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Wong AKC, Wong FKY, Chow KKS, Wong SM, Bayuo J, Ho AKY. Effect of a Mobile Health Application With Nurse Support on Quality of Life Among Community-Dwelling Older Adults in Hong Kong: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2241137. [PMID: 36350651 PMCID: PMC9647479 DOI: 10.1001/jamanetworkopen.2022.41137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
IMPORTANCE Mobile health (mHealth) smartphone apps are becoming increasingly popular among older adults, although the reactive care approach of these apps has limited their usability. OBJECTIVE To evaluate the effects of an interactive mHealth program supported by a health-social partnership team on quality of life (QOL) among community-dwelling older adults in Hong Kong. DESIGN, SETTING, AND PARTICIPANTS This was a 3-group, randomized clinical trial conducted in 5 community centers in Hong Kong from December 1, 2020, to April 30, 2022, with a last follow-up date of January 31, 2022. Participants included older adults aged at least 60 years who were living within the service area, used a smartphone, and had at least 1 of the following problems: chronic pain, hypertension, or diabetes. Data were analyzed from May 1 to 10, 2022. INTERVENTIONS Participants were randomly assigned to the mHealth with interactivity (mHealth+I) group, mHealth group, or control group. Participants in the mHealth+I group received the mHealth app and nurse case management supported by a health-social partnership team. The mHealth group received the mHealth app only. The control group received no mHealth app or health-social care services. MAIN OUTCOMES AND MEASURES The primary outcome was the change in QOL from baseline to 3 months after completion of the intervention. RESULTS Among 221 participants (mean [SD] age 76.6 [8.0] years; 185 [83.7%] women), 76 were randomized to the control group, 71 were randomized to the mHealth group, and 74 were randomized to the mHealth+I group. The most common chronic diseases or problems were hypertension (147 participants [66.5%]), pain (144 participants [65.2%]), cataracts (72 participants [32.6%]), and diabetes (61 participants [27.6%]). At 3 months after the intervention and compared with the intervention group, there were no statistically significant differences in either the physical component summary (mHealth+I: β = -1.01 [95% CI, -4.13 to 2.11]; P = .53; mHealth: β = 0.22 [95% CI, -3.07 to 3.50]; P = .90) or the mental component summary (mHealth+I: β = -0.87 [95% CI, -4.42 to 2.69]; P = .63; mHealth: β = 1.73 [95% CI, -1.89 to 5.34]; P = .35) QOL scores. Only secondary outcomes, including self-efficacy (β = -2.31 [95% CI, -4.26 to -0.36]; P = .02), systolic blood pressure (β = -2.30 [95% CI, -5.00 to -0.13]; P = .04), pain levels (β = 1.18 [95% CI, 0.52 to 2.00]; P = .02), and health services utilization (β = 0.98 [95% CI, 0.32 to 2.09]; P = .048) improved in the mHealth+I group compared with the control group. CONCLUSIONS AND RELEVANCE This randomized clinical trial found no difference in the primary outcome between the mHealth+I group and the control group confirming that there were no incremental benefits to adding interactivity in mHealth programs for older adults with chronic diseases. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03878212.
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Affiliation(s)
| | | | | | - Siu Man Wong
- The Hong Kong Lutheran Social Service, Homantin, Hong Kong
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Annie Ka Ying Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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2
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Olomu A, Kelly-Blake K, Hart-Davidson W, Gardiner J, Luo Z, Heisler M, Holmes-Rovner M. Improving diabetic patients' adherence to treatment and prevention of cardiovascular disease (Office Guidelines Applied to Practice-IMPACT Study)-a cluster randomized controlled effectiveness trial. Trials 2022; 23:659. [PMID: 35971135 PMCID: PMC9376908 DOI: 10.1186/s13063-022-06581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite nationwide improvements in cardiovascular disease (CVD) mortality and morbidity, CVD deaths in adults with type 2 diabetes (T2DM) are 2-4 times higher than among those without T2DM. A key contributor to these poor health outcomes is medication non-adherence. Twenty-one to 42% of T2DM patients do not take blood sugar, blood pressure (BP), or statin medications as prescribed. Interventions that foster and reinforce patient-centered communication show promise in improving health outcomes. However, they have not been widely implemented, in part due to a lack of compelling evidence for their effectiveness in real-life primary care settings. METHODS This pragmatic cluster-randomized trial randomizes 17 teams in 12 Federally Qualified Healthcare Centers (FQHCs) to two experimental groups: intervention (group 1): Office-Gap + Texting vs. control (group 2): Texting only. Office-GAP (Office-Guidelines Applied to Practice) is a patient activation intervention to improve communication and patient-provider partnerships through brief patient and provider training in shared decision-making (SDM) and use of a guideline-based checklist. The texting intervention (Way2Health) is a cell phone messaging service that informs and encourages patients to adhere to goals, adhere to medication use and improve communication. After recruitment, patients in groups 1 and 2 will both attend (1) one scheduled group visit, (90-120 min) conducted by trained research assistants, and (2) follow-up visits with their providers after group visit at 0-1, 3, 6, 9, and 12 months. Data will be collected over 12-month intervention period. Our primary outcome is medication adherence measured using eCAP electronic monitoring and self-report. Secondary outcomes are (a) diabetes-specific 5-year CVD risk as measured with the UK Prospective Diabetes Study (UKPDS) Engine score, (b) provider engagement as measured by the CollaboRATE Shared-Decision Making measure, and (c) patient activation measures (PAM). DISCUSSION This study will provide a rigorous pragmatic evaluation of the effectiveness of combined mHealth, and patient activation interventions compared to mHealth alone, targeting patients and healthcare providers in safety net health centers, in improving medication adherence and decreasing CVD risk. Given that 20-50% of adults with chronic illness demonstrate medication non-adherence, increasing adherence is essential to improve CVD outcomes as well as healthcare cost savings. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT04874116.
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Affiliation(s)
- Adesuwa Olomu
- Division of General Internal Medicine, Department of Medicine, Michigan State University, East Lansing, MI, USA.
| | - Karen Kelly-Blake
- grid.17088.360000 0001 2150 1785Center for Bioethics and Social Justice & Department of Medicine, Michigan State University, East Lansing, MI USA
| | - William Hart-Davidson
- grid.17088.360000 0001 2150 1785Department of Writing, Rhetoric, and American Cultures, Michigan State University, East Lansing, MI USA
| | - Joseph Gardiner
- grid.17088.360000 0001 2150 1785Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI USA
| | - Zhehui Luo
- grid.17088.360000 0001 2150 1785Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI USA
| | - Michele Heisler
- grid.214458.e0000000086837370Department of Internal Medicine, University of Michigan, East Lansing, MI USA
| | - Margaret Holmes-Rovner
- grid.17088.360000 0001 2150 1785Center for Bioethics and Social Justice & Department of Medicine, Michigan State University, East Lansing, MI USA
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Pathak LE, Aguilera A, Williams JJ, Lyles CR, Hernandez-Ramos R, Miramontes J, Cemballi AG, Figueroa CA. Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach. JMIR Mhealth Uhealth 2021; 9:e21177. [PMID: 34009130 PMCID: PMC8173396 DOI: 10.2196/21177] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/21/2020] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Text messaging interventions can be an effective and efficient way to improve health behavioral changes. However, most texting interventions are neither tested nor designed with diverse end users, which could reduce their impact, and there is limited evidence regarding the optimal design methodology of health text messages tailored to low-income, low–health literacy populations and non-English speakers. Objective This study aims to combine participant feedback, crowdsourced data, and researcher expertise to develop motivational text messages in English and Spanish that will be used in a smartphone app–based texting intervention that seeks to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms. Methods The design process consisted of 5 phases and was iterative in nature, given that the findings from each step informed the subsequent steps. First, we designed messages to increase physical activity based on the behavior change theory and knowledge from the available evidence. Second, using user-centered design methods, we refined these messages after a card sorting task and semistructured interviews (N=10) and evaluated their likeability during a usability testing phase of the app prototype (N=8). Third, the messages were tested by English- and Spanish-speaking participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform (N=134). Participants on MTurk were asked to categorize the messages into overarching theoretical categories based on the capability, opportunity, motivation, and behavior framework. Finally, each coauthor rated the messages for their overall quality from 1 to 5. All messages were written at a sixth-grade or lower reading level and culturally adapted and translated into neutral Spanish by bilingual research staff. Results A total of 200 messages were iteratively refined according to the feedback from target users gathered through user-centered design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged to discard unappealing messages and edit the thematic aspects of messages that did not resonate well with the target users. Overall, 54 messages were sorted into the correct theoretical categories at least 50% of the time in the MTurk categorization tasks and were rated 3.5 or higher by the research team members. These were included in the final text message bank, resulting in 18 messages per motivational category. Conclusions By using an iterative process of expert opinion, feedback from participants that were reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable inputs for the design of motivational text messages developed in English and Spanish with a low literacy level to increase physical activity. We describe the design considerations and lessons learned for the text messaging development process and provide a novel, integrative framework for future developers of health text messaging interventions.
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Affiliation(s)
- Laura Elizabeth Pathak
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | | | - Courtney Rees Lyles
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Rosa Hernandez-Ramos
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Jose Miramontes
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Anupama Gunshekar Cemballi
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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Gupta SK, Lakshmi PVM, Kaur M, Rastogi A. Role of self-care in COVID-19 pandemic for people living with comorbidities of diabetes and hypertension. J Family Med Prim Care 2020; 9:5495-5501. [PMID: 33532385 PMCID: PMC7842493 DOI: 10.4103/jfmpc.jfmpc_1684_20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/27/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022] Open
Abstract
People living with comorbidities especially chronic non-communicable disease (NCDs) like diabetes and hypertension are at greater risk of acquiring severe form of Corona Virus Disease (COVID-19) infection known to be caused by Severe Acute Respiratory Syndrome-CoV -2 (SARS-CoV-2) due to underlying immunodeficiency. The government has taken various public health measures to reduce the risk of infection, such as physical distancing, Information Education and Communication (IEC) messages regarding hand-washing, usage of masks, and avoidance of unnecessary travel including lockdown to combat the spread of disease. However, nationwide lockdown due to COVID-19 pandemic has also confronted the existing health care system (clinician centric approach) for the management of diabetes and hypertension in India. Using secondary source of data from specific website and search engine a review was done for existing guidelines and literature focusing on the various components of self-care management (patient-centered care) and highlights the importance of self-care management education to cope up with twin pandemic of COVID-19 and NCDs. An attempt was also made to highlight the use of eHealth to manage diabetes and hypertension which may act as a bridge to fill the gap between primary care physician and patient's amid lockdown and help physician to deliver comprehensive care for people suffering from comorbidities.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P. V. M. Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Geerds MAJ, Nijmeijer WS, Hegeman JH, Vollenbroek-Hutten MMR. Mobile App for Monitoring 3-Month Postoperative Functional Outcome After Hip Fracture: Usability Study. JMIR Hum Factors 2020; 7:e16989. [PMID: 32924949 PMCID: PMC7522745 DOI: 10.2196/16989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background As a result of an aging population, there has been an increasing incidence of hip fractures worldwide. In the Netherlands, in order to improve the quality of care for elderly patients with hip fractures, the multidisciplinary Centre for Geriatric Traumatology was established in 2008 at the Department of Trauma Surgery at Ziekenhuisgroep Twente hospital (located in Almelo and Hengelo in the Netherlands). Objective Though the Dutch Hip Fracture audit is used to monitor the quality of care for patients with fractures of the hip, only 30.7% of patients complete registration in the 3-month follow-up period. Mobile apps offer an opportunity for improvement in this area. The aim of this study was to investigate the usability and acceptance of a mobile app for gathering indicators of quality of care in a 3-month follow-up period after postoperative treatment of hip fracture. Methods From July 2017 to December 2017, patients who underwent surgical treatment for hip fracture were recruited. Patients and caregivers, who were collectively considered the participant cohort, were asked to download the app and answer a questionnaire. Participants were divided into two groups—those who downloaded the app and those who did not download the app. A telephone interview that was based upon the Unified Theory of Acceptance and Use of Technology was conducted with a subset of participants from each group (1:1 ratio). This study was designated as not being subject to the Dutch Medical Research Involving Human Subjects Act according to the appropriate medical research ethics committees. Results Of the patients and caregivers who participated, 26.4% (29/110) downloaded the app, whereas 73.6% (81/110) did not. Telephone interviews with the subset of participants (n=24 per group) revealed that 54.0% (13/24) of the group of participants who did not download the app had forgotten the study. Among the group who downloaded the app, 95.8% (23/24) had the intention of completing the questionnaire, but only 4.2% (1/24) did so. The reasons for not completing the questionnaire included technical problems, cognitive disorders, or patient dependency on caregivers. Most participants in the group who downloaded the app self-reported a high level of expertise in using a smartphone (22/24, 91.7%), and sufficient facilitating conditions for using a smartphone were self-reported in both groups (downloaded the app: 23/24, 95.8%; did not download the app: 21/24, 87.5%), suggesting that these factors were not barriers to completion. Conclusions Despite self-reported intention to use the app, smartphone expertise, and sufficient facilitating conditions for smartphone use, implementation of the mobile app was infeasible for daily practice. This was due to a combination of technical problems, factors related to the implementation process, and the population of interest having cognitive disorders or a dependency on caregivers for mobile technology.
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Affiliation(s)
- Merle A J Geerds
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Wieke S Nijmeijer
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands.,Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, Netherlands
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, Netherlands.,Ziekenhuisgroep Twente Academy, Ziekenhuisgroep Twente, Almelo, Netherlands
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Haun JN, Alman AC, Melillo C, Standifer M, McMahon-Grenz J, Shin M, Lapcevic WA, Patel N, Elwy AR. Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project. JMIR Med Inform 2020; 8:e15609. [PMID: 32589163 PMCID: PMC7381258 DOI: 10.2196/15609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/06/2019] [Accepted: 04/27/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. OBJECTIVE This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. METHODS In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. RESULTS This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ≥1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. CONCLUSIONS This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness.
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Affiliation(s)
- Jolie N Haun
- Research Service, James A. Haley VA Medical Center, Tampa, FL, United States.,Department of Community & Family Health, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Amy C Alman
- Research Service, James A. Haley VA Medical Center, Tampa, FL, United States.,Department of Public Health, University of South Florida, Tampa, FL, United States
| | - Christine Melillo
- Research Service, James A. Haley VA Medical Center, Tampa, FL, United States
| | - Maisha Standifer
- Research Service, James A. Haley VA Medical Center, Tampa, FL, United States.,Department of Pharmacy Practice, College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Julie McMahon-Grenz
- Research Service, James A. Haley VA Medical Center, Tampa, FL, United States
| | - Marlena Shin
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - W A Lapcevic
- Research Service, James A. Haley VA Medical Center, Tampa, FL, United States
| | - Nitin Patel
- Performance Improvement and Reporting, VHA Office of Community Care, Department of Veteran Affairs, Washington, DC, United States
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, MA, United States.,Brown University, Providence, RI, United States
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Uhrig Castonguay BJ, Cressman AE, Kuo I, Patrick R, Trezza C, Cates A, Olsen H, Peterson J, Kurth A, Bazerman LB, Beckwith CG. The Implementation of a Text Messaging Intervention to Improve HIV Continuum of Care Outcomes Among Persons Recently Released From Correctional Facilities: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16220. [PMID: 32053119 PMCID: PMC7055782 DOI: 10.2196/16220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/19/2019] [Accepted: 10/20/2019] [Indexed: 01/19/2023] Open
Abstract
Background Previously incarcerated individuals have suboptimal linkage and engagement in community HIV care. Mobile health (mHealth) interventions have been shown to be effective in addressing these gaps. In Washington, District of Columbia (DC), we conducted a randomized trial of an SMS text messaging–based mHealth intervention (CARE+ Corrections) to increase linkage to community HIV care and antiretroviral treatment adherence among HIV-infected persons involved in the criminal justice system. Objective This study aimed to describe the SMS text messaging–based intervention, participant use of the intervention, and barriers and facilitators of implementation. Methods From August 2013 to April 2015, HIV-positive incarcerated individuals were recruited within the DC Department of Corrections, and persons released in the past 6 months were recruited within the community via street-based recruitment, community partnerships, and referrals. Participants were followed for 6 months and received weekly or daily SMS text messages. Formative research resulted in the development of the content of the messages in 4 categories: HIV Appointment Reminders, Medication Adherence, Prevention Reminders, and Barriers to Care following release from jail. Participants could customize the timing, frequency, and message content throughout the study period. Results Of the 112 participants enrolled, 57 (50.9%) were randomized to the intervention group and 55 (49.1%) to the control group; 2 control participants did not complete the baseline visit, and were dropped from the study, leaving a total of 110 participants who contributed to the analyses. Study retention was similar across both study arms. Median age was 42 years (IQR 30-50), 86% (49/57) were black or African American, 58% (33/57) were male, 25% (14/57) were female, and 18% (10/57) were transgender. Median length of last incarceration was 4 months (IQR 1.7-9.0), and median lifetime number of times incarcerated was 6.5 (IQR 3.5-14.0). Most participants (32/54, 59%) had a baseline viral load of <200 copies/mL. Nearly all participants (52/57, 91%) chose to use a cell phone provided by the study. The most preferred Appointment Reminder message was Hey how you feeling? Don’t forget to give a call and make your appointment (19/57, 33%). The most preferred Medication Adherence message was Don’t forget your skittles! (31/57, 54%), and 63% (36/57) of participants chose to receive daily (vs weekly) messages from this category at baseline. The most preferred Prevention Reminder message was Stay strong. Stay clean (18/57, 32%). The most preferred Barriers to Care message was Holla at your case manager, they’re here to help (12/57, 22%). Minor message preference differences were observed among participants enrolled in the jail versus those from the community. Conclusions Participants’ ability to customize their SMS text message plan proved helpful. Further large-scale research on mHealth platforms is needed to assess its efficacy among HIV-infected persons with a history of incarceration. Trial Registration ClinicalTrials.gov NCT01721226; https://clinicaltrials.gov/ct2/show/NCT01721226
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Affiliation(s)
- Breana J Uhrig Castonguay
- University of North Carolina Center for AIDS Research, Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Andrew E Cressman
- The Center for Prisoner Health and Human Rights, Providence, RI, United States.,Brown University School of Public Health, Providence, RI, United States
| | - Irene Kuo
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States.,District of Columbia Center for AIDS Research, Washington, DC, United States
| | - Rudy Patrick
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Claudia Trezza
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Alice Cates
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Halli Olsen
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - James Peterson
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States.,District of Columbia Center for AIDS Research, Washington, DC, United States
| | - Ann Kurth
- Yale University School of Nursing, New Haven, CT, United States
| | | | - Curt G Beckwith
- The Miriam Hospital, Providence, RI, United States.,Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, United States
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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9
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Reading MJ, Merrill JA. Converging and diverging needs between patients and providers who are collecting and using patient-generated health data: an integrative review. J Am Med Inform Assoc 2019; 25:759-771. [PMID: 29471330 PMCID: PMC5978018 DOI: 10.1093/jamia/ocy006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/29/2018] [Indexed: 12/11/2022] Open
Abstract
Objective This integrative review identifies convergent and divergent areas of need for collecting and using patient-generated health data (PGHD) identified by patients and providers (i.e., physicians, nurses, advanced practice nurses, physician assistants, and dietitians). Methods A systematic search of 9 scholarly databases targeted peer-reviewed studies published after 2010 that reported patients’ and/or providers’ needs for incorporating PGHD in clinical care. The studies were assessed for quality and bias with the Mixed-Methods Appraisal Tool. The results section of each article was coded to themes inductively developed to categorize patient and provider needs. Distinct claims were extracted and areas of convergence and divergence identified. Results Eleven studies met inclusion criteria. All had moderate to low risk of bias. Three themes (clinical, logistic, and technological needs), and 13 subthemes emerged. Forty-eight claims were extracted. Four were divergent and twenty were convergent. The remainder was discussed by only patients or only providers. Conclusion As momentum gains for integrating PGHD into clinical care, this analysis of primary source data is critical to understanding the requirements of the 2 groups directly involved in collection and use of PGHD.
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Affiliation(s)
| | - Jacqueline A Merrill
- School of Nursing, Columbia University, New York, NY 10032, USA.,School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
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10
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Lygidakis C, Uwizihiwe JP, Kallestrup P, Bia M, Condo J, Vögele C. Community- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda (D²Rwanda): the protocol of a mixed-methods study including a cluster randomised controlled trial. BMJ Open 2019; 9:e028427. [PMID: 31345971 PMCID: PMC6661689 DOI: 10.1136/bmjopen-2018-028427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has introduced the home-based care practitioners (HBCPs) programme: laypeople provide longitudinal care to chronic patients after receiving a six-month training. Leveraging technological mobile solutions may also help improve health and healthcare. The D²Rwanda study aims at: (a) determining the efficacy of an integrated programme for the management of diabetes in Rwanda, which will provide monthly patient assessments by HBCPs, and an educational and self-management mHealth patient tool, and; (b) exploring qualitatively the ways the interventions will have been enacted, their challenges and effects, and changes in the patients' health behaviours and HBCPs' work satisfaction. METHODS AND ANALYSIS This is a mixed-methods sequential explanatory study. First, there will be a one-year cluster randomised controlled trial including two interventions ((1) HBCPs' programme; (2) HBCPs' programme + mobile health application) and usual care (control). Currently, nine hospitals run the HBCPs' programme. Under each hospital, administrative areas implementing the HBCPs' programme will be randomised to receive intervention 1 or 2. Eligible patients from each area will receive the same intervention. Areas without the HBCPs' programme will be assigned to the control group. The primary outcome will be changes in glycated haemoglobin. Secondary outcomes include medication adherence, mortality, complications, health-related quality of life, diabetes-related distress and health literacy. Second, at the end of the trial, focus group discussions will be conducted with patients and HBCPs. Financial support was received from the Karen Elise Jensens Fond, and the Universities of Aarhus and Luxembourg. ETHICS AND DISSEMINATION Ethics approval was obtained from the Rwanda National Ethics Committee and the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03376607; Pre-results.
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Affiliation(s)
- Charilaos Lygidakis
- Institute for Health and Behaviour – Research Unit INSIDE, Universite du Luxembourg, Esch-sur-Alzette, Luxembourg
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Jean Paul Uwizihiwe
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
- Centre for Global Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Michela Bia
- Labor Market, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Jeanine Condo
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
| | - Claus Vögele
- Institute for Health and Behaviour – Research Unit INSIDE, Universite du Luxembourg, Esch-sur-Alzette, Luxembourg
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11
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Salari R, R Niakan Kalhori S, Ghazisaeidi M, Fatehi F. Conformity of Diabetes Mobile apps with the Chronic Care Model. BMJ Health Care Inform 2019; 26:bmjhci-2019-000017. [PMID: 31039125 PMCID: PMC7062315 DOI: 10.1136/bmjhci-2019-000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
Background Despite the growing use of mobile applications (apps) for chronic disease management, the evidence on the effectiveness of this technology on clinical and behavioural outcomes of the patients is scant. Many studies highlight the importance of the theoretical foundations of mobile-based interventions. One of the most widely accepted models for the management of chronic diseases, such as diabetes, is the Chronic Care Model (CCM). In this study, we investigated the conformity of the selected diabetes mobile apps with CCM. Method We searched online journal databases related to diabetes mobile apps to find common features. Then considering the components of the CCM as a reference model, features of some popular and top-ranking apps were compared with CCM. Results Among 23 studied apps, 34 per cent of them had medium conformity and 66 per cent of these apps were in weak conformity. The self-management support component is covered by 100 per cent of them. Ninety-five per cent of apps have covered the proactive follow-up component. Conclusions App conformance with CCM is generally weak. App developers are recommended to give greater consideration to established theoretical models in their design and implementation.
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Affiliation(s)
- Raheleh Salari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Marjan Ghazisaeidi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Farhad Fatehi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Science, Tehran, Iran.,Australian eHealth Research Centre, CSIRO, Brisbane, Queensland, Australia.,Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
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12
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Menon A, Gray L, Fatehi F, Bird D, Darssan D, Karunanithi M, Russell A. Mobile-based insulin dose adjustment for type 2 diabetes in community and rural populations: study protocol for a pilot randomized controlled trial. Ther Adv Endocrinol Metab 2019; 10:2042018819836647. [PMID: 30967927 PMCID: PMC6444780 DOI: 10.1177/2042018819836647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Insulin initiation and/or titration for type 2 diabetes (T2DM) is often delayed as it is a resource-intensive process, often requiring frequent exchange of information between a patient and their diabetes healthcare professional, such as a credentialed diabetes educator (CDE) for insulin dose adjustment (IDA). Existing models of IDA are unlikely to meet the increasing service demand unless efficiencies are increased. Mobile health (mHealth), a subset of Ehealth, has been shown to improve glycaemic control through enhanced self-management and feedback leading to improved patient satisfaction and could simultaneously reduce costs. Considering the potential benefits of mHealth, we have developed an innovative mHealth-based care model to support patients and clinicians in diabetes specialist community outreach and telehealth clinics, that is, REthinking Model of Outpatient Diabetes care utilizing EheaLth - Insulin Dose Adjustment (REMODEL-IDA). This model primarily aims to improve the glycaemic management of patients with T2DM on insulin, with the secondary aims of improving healthcare service delivery efficiency and the patients' experience. METHODS/DESIGN A two-arm pilot randomized controlled trial (RCT) will be conducted for 3 months with 44 participants, randomized at a 1:1 ratio to receive either the mHealth-based model of care (intervention) or routine care (control), in diabetes specialist community outreach and telehealth clinics. The intervention arm will exchange information related to blood glucose levels via the Mobile Diabetes Management System developed for outpatients with T2DM. They will receive advice on insulin titration from the CDE via the mobile-app and receive automated text-message prompts for better self-management based on their blood glucose levels and frequency of blood glucose testing. The routine care arm will be followed up via telephone calls by the CDE as per usual practice. The primary outcome is change in glycated haemoglobin, a marker of glycaemic management, at 3 months. Patient and healthcare provider satisfaction, and time required to perform IDA by healthcare providers in both arms will be collected. This pilot study will guide the conduct of a large-scale pragmatic RCT in regional Australia.
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Affiliation(s)
| | - Leonard Gray
- The University of Queensland, Centre for Health
Services Research, Brisbane, Australia
| | - Farhad Fatehi
- The University of Queensland, Centre for Health
Services Research, Brisbane, Australia, and CSIRO Australian eHealth
Research Centre, Brisbane, Australia
| | - Dominique Bird
- The University of Queensland, Centre for Health
Services Research, Brisbane, Australia
| | - Darsy Darssan
- The University of Queensland, School of Public
Health, Brisbane, Australia
| | | | - Anthony Russell
- Department of Diabetes and Endocrinology,
Princess Alexandra Hospital, Woolloongabba, Australia, and The University of
Queensland, Faculty of Medicine, Brisbane, Australia
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13
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Anderson-Lewis C, Darville G, Mercado RE, Howell S, Di Maggio S. mHealth Technology Use and Implications in Historically Underserved and Minority Populations in the United States: Systematic Literature Review. JMIR Mhealth Uhealth 2018; 6:e128. [PMID: 29914860 PMCID: PMC6028762 DOI: 10.2196/mhealth.8383] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/31/2018] [Accepted: 03/14/2018] [Indexed: 11/26/2022] Open
Abstract
Background The proportion of people in the United States who are members of at least two ethnic groups is projected to increase to 10% by the year 2050. This makes addressing health disparities and health inequities in minority populations increasingly more difficult. Minority populations, including those who classify themselves as African American and Hispanic, are using mobile phones to access health information via the internet more frequently than those who classify themselves as white, providing unique opportunities for those in public health and health education to reach these traditionally underserved populations using mobile health (mHealth) interventions. Objective The objective of this review was to assess studies conducted in the United States that have used mHealth tools and strategies to develop and implement interventions in underserved populations. This review also examines the ways in which mHealth strategies are being employed in public health interventions to these priority population groups, as mobile phone capabilities include text messaging, mobile apps, internet access, emails, video streaming, social media, instant messaging, and more. Methods A systematic literature review was conducted using key search phrases, the matrix method, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart diagram to identify key studies conducted between the years of 2009-2016 in the United States. These studies were reviewed for their use of mHealth interventions in historically underserved and minority populations. Results A total of 16,270 articles were initially identified using key search phrases in three databases. Titles were reviewed and articles not meeting criteria were excluded, leaving 156 articles for further review. After additional review for relevance and inclusion criteria, 16 articles were qualified and analyzed. Conclusions mHealth is a promising area of development for public health and health education. While successful research has been done using text messaging (short message service, SMS) and other mHealth strategies, there is a need for more research using mobile phones and tablet applications. This literature review demonstrates mHealth technology has the ability to increase prevention and health education in health disparate communities and concludes that more specified research is needed.
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Affiliation(s)
| | - Gabrielle Darville
- College of Public Health, University of Georgia, Athens, GA, United States
| | - Rebeccah Eve Mercado
- College of Medicine, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Savannah Howell
- Department of Public Health, University of Southern Mississippi, Hattiesburg, MS, United States
| | - Samantha Di Maggio
- Department of Public Health, University of Southern Mississippi, Hattiesburg, MS, United States
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14
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Sigler BE. Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study. JMIR Mhealth Uhealth 2017; 5:e36. [PMID: 28325711 PMCID: PMC5380813 DOI: 10.2196/mhealth.5892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/07/2016] [Accepted: 01/30/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting. OBJECTIVE The aim of our study was to investigate care coordinators' perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI). METHODS Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement. RESULTS The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients' agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship. CONCLUSIONS Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations.
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Affiliation(s)
- Brittany Erika Sigler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.,Wellpass (formerly Sense Health), New York, NY, United States
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15
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Matthew-Maich N, Harris L, Ploeg J, Markle-Reid M, Valaitis R, Ibrahim S, Gafni A, Isaacs S. Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review. JMIR Mhealth Uhealth 2016; 4:e29. [PMID: 27282195 PMCID: PMC4919548 DOI: 10.2196/mhealth.5127] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/11/2015] [Accepted: 11/29/2015] [Indexed: 11/30/2022] Open
Abstract
Background The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. Conclusions There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.
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Affiliation(s)
- Nancy Matthew-Maich
- Aging, Community & Health Research Unit, McMaster University, Mohawk College/McMaster University School of Nursing, Hamilton, ON, Canada.
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16
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Peek ME, Ferguson MJ, Roberson TP, Chin MH. Putting theory into practice: a case study of diabetes-related behavioral change interventions on Chicago's South Side. Health Promot Pract 2015; 15:40S-50S. [PMID: 25359248 DOI: 10.1177/1524839914532292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes self-management is central to diabetes care overall, and much of self-management entails individual behavior change, particularly around dietary patterns and physical activity. Yet individual-level behavior change remains a challenge for many persons with diabetes, particularly for racial/ethnic minorities who disproportionately face barriers to diabetes-related behavioral changes. Through the South Side Diabetes Project, officially known as "Improving Diabetes Care and Outcomes on the South Side of Chicago," our team sought to improve health outcomes and reduce disparities among residents in the largely working-class African American communities that comprise Chicago's South Side. In this article, we describe several aspects of the South Side Diabetes Project that are directly linked to patient behavioral change, and discuss the theoretical frameworks we used to design and implement our programs. We also briefly discuss more downstream program elements (e.g., health systems change) that provide additional support for patient-level behavioral change.
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17
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Chin MH, Goddu AP, Ferguson MJ, Peek ME. Expanding and sustaining integrated health care-community efforts to reduce diabetes disparities. Health Promot Pract 2015; 15:29S-39S. [PMID: 25359247 DOI: 10.1177/1524839914532649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To reduce racial and ethnic disparities in diabetes care and outcomes, it is critical to integrate health care and community approaches. However, little work describes how to expand and sustain such partnerships and initiatives. We outline our experience creating and growing an initiative to improve diabetes care and outcomes in the predominantly African American South Side of Chicago. Our project involves patient education and activation, a quality improvement collaborative with six clinics, provider education, and community partnerships. We aligned our project with the needs and goals of community residents and organizations, the mission and strategic plan of our academic medical center, various strengths and resources in Chicago, and the changing health care marketplace. We use the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change conceptual model and the Consolidated Framework for Implementation Research to elucidate how we expanded and sustained our project within a shifting environment. We recommend taking action to integrate health care with community projects, being inclusive, building partnerships, working with the media, and understanding vital historical, political, and economic contexts.
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18
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Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Serv Res 2015; 15:194. [PMID: 25958128 PMCID: PMC4448852 DOI: 10.1186/s12913-015-0854-8] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background The increasing prevalence of chronic disease and even multiple chronic diseases faced by both developed and developing countries is of considerable concern. Many of the interventions to address this within primary healthcare settings are based on a chronic care model first developed by MacColl Institute for Healthcare Innovation at Group Health Cooperative. Methods This systematic literature review aimed to identify and synthesise international evidence on the effectiveness of elements that have been included in a chronic care model for improving healthcare practices and health outcomes within primary healthcare settings. The review broadens the work of other similar reviews by focusing on effectiveness of healthcare practice as well as health outcomes associated with implementing a chronic care model. In addition, relevant case series and case studies were also included. Results Of the 77 papers which met the inclusion criteria, all but two reported improvements to healthcare practice or health outcomes for people living with chronic disease. While the most commonly used elements of a chronic care model were self-management support and delivery system design, there were considerable variations between studies regarding what combination of elements were included as well as the way in which chronic care model elements were implemented. This meant that it was impossible to clearly identify any optimal combination of chronic care model elements that led to the reported improvements. Conclusions While the main argument for excluding papers reporting case studies and case series in systematic literature reviews is that they are not of sufficient quality or generalizability, we found that they provided a more detailed account of how various chronic care models were developed and implemented. In particular, these papers suggested that several factors including supporting reflective healthcare practice, sending clear messages about the importance of chronic disease care and ensuring that leaders support the implementation and sustainability of interventions may have been just as important as a chronic care model’s elements in contributing to the improvements in healthcare practice or health outcomes for people living with chronic disease. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0854-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carol Davy
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
| | - Jonathan Bleasel
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Maria Tchan
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Sharon Ponniah
- The George Institute for Global Health, Camperdown, New South Wales, Australia.
| | - Alex Brown
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia.
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Holcomb LS. A Taxonomic Integrative Review of Short Message Service (SMS) Methodology: A Framework for Improved Diabetic Outcomes. J Diabetes Sci Technol 2015; 9:1321-6. [PMID: 25934517 PMCID: PMC4667321 DOI: 10.1177/1932296815585132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To acquire self-management skills that affect clinical outcomes, collaboration and communication with one's health care team is essential, yet many health care systems are not designed adequately to be responsive to a patient's efforts to self-manage. This review synthesizes the intervention methodology of current studies facilitating the efforts of health care providers who wish to design, develop, and implement evidence-based SMS programs for patients with diabetes, focusing on clinical outcomes of A1C values, medication adherence rates, and participant satisfaction. METHODS This integrative review was conducted using an integrative taxonomic analysis approach. This approach involves creating a classification system with domains or characteristics, defining the relationships between those domains, and creating a foundation for new theories or constructs. RESULTS Synthesis of the evidence included in this integrated review suggests the best design for a SMS diabetes management program aimed at improving A1C levels, medication adherence rates, and participant satisfaction is an intervention providing weekly SMS education, with 2-way message direction, that is 3 months in length. CONCLUSIONS The studies in this review have demonstrated that SMS interventions can be an important part of a viable and effective program in the effort to better manage adults with type 2 diabetes.
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Affiliation(s)
- Linda S Holcomb
- College of Nursing and Health Professions, Valparaiso University, Valparaiso, IN, USA
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20
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Nundy S, Dick JJ, Chou CH, Nocon RS, Chin MH, Peek ME. Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants. Health Aff (Millwood) 2015; 33:265-72. [PMID: 24493770 DOI: 10.1377/hlthaff.2013.0589] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Even with the best health care available, patients with chronic illnesses typically spend no more than a few hours a year in a health care setting, while their outcomes are largely determined by their activities during the remaining 5,000 waking hours of the year. As a widely available, low-cost technology, mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. We examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes who belonged to an academic medical center's employee health plan. In addition to pre-post improvements in glycemic control (p=0.01) and patients' satisfaction with overall care (p=0.04), we observed a net cost savings of 8.8 percent. Those early results suggest that mHealth programs can support health care organizations' pursuit of the triple aim of improving patients' experiences with care, improving population health, and reducing the per capita cost of health care
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21
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Performance assessment of a closed-loop system for diabetes management. Med Biol Eng Comput 2015; 53:1295-303. [PMID: 25667016 DOI: 10.1007/s11517-015-1245-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 01/23/2015] [Indexed: 10/24/2022]
Abstract
Telemedicine systems can play an important role in the management of diabetes, a chronic condition that is increasing worldwide. Evaluations on the consistency of information across these systems and on their performance in a real situation are still missing. This paper presents a remote monitoring system for diabetes management based on physiological sensors, mobile technologies and patient/doctor applications over a service-oriented architecture that has been evaluated in an international trial (83,905 operation records). The proposed system integrates three types of running environments and data engines in a single service-oriented architecture. This feature is used to assess key performance indicators comparing them with other type of architectures. Data sustainability across the applications has been evaluated showing better outcomes for full integrated sensors. At the same time, runtime performance of clients has been assessed spotting no differences regarding the operative environment.
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Gammon D, Berntsen GKR, Koricho AT, Sygna K, Ruland C. The chronic care model and technological research and innovation: a scoping review at the crossroads. J Med Internet Res 2015; 17:e25. [PMID: 25677200 PMCID: PMC4342659 DOI: 10.2196/jmir.3547] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/26/2014] [Accepted: 12/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background Information and communication technologies (ICT) are key to optimizing the outcomes of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence for chronic illness prevention and management. At the same time, CCM can offer a needed framework for increasing the relevance and feasibility of ICT innovation and research in health care. Little is known about how and to what extent CCM and ICT research inform each other to leverage mutual strengths. The current study examines: What characterizes work being done at the crossroads of CCM and ICT research and innovation? Objective Our aim is identify the gaps and potential that lie between the research domains CCM and ICT, thus enabling more substantive questions and opportunities for accelerating improvements in ICT-supported chronic care. Methods Using a scoping study approach, we developed a search strategy applied to medical and technical databases resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20 studies were found to fulfill our criteria. Following initial coding of each article according to predefined categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted resulting in a broad range of categories. These were gradually reduced by constantly comparing them for underlying commonalities and discrepancies. Results None of the studies included were from technical databases and interventions relied mostly on “old-fashioned” technologies. Technologies supporting “productive interactions” were often one-way (provider to patient), and it was sometimes difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to support providers did not appear unique to the challenges of chronic care. Challenges in facilitating CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack of integration with existing infrastructure. Conclusions The CCM is a highly influential guide for health care development, which recognizes the need for alignment of system tools such as ICT. Yet, there seem to be alarmingly few touch points between the subject fields of “health service development” and “ICT-innovation”. Bridging these gaps needs explicit and urgent attention as the synergies between these domains have enormous potential. Policy makers and funding agencies need to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic care system redesign that is required for tackling the current epidemic of long-term multiple conditions.
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Affiliation(s)
- Deede Gammon
- Norwegian Center for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsoe, Norway.
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Fioravanti A, Fico G, Salvi D, García-Betances RI, Arredondo MT. Automatic messaging for improving patients engagement in diabetes management: an exploratory study. Med Biol Eng Comput 2015; 53:1285-94. [PMID: 25564181 DOI: 10.1007/s11517-014-1237-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 12/22/2014] [Indexed: 12/31/2022]
Abstract
Mobile health systems aiming to promote adherence may cost-effectively improve the self-management of chronic diseases like diabetes, enhancing the compliance to the medical prescription, encouraging and stimulating patients to adopt healthy life styles and promoting empowerment. This paper presents a strategy for m-health applications in diabetes self-management that is based on automatic generation of feedback messages. A feedback assistant, representing the core of architecture, delivers dynamic and automatically updated text messages set up on clinical guideline and patient's lifestyle. Based on this strategy, an m-health adherence system was designed, developed and tested in a small-scale exploratory study with T1DM and T2DM patients. The results indicate that the system could be feasible and well accepted and that its usage increased along with adherence to prescriptions during the 4 weeks of the study. A more extensive research is pending to corroborate these outcomes and to establish a clear benefit of the proposed solution.
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Affiliation(s)
- Alessio Fioravanti
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain.
| | - Giuseppe Fico
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
| | - Dario Salvi
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
| | - Rebeca I García-Betances
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
| | - Maria Teresa Arredondo
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
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Nundy S, Mishra A, Hogan P, Lee SM, Solomon MC, Peek ME. How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. DIABETES EDUCATOR 2014; 40:806-19. [PMID: 25278512 DOI: 10.1177/0145721714551992] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to investigate the behavioral effects of a theory-driven, mobile phone-based intervention that combines automated text messaging and remote nursing, using an automated, interactive text messaging system. METHODS This was a mixed methods observational cohort study. Study participants were members of the University of Chicago Health Plan (UCHP) who largely reside in a working-class, urban African American community. Surveys were conducted at baseline, 3 months (mid-intervention), and 6 months (postintervention) to test the hypothesis that the intervention would be associated with improvements in self-efficacy, social support, health beliefs, and self-care. In addition, in-depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention. RESULTS The intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating) and improvements in 1 or more measures of self-efficacy, social support, and health beliefs (perceived control). Qualitatively, participants reported that knowledge, attitudes, and ownership were also affected by the program. Together these findings were used to construct a new behavioral model. CONCLUSIONS This study's findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change.
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Affiliation(s)
- Shantanu Nundy
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois (Dr Nundy, Ms Mishra, Mr Hogan, Dr Peek),Chicago Center for Diabetes Translation Research, Chicago, Illinois (Dr Nundy, Dr Peek)
| | - Anjuli Mishra
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois (Dr Nundy, Ms Mishra, Mr Hogan, Dr Peek)
| | - Patrick Hogan
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois (Dr Nundy, Ms Mishra, Mr Hogan, Dr Peek)
| | - Sang Mee Lee
- Department of Health Studies, University of Chicago, Chicago, Illinois (Dr Lee)
| | - Marla C Solomon
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois (Ms Solomon)
| | - Monica E Peek
- Department of Health Studies, University of Chicago, Chicago, Illinois (Dr Lee),Center for Health and Social Sciences, University of Chicago, Chicago, Illinois (Dr Peek),Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, Illinois (Dr Peek)
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25
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Nundy S, Lu CYE, Hogan P, Mishra A, Peek ME. Using Patient-Generated Health Data From Mobile Technologies for Diabetes Self-Management Support: Provider Perspectives From an Academic Medical Center. J Diabetes Sci Technol 2014; 8:74-82. [PMID: 24876541 PMCID: PMC4454095 DOI: 10.1177/1932296813511727] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mobile health and patient-generated health data are promising health IT tools for delivering self-management support in diabetes, but little is known about provider perspectives on how best to integrate these programs into routine care. We explored provider perceptions of a patient-generated health data report from a text-message-based diabetes self-management program. The report was designed to relay clinically relevant data obtained from participants' responses to self-assessment questions delivered over text message. METHODS Likert-type scale response surveys and in-depth interviews were conducted with primary care physicians and endocrinologists who pilot tested the patient-generated health data report in an actual clinical encounter. Interview guides were designed to assess providers' perceptions of the feasibility and utility of patient-generated health data in routine clinical practice. Interviews were audiotaped, transcribed, and analyzed using the constant comparative method. RESULTS Twelve providers successfully piloted the summary report in clinic. Although only a minority of providers felt the report changed the care they provided (3 of 12 or 25%), most were willing to use the summary report in a future clinical encounter (9 of 12 or 75%). Perceived benefits of patient-generated health data included agenda setting, assessment of self-care, and identification of patient barriers. Major themes discussed included patient selection, reliability of patient-generated health information, and integration into clinical workflow. CONCLUSION Providers perceived multiple benefits of patient-generated health data in overcoming common barriers to self-management support in clinical practice and found the summary report feasible and usable in a clinical context.
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Affiliation(s)
- Shantanu Nundy
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA
| | - Chen-Yuan E Lu
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Patrick Hogan
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Anjuli Mishra
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, IL, USA
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Lee J, Rho MJ. Perception of Influencing Factors on Acceptance of Mobile Health Monitoring Service: A Comparison between Users and Non-users. Healthc Inform Res 2013; 19:167-76. [PMID: 24175115 PMCID: PMC3810524 DOI: 10.4258/hir.2013.19.3.167] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/06/2013] [Accepted: 09/17/2013] [Indexed: 01/18/2023] Open
Abstract
Objectives To improve and promote mobile health monitoring services, this study investigated the perception of various factors influencing the acceptance of services between users and non-users. Methods This study drew 9 variables from studies related to mobile health monitoring services and the unified theory of acceptance and the use of technology model. A total of 219 samples were collected by a paper-based survey from users (n = 106) and non-users (n = 113). Analysis was carried out using a two-independent samples t-test. Results The findings indicate that users have a more positive perception of service benefits than non-users. Although there were difference between users and non-users, all respondents had a positive perception of the service benefits. After users used the service, they were less concerned about the risks involved with it. However, both users and non-users had a high negative perception of service risk. Users also had a more positive perception of intimacy and communication associated with the services than non-users. Both users and non-users had a high behavioral intention to use the services. Finally, this study observed that older subjects tended to recognize the higher value of the services. Conclusions This study provides insights to improve and invigorate mobile health monitoring services. This study also offers insights into how to increase the number of users of mobile health monitoring services in South Korea.
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Affiliation(s)
- Jaebeom Lee
- Graduate School of Business, Sogang University, Seoul, Korea
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