemonitoring for glucose management that considers the distinct characteristics of different countries.
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Affiliation(s)
- Mi Jung Rho
- 1 Department of Medical Informatics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,2 Graduate School of Healthcare Management and Policy, Catholic University of Korea , Seoul, Republic of Korea
| | - Hun-Sung Kim
- 3 Department of Endocrinology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,4 The Catholic Institute of Ubiquitous Health Care, Catholic University of Korea , Seoul, Korea
| | - Chenglin Sun
- 5 Department of Endocrinology and Metabolism, The First Hospital of Jilin University , Changchun, China
| | - Guixia Wang
- 5 Department of Endocrinology and Metabolism, The First Hospital of Jilin University , Changchun, China
| | - Kun-Ho Yoon
- 3 Department of Endocrinology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,4 The Catholic Institute of Ubiquitous Health Care, Catholic University of Korea , Seoul, Korea
| | - In Young Choi
- 1 Department of Medical Informatics, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.,2 Graduate School of Healthcare Management and Policy, Catholic University of Korea , Seoul, Republic of Korea
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Weller SC, Baer R, Nash A, Perez N. Discovering successful strategies for diabetic self-management: a qualitative comparative study. BMJ Open Diabetes Res Care 2017; 5:e000349. [PMID: 28761649 PMCID: PMC5530238 DOI: 10.1136/bmjdrc-2016-000349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/03/2017] [Accepted: 03/14/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This project explored lifestyles of patients in good and poor control to identify naturally occurring practices and strategies that result in successful diabetes management. RESEARCH DESIGN AND METHODS Semistructured interviews with adult patients with type 2 diabetes explored diet, food preparation, physical activity, medication use and glucose monitoring. Patients (n=56) were classified into good (A1C <7.0%), fair (7.0% 8.0%) control groups and matched across groups on diabetes duration (±5 years) and medication modality (none, oral, insulin±oral) to control for non-lifestyle factors. A qualitative comparative analysis identified practices that distinguished glycemic groups. RESULTS Good control patients were more likely to test their glucose two or more times a day and reduce their sodium intake, as well as increase fruits and vegetables and limit portion sizes, some attaining good control without exercise. Fair control patients discussed several dietary strategies including limiting sweets, drinking non-caloric beverages, reducing carbs, 'cheating' (eating only a few sweets/limiting carbs in one meal to have more in another meal) and tested their glucose once a day. Poor control patients were more likely to skip antidiabetic medications and not test their glucose. CONCLUSIONS Although clinical trials indicate most self-management practices have limited effectiveness over time, increased glucose monitoring is a valuable component in daily management. Research is needed on effectiveness of dietary strategies that emphasize sodium monitoring and allow some degree of cheating. Reoffering diabetes education classes and providing pill boxes as memory aids may help improve poor control.
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Affiliation(s)
- Susan C Weller
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, USA
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Roberta Baer
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
| | - Anita Nash
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
| | - Noe Perez
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
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McKinstry B. The march of telehealth. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 25:183-184. [DOI: 10.1111/ijpp.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Brian McKinstry
- Centre for Medical Informatics, Usher Institute the University of Edinburgh
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Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies. PATIENT EDUCATION AND COUNSELING 2017; 100:616-635. [PMID: 28029572 PMCID: PMC5380218 DOI: 10.1016/j.pec.2016.10.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To understand the experiences of patients and healthcare professionals (HCPs) using self-management digital interventions (DIs) for chronic physical health conditions. METHODS A systematic search was conducted in 6 electronic databases. Qualitative studies describing users' experiences of self-management DIs were included, and authors' interpretations were synthesised using meta-ethnography. RESULTS 30 papers met the inclusion criteria, covering a range of DIs and chronic conditions, including hypertension, asthma and heart disease. The review found that patients monitoring their health felt reassured by the insight this provided, and perceived they had more meaningful consultations with the HCP. These benefits were elicited by simple tele-monitoring systems as well as multifaceted DIs. Patients appeared to feel more reliant on HCPs if they received regular feedback from the HCP. HCPs focused mainly on their improved clinical control, and some also appreciated patients' increased understanding of their condition. CONCLUSIONS Patients using self-management DIs tend to feel well cared for and perceive that they adopt a more active role in consultations, whilst HCPs focus on the clinical benefits provided by DIs. PRACTICE IMPLICATIONS DIs can simultaneously support patient condition management, and HCPs' control of patient health. Tele-monitoring physiological data can promote complex behaviour change amongst patients.
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Affiliation(s)
- Katherine Morton
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Laura Dennison
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK.
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Lucy Yardley
- Academic unit of Psychology, University of Southampton, Southampton, UK.
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What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121268. [PMID: 28009850 PMCID: PMC5201409 DOI: 10.3390/ijerph13121268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 01/13/2023]
Abstract
Regular maintenance of non-communicable chronic diseases can constrain disease progression in diabetic and hypertensive patients. To identify the individual and social factors that are associated with positive health-seeking behaviors and regular maintenance of chronic diseases, we have conducted a follow up study in 2015 on diabetic and hypertensive patients in Hubei Province. We used binary logistic regression models to determine specific factors associated with diabetic and hypertensive patients that sought healthcare services for their conditions in accordance with current Chinese Centers for Disease Prevention and Control (CDC) guidelines. Our findings show that 42.16% of 510 people living with chronic conditions (PLCDs) sought health services in line with existing guidelines. Findings also show a higher probability (8.418 times) for PLCDs seeking healthcare services at higher-tiered hospitals (secondary and tertiary hospitals) than for PLCDs seeking care at primary hospitals (odds ratio (OR) = 8.418, 95% confidence interval (CI) = 4.82, 14.27, p < 0.001). These analyses underscore the importance of having patient advocates who can provide support, where necessary, and encourage positive health-seeking behavior. The study also shows a negative impact on regular maintenance for PLCDs in households with high financial constraints. In contrast, the study shows positive impacts for increased household income, age, and residency in rural locations. In sum, this study underscores the importance of primary hospitals as key points of care and critical players in care coordination for PLCDs. The study provides more evidence for Chinese policymakers seeking to contain costs and improve population health. The findings also underscore the need for community-based interventions, specifically interventions that link local primary hospitals, friends/family members, and PLCDs.
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Jafari J, Karimi Moonaghi H, Zary N, Masiello I. Exploring educational needs and design aspects of internet-enabled patient education for persons with diabetes: a qualitative interview study. BMJ Open 2016; 6:e013282. [PMID: 27799245 PMCID: PMC5093674 DOI: 10.1136/bmjopen-2016-013282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The objective of this article is to explore the educational needs and design aspects of personalised internet-enabled education for patients with diabetes in Iran. DESIGN Data were collected using semistructured interviews and then qualitatively analysed using inductive content analysis. PARTICIPANTS 9 patients with type 2 diabetes were included. Inclusion criteria were access to and knowledge on how to use the internet. The selection ensured representation based on gender, age, occupation and educational background. SETTING The sample population was patients with diabetes who were admitted to an outpatient diabetes clinic in Mashhad, a large city of Iran with about 3 million inhabitants. RESULTS 4 core categories emerged from the data: (1) seeking knowledge about diabetes, including specific knowledge acquisition, patient's interactions and learning requirements; (2) teaching and learning, including using different teaching methods and different ways to learn about the disease; (3) facilitators, including internet and mobile phone use to learn about the disease; and (4) barriers, including lack of internet access, uncertainty of access to the internet and lack of website in the local language and also perceived cultural barriers, such as patients' fears of the internet, lack of time and awareness. CONCLUSIONS This study provides a better understanding of the patient's educational expectations and technical needs in relation to internet-enabled education. This knowledge will inform the development of functional mock-ups in the next research phase using a design-based research approach in order to design internet-enabled patient education for self-management of diabetes.
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Affiliation(s)
- Javad Jafari
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Karimi Moonaghi
- Evidence-Based Caring Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nabil Zary
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Italo Masiello
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial. PLoS Med 2016; 13:e1002098. [PMID: 27458809 PMCID: PMC4961438 DOI: 10.1371/journal.pmed.1002098] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/17/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control. We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes. METHODS AND FINDINGS We performed a randomized, parallel, investigator-blind controlled trial with centralized randomization in family practices in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin (HbA1c) >58 mmol/mol. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group. The control group received usual care, with at least annual review and more frequent reviews for people with poor glycemic or blood pressure control. HbA1c assessed at 9 mo was the primary outcome. Intention-to-treat analyses were performed. 160 people were randomized to the intervention group and 161 to the usual care group between June 6, 2011, and July 19, 2013. HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group. The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group. For primary analysis, adjusted mean HbA1c was 5.60 mmol/mol / 0.51% lower (95% CI 2.38 to 8.81 mmol/mol/ 95% CI 0.22% to 0.81%, p = 0·0007). For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower (95% CI 0.56-5.56 mmHg, p = 0.017) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower (95% CI 0.62-3.72, p = 0.006) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata. No significant differences were identified between groups in weight, treatment pattern, adherence to medication, or quality of life in secondary analyses. There were few adverse events and these were equally distributed between the intervention and control groups. In secondary analysis, there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group (rate ratio 7.50 (95% CI 4.45-12.65, p < 0.0001) but no other significant differences between groups in use of health services were identified between groups. Key limitations include potential lack of representativeness of trial participants, inability to blind participants and health professionals, and uncertainty about the mechanism, the duration of the effect, and the optimal length of the intervention. CONCLUSIONS Supported telemonitoring resulted in clinically important improvements in control of glycaemia in patients with type 2 diabetes in family practice. Current Controlled Trials, registration number ISRCTN71674628. TRIAL REGISTRATION Current Controlled Trials ISRCTN 71674628.
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