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Griggs S, Ash GI, Pignatiello G, Papik A, Huynh J, Leuchtag M, Hickman RL. Internet-Based Recruitment and Retention of Young Adults With Type 1 Diabetes: Cross-Sectional Study. JMIR Form Res 2023; 7:e46415. [PMID: 37606985 PMCID: PMC10481220 DOI: 10.2196/46415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Multiple research strategies are required to recruit and engage a representative cohort of young adults in diabetes research. In this report, we describe an approach for internet-based recruitment for a repeated-measures descriptive study. OBJECTIVE The objective of this cross-sectional study was to determine whether internet-based recruitment through multiple social media platforms, a clinical research platform, and cooperation with community partnerships-College Diabetes Network and Beyond Type 1-would serve as an effective way to recruit a representative sample of young adults aged 18-25 years with type 1 diabetes (T1D). METHODS We conducted a repeated-measures descriptive study. We captured enrollment rates and participant characteristics acquired from each social media platform through survey data and Facebook analytics. This study was advertised via paid postings across a combination of different social media platforms (eg, Facebook, Instagram, Twitter, and Reddit). We used quarterly application postings, quarterly newsletters, and participation in the ResearchMatch registry to identify potentially eligible participants from February 3, 2021, to June 6, 2022. RESULTS ResearchMatch proved to be the most cost-effective strategy overall, yielding the highest gender and racial diversity compared to other internet platforms (eg, Facebook, Instagram, Twitter, and Reddit), application postings (eg, Beyond Type 1), and newsletters (eg, College Diabetes Network and a local area college). However, we propose that the combination of these approaches yielded a larger, more diverse sample compared to any individual strategy. Our recruitment cost was US $16.69 per eligible participant, with a 1.27% conversion rate and a 30% eligibility rate. CONCLUSIONS Recruiting young adults with T1D across multiple internet-based platforms was an effective strategy to yield a moderately diverse sample. Leveraging various recruitment strategies is necessary to produce a representative sample of young adults with T1D. As the internet becomes a larger forum for study recruitment, participants from underrepresented backgrounds may continue engaging in research through advertisements on the internet and other internet-based recruitment platforms.
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Affiliation(s)
- Stephanie Griggs
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH, United States
| | - Garrett I Ash
- Yale School of Medicine, New Haven, CT, United States
| | - Grant Pignatiello
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH, United States
| | - AnnMarie Papik
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH, United States
| | - Johnathan Huynh
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH, United States
| | - Mary Leuchtag
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH, United States
| | - Ronald L Hickman
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH, United States
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2
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Dahlberg M, Lek M, Malmqvist Castillo M, Bylund A, Hasson H, Riggare S, Reinius M, Wannheden C. Objectives and outcomes of patient-driven innovations published in peer-reviewed journals: a qualitative analysis of publications included in a scoping review. BMJ Open 2023; 13:e071363. [PMID: 37263703 PMCID: PMC10255190 DOI: 10.1136/bmjopen-2022-071363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to gain a deeper understanding of the objectives and outcomes of patient-driven innovations that have been published in the scientific literature, focusing on (A) the unmet needs that patient-driven innovations address and (B) the outcomes for patients and healthcare that have been reported. METHODS We performed an inductive qualitative content analysis of scientific publications that were included in a scoping review of patient-driven innovations, previously published by our research group. The review was limited to English language publications in peer-reviewed journals, published in the years 2008-2020. RESULTS In total, 83 publications covering 21 patient-driven innovations were included in the analysis. Most of the innovations were developed for use on an individual or community level without healthcare involvement. We created three categories of unmet needs that were addressed by these innovations: access to self-care support tools, open sharing of information and knowledge, and patient agency in self-care and healthcare decisions. Eighteen (22%) publications reported outcomes of patient-driven innovations. We created two categories of outcomes: impact on self-care, and impact on peer interaction and healthcare collaboration. CONCLUSIONS The patient-driven innovations illustrated a diversity of innovative approaches to facilitate patients' and informal caregivers' daily lives, interactions with peers and collaborations with healthcare. As our findings indicate, patients and informal caregivers are central stakeholders in driving healthcare development and research forward to meet the needs that matter to patients and informal caregivers. However, only few studies reported on outcomes of patient-driven innovations. To support wider implementation, more evaluation studies are needed, as well as research into regulatory approval processes, dissemination and governance of patient-driven innovations.
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Affiliation(s)
- Marie Dahlberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Madelen Lek
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Moa Malmqvist Castillo
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Ami Bylund
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Stockholms Lans Landsting, Stockholm, Sweden
| | - Sara Riggare
- Participatory eHealth and Health Data, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
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3
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Ramfelt K, Andersson Gäre B, Andersson AC, Petersson C. 'It's like a never-ending diabetes youth camp': Co-designing a digital social network for young people with type 1 diabetes. Health Expect 2023; 26:662-669. [PMID: 36541231 PMCID: PMC10010099 DOI: 10.1111/hex.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Living with a chronic condition such as type 1 diabetes (T1D) affects everyday life and support from others experiencing a similar situation can be helpful. A way to receive such support is to use an online network where people can connect and share experiences. Research has described the benefits of using such tools for connecting patients. The aim of this study was to describe the co-design of a social network for young people with T1D and to describe their experiences when using this network. METHODS A co-design approach was used, following three steps adapted from Sanders and Stappers (2008). In all, 36 adolescents with T1D participated. Data in the form of recordings and notes from telephone interviews, workshops and focus groups were collected and then analysed using content analysis. Numerical data from the digital platform were also used. FINDINGS For the interpersonal values, supporting, learning and relating to emerge, the framework of the network must be appealing and user-friendly. The limits of time and place are eliminated, and there is a possibility for many more to join in. CONCLUSION Co-design ensures that what stakeholders think is important forms the basis for the design. The interpersonal values that are promoted are ones that only the exchange of lived knowledge and experience can generate. It is complementary to the support that healthcare professionals can offer; thus, this kind of social network is important for improved, coproduced care. PATIENT OR PUBLIC CONTRIBUTION The participants in the present study were persons living with T1D. They were active co-creators from the start to the end. An adult person with experience of living with T1D was involved as an advisor in the research team when drafting the manuscript.
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Affiliation(s)
- Kerstin Ramfelt
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Qulturum-Center for Learning and Innovation in Healthcare, Jönköping, Sweden
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Futurum, Jönköping, Sweden
| | - Ann-Christine Andersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Health Society and Health Science, Malmö University, Malmö, Sweden
| | - Christina Petersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Qulturum-Center for Learning and Innovation in Healthcare, Jönköping, Sweden
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4
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Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, Agarwal S, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022; 23:857-871. [PMID: 36250644 PMCID: PMC9828225 DOI: 10.1111/pedi.13408] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- John W. Gregory
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Fergus J. Cameron
- Royal Children's HospitalMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia,Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Kriti Joshi
- Department of Endocrinology & DiabetesQueensland Children's HospitalSouth BrisbaneAustralia
| | - Mirjam Eiswirth
- Department of Anglophone StudiesUniversität Duisburg EssenEssenGermany
| | - Christopher Garrett
- Institute of Psychiatry, Psychology and NeuroscienceBart's Health and East London Foundation TrustLondonUK
| | - Katharine Garvey
- Division of EndocrinologyBoston Children's HospitalBostonMassachusettsUSA
| | - Shivani Agarwal
- Department of Medicine (Endocrinology), Albert Einstein College of MedicineMontefiore Medical CenterBronxNew YorkUSA
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de MedicinaUniversity of ChileSantiagoChile
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Frenzel SB, Kaluza AJ, Junker NM, van Dick R. Sweet as Sugar-How Shared Social Identities Help Patients in Coping with Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10508. [PMID: 36078223 PMCID: PMC9518400 DOI: 10.3390/ijerph191710508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Social identification is health-beneficial as social groups provide social support (i.e., the social cure effect). We study this social cure effect in diabetes patients by focusing on two relevant sources of social support, namely medical practitioners (MP) and fellow patients. As both groups have diabetes-specific knowledge, we predict that sharing an identity with them provides access to specific support, which, in turn, optimizes individuals' diabetes management and reduces diabetes-related stress. We further predict that identifying with their MP or fellow patients will be more strongly related to perceived social support among individuals with lower diabetes-specific resilience because they pay more attention to supportive cues. We tested this moderated mediation model in a two-wave study with n = 200 diabetes patients. Identification with the MP related to more support, which, in turn, was related to better diabetes management and less diabetes-specific stress. Identification with fellow patients related to more support; however, social support was unrelated to diabetes management and stress. Resilience only moderated the relationship between MP identification and support, as people with lower resilience levels reported more support from their MP. This study shows the importance of social identification with the MP and other diabetes patients, especially for people with lower resilience levels.
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Affiliation(s)
- Svenja B. Frenzel
- Department of Social Psychology, Goethe University Frankfurt, 60323 Frankfurt, Germany
| | - Antonia J. Kaluza
- Department of Social Psychology, Goethe University Frankfurt, 60323 Frankfurt, Germany
| | - Nina M. Junker
- Department of Social Psychology, Goethe University Frankfurt, 60323 Frankfurt, Germany
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Rolf van Dick
- Department of Social Psychology, Goethe University Frankfurt, 60323 Frankfurt, Germany
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6
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Tanenbaum ML, Commissariat PV. Barriers and Facilitators to Diabetes Device Adoption for People with Type 1 Diabetes. Curr Diab Rep 2022; 22:291-299. [PMID: 35522355 PMCID: PMC9189072 DOI: 10.1007/s11892-022-01469-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Diabetes technology (insulin pumps, continuous glucose monitoring, automated insulin delivery systems) has advanced significantly and provides benefits to the user. This article reviews the current barriers to diabetes device adoption and sustained use, and outlines the known and potential facilitators for increasing and sustaining device adoption. RECENT FINDINGS Barriers to diabetes device adoption continue to exist at the system-, provider-, and individual-level. Known facilitators to promote sustained adoption include consistent insurance coverage, support for providers and clinics, structured education and support for technology users, and device user access to support as needed (e.g., through online resources). Systemic barriers to diabetes device adoption persist while growing evidence demonstrates the increasing benefits of newest devices and systems. There are ongoing efforts to develop evidence-based structured education programs to support device adoption and sustained use.
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Affiliation(s)
- Molly L Tanenbaum
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.
| | - Persis V Commissariat
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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7
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McLarney M, Litchman ML, Greenwood D, Drincic A. Navigating Diabetes Online Communities in Clinical Practice. J Diabetes Sci Technol 2022; 16:874-886. [PMID: 35125019 PMCID: PMC9264440 DOI: 10.1177/19322968211069409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This purpose of this study was to conduct a rapid review and environmental scan of diabetes online communities (DOCs) to highlight the clinical impact of DOC engagement and provide guidance to health care providers for navigating and prescribing DOCs. METHODS This two-phase review included a rapid review of clinical outcomes and an assessment of DOC content. We conducted a literature search for studies evaluating DOC use and glucometric (glycated hemoglobin [A1C], time-in-range, hypoglycemia), behavioral, and psychosocial outcomes. The environmental scan of current DOC sites established key features, including available platforms, target population, content areas, and reach. RESULTS Twelve papers were included-eight reported DOC use within a context of do-it-yourself (DIY) noncommercial, opensource hybrid closed loop systems community and four were non-DYI related. In latter, all studies were cross-sectional, describing patient-reported outcomes. Two studies reported A1C lowering with DOC use, two DOC use was associated with high self-efficacy, one showed association with higher self-care levels, and one showed higher quality of life scores when compared with population norms. All DIY studies showed improvement in glucometrics after initiation of sensor augmented pump technology with DOC support. Of 54 DOC sites reviewed in the environmental scan, 29 were included. Diabetes online community sites were heterogenous in social media platform and type of diabetes targeted. CONCLUSION Diabetes online communities have the potential to improve clinical, behavioral, and psychosocial outcomes. Randomized control trials and/or longitudinal prospective studies evaluating outcomes are needed to further examine the potential benefits of DOC use. Diabetes online communities are diverse and span a variety of social media platforms, providing clinicians opportunities to individualize recommendations for DOC use.
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Affiliation(s)
- Meghan McLarney
- Department of Internal Medicine,
Diabetes and Endocrinology Center, University of Nebraska Medical Center, Omaha, NE,
USA
| | | | - Deborah Greenwood
- School of Nursing, UT Health San
Antonio, San Antonio, TX, USA
- Deborah Greenwood Consulting, Granite
Bay, CA, USA
| | - Andjela Drincic
- Department of Internal Medicine,
Diabetes and Endocrinology Center, University of Nebraska Medical Center, Omaha, NE,
USA
- Division of Diabetes, Endocrinology and
Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
- Andjela Drincic, MD, FACP, Department of
Internal Medicine, Diabetes and Endocrinology Center, University of Nebraska
Medical Center, 984120 Nebraska Medical Center, Omaha, NE 68198-4120, USA.
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8
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Chalmers K, Smith M, Moreno M, Malik F. "It Got Likes, But I Don't Think People Understood": A Qualitative Study of Adolescent Experiences Discussing Type 1 Diabetes on Social Media. J Diabetes Sci Technol 2022; 16:858-865. [PMID: 33106051 PMCID: PMC9264429 DOI: 10.1177/1932296820965588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The majority of adolescents with type 1 diabetes (T1D) integrate social media engagement into their daily lives. The aim of this study was to explore adolescents' experiences and perspectives discussing their T1D on social media. METHODS Semi-structured interviews with adolescents with T1D were conducted in person and via telephone. Questions focused on the participant's experiences utilizing social media to discuss T1D and factors that informed the nature of T1D-related social media engagement. Open coding and thematic content analysis were used to identify emergent themes that aligned with accepted domains of social media affordances. RESULTS Participants included 35 adolescents with T1D. Adolescents' experiences related to discussing T1D on social media aligned with four affordances of social media: identity, cognitive, emotional, and social. The identity affordances of social media platforms allowed adolescents to curate online personas that selectively included their diagnosis of T1D, while managing the potential negative emotional and social implications linked to the stigma of T1D. Adolescents who decided to discuss T1D on social media leveraged cognitive affordances by providing and receiving diabetes management advice, emotional affordances by obtaining affirmation from peers, and social affordances by extending their network to include other individuals with T1D. CONCLUSIONS Adolescents with T1D flexibly leverage the affordances offered by social media to access emotional support, information, and identity affirmation resources while navigating stigma-based social consequences. Our findings highlight the value of developing tools to support adolescents with T1D in comfortably discussing and receiving appropriate support about T1D on social media.
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Affiliation(s)
- Kristen Chalmers
- Center for Child Health, Behavior and
Development, Seattle Children’s Research Institute, WA, USA
| | - Mia Smith
- Center for Child Health, Behavior and
Development, Seattle Children’s Research Institute, WA, USA
| | - Megan Moreno
- Department of Pediatrics, University of
Wisconsin-Madison, WI, USA
| | - Faisal Malik
- Center for Child Health, Behavior and
Development, Seattle Children’s Research Institute, WA, USA
- Department of Pediatrics, University of
Washington, Seattle, WA, USA
- Faisal Malik, MD, MSHS, Seattle Children’s
Research Institute, 2001 8th Ave #400, Seattle, WA 98121, USA.
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9
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Reinius M, Mazzocato P, Riggare S, Bylund A, Jansson H, Øvretveit J, Savage C, Wannheden C, Hasson H. Patient-driven innovations reported in peer-reviewed journals: a scoping review. BMJ Open 2022; 12:e053735. [PMID: 35074818 PMCID: PMC8788234 DOI: 10.1136/bmjopen-2021-053735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Awareness of patients' innovative capabilities is increasing, but there is limited knowledge regarding the extent and nature of patient-driven innovations in the peer-reviewed literature. OBJECTIVES The objective of the review was to answer the question: what is the nature and extent of patient-driven innovations published in peer-reviewed scientific journals? ELIGIBILITY CRITERIA We used a broad definition of innovation to allow for a comprehensive review of different types of innovations and a narrow definition of 'patient driven' to focus on the role of patients and/or family caregivers. The search was limited to years 2008-2020. SOURCES OF EVIDENCE Four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycINFO (Ovid) and Cinahl (Ebsco)) were searched in December 2020 for publications describing patient-driven innovations and complemented with snowball strategies. CHARTING METHODS Data from the included articles were extracted and categorised inductively. RESULTS A total of 96 articles on 20 patient-driven innovations were included. The number of publications increased over time, with 69% of the articles published between 2016 and 2020. Author affiliations were exclusively in high income countries with 56% of first authors in North America and 36% in European countries. Among the 20 innovations reported, 'Do-It-Yourself Artificial Pancreas System' and the online health network 'PatientsLikeMe', were the subject of half of the articles. CONCLUSIONS Peer-reviewed publications on patient-driven innovations are increasing and we see an important opportunity for researchers and clinicians to support patient innovators' research while being mindful of taking over the work of the innovators themselves.
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Affiliation(s)
- Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Sara Riggare
- Department of Women's and Children's Health, Healthcare Sciences and E-Health, Uppsala University, Uppsala, Sweden
| | - Ami Bylund
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Jansson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - John Øvretveit
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Research Development and Education, Region Stockholm, Stockholm, Sweden
| | - Carl Savage
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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10
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Bedford-Petersen C, Weston SJ. Mapping Individual Differences on the Internet: Case Study of the Type 1 Diabetes Community. JMIR Diabetes 2021; 6:e30756. [PMID: 34652277 PMCID: PMC8556640 DOI: 10.2196/30756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 01/16/2023] Open
Abstract
Background Social media platforms, such as Twitter, are increasingly popular among communities of people with chronic conditions, including those with type 1 diabetes (T1D). There is some evidence that social media confers emotional and health-related benefits to people with T1D, including emotional support and practical information regarding health maintenance. Research on social media has primarily relied on self-reports of web-based behavior and qualitative assessment of web-based content, which can be expensive and time-consuming. Meanwhile, recent advances in natural language processing have allowed for large-scale assessment of social media behavior. Objective This study attempts to document the major themes of Twitter posts using a natural language processing method to identify topics of interest in the T1D web-based community. We also seek to map social relations on Twitter as they relate to these topics of interest, to determine whether Twitter users in the T1D community post in “echo chambers,” which reflect their own topics back to them, or whether users typically see a mix of topics on the internet. Methods Through Twitter scraping, we gathered a data set of 691,691 tweets from 8557 accounts, spanning a date range from 2008 to 2020, which includes people with T1D, their caregivers, health practitioners, and advocates. Tweet content was analyzed for sentiment and topic, using Latent Dirichlet Allocation. We used social network analysis to examine the degree to which identified topics are siloed within specific groups or disseminated through the broader T1D web-based community. Results Tweets were, on average, positive in sentiment. Through topic modeling, we identified 6 broad-bandwidth topics, ranging from clinical to advocacy to daily management to emotional health, which can inform researchers and practitioners interested in the needs of people with T1D. These analyses also replicate prior work using machine learning methods to map social behavior on the internet. We extend these results through social network analysis, indicating that users are likely to see a mix of these topics discussed by the accounts they follow. Conclusions Twitter communities are sources of information for people with T1D and members related to that community. Topics identified reveal key concerns of the T1D community and may be useful to practitioners and researchers alike. The methods used are efficient (low cost) while providing researchers with enormous amounts of data. We provide code to facilitate the use of these methods with other populations.
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Affiliation(s)
| | - Sara J Weston
- Department of Psychology, University of Oregon, Eugene, OR, United States
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11
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Ash GI, Griggs S, Nally LM, Stults-Kolehmainen M, Jeon S, Brandt C, Gulanski BI, Spanakis EK, Baker JS, Whittemore R, Weinzimer SA, Fucito LM. Evaluation of Web-Based and In-Person Methods to Recruit Adults With Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study. JMIR Diabetes 2021; 6:e28309. [PMID: 34047700 PMCID: PMC8299346 DOI: 10.2196/28309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our clinical trial of a mobile exercise intervention for adults 18 to 65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic. OBJECTIVE Our objectives for this study were to (1) evaluate the effectiveness and cost of using social media news feed advertisements, a clinic-based approach method, and web-based snowball sampling to reach inadequately active adults with T1D and (2) compare characteristics of enrollees against normative data. METHODS Participants were recruited between November 2019 and August 2020. In method #1, Facebook and Instagram news feed advertisements ran for five 1-to-8-day windows targeting adults (18 to 64 years old) in the greater New Haven and Hartford, Connecticut, areas with one or more diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. In method #2, patients 18 to 24 years old with T1D were approached in person at clinical visits in November and December 2019. Those who were interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. In method #3, snowball sampling was conducted by physically active individuals with T1D contacting their peers on Facebook and via email for 48 days, with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants to the study similarly to snowball sampling. RESULTS In method #1, advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%); 20 participants from this group (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%; P<.001), but their responsiveness and eligibility rates did not differ. In method #2, we approached 40 patients; 32 of these patients (80%) inquired about the study, of whom 20 (63%) volunteered, and 2 of these volunteers (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. In method #3, snowball sampling generated 13 inquirers; 12 of these inquirers (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $20.59 per eligible volunteer. Other methods yielded 7 inquirers; 5 of these inquirers (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (ie, optimal glycemic control, obesity, and low exercise), among those recruited by news feed advertisements (ie, obesity and older age), and among those recruited by snowball sampling (ie, optimal glycemic control and low exercise). CONCLUSIONS Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, with costs comparing favorably to prior trials despite targeting an uncommon condition (ie, T1D) and commitment to an intervention. These strategies should be tailored in future studies to increase access to higher-risk participants. TRIAL REGISTRATION ClinicalTrials.gov NCT04204733; https://clinicaltrials.gov/ct2/show/NCT04204733.
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Affiliation(s)
- Garrett I Ash
- Pain, Research, Informatics, Medical Comorbidities and Education Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, United States
| | - Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Laura M Nally
- Section of Pediatric Endocrinology & Diabetes, Yale University School of Medicine, New Haven, CT, United States
| | - Matthew Stults-Kolehmainen
- Digestive Health Multispecialty Clinic, Yale-New Haven Hospital, New Haven, CT, United States.,Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Sangchoon Jeon
- School of Nursing, Yale University, Orange, CT, United States
| | - Cynthia Brandt
- Pain, Research, Informatics, Medical Comorbidities and Education Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, United States
| | - Barbara I Gulanski
- Section of Endocrinology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Section of Endocrinology, Yale University School of Medicine, New Haven, CT, United States
| | - Elias K Spanakis
- Division of Endocrinology, Baltimore Veterans Administrative Medical Center, Baltimore, MD, United States.,Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Julien S Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, China (Hong Kong)
| | | | - Stuart A Weinzimer
- Section of Pediatric Endocrinology & Diabetes, Yale University School of Medicine, New Haven, CT, United States
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Yale Cancer Center, New Haven, CT, United States.,Smilow Cancer Hospital, Yale-New Haven Hospital, New Haven, CT, United States
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12
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Min J, Chen Y, Wang L, He T, Tang S. Diabetes self-management in online health communities: an information exchange perspective. BMC Med Inform Decis Mak 2021; 21:201. [PMID: 34182977 PMCID: PMC8240193 DOI: 10.1186/s12911-021-01561-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Online health communities (OHCs), with a wealth of multi-source information exchange, have provided a convenient way for people with diabetes to actively participate in their self-management and have been widely used. Information exchange assists people with diabetes with health-related decisions to actively engage in their care, and reduce the occurrence of potential complications of diabetes. However, there has been relatively little research on the information exchange behaviors and their effect on health in professional online medical platforms—OHCs. Objective Using a social exchange theory, this study focuses on two sources of information (doctors and people with diabetes) to investigate information exchange behaviors and consequences. Moreover, we also examine moderating effects of information price as patients need to pay prices for consulting with doctors to obtain medical information on OHCs. Methods By using the Python program, a rich dataset contained 22,746 doctor-patient dialogues from December 2017 to December 2018 is collected from the biggest OHC in China. Then the logistic and ordinal regression models are used to get empirical results. Results We found that first information sharing from doctors and other people with diabetes can promote their information sharing behavior. Second, the moderating effects of information price are heterogeneous and change with the exchange participants. Third, rich information exchange supports self-management of people with diabetes and improves their health status. Conclusion This study is among the first that tests the information exchange behavior and consequence for diabetes in OHCs and examines the moderating effects of the information price. The present study produces several insights, which have implications for social exchange, patient behavior, online health communities, and information technology in diabetes self-management literature.
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Affiliation(s)
- Jing Min
- Department of Endocrinology, The Central Hospital of Wuhan, No. 26, Shengli Street, Jiang'an District, Wuhan, 430000, Hubei Province, China
| | - Yan Chen
- Department of Endocrinology, The Central Hospital of Wuhan, No. 26, Shengli Street, Jiang'an District, Wuhan, 430000, Hubei Province, China.
| | - Li Wang
- Department of Endocrinology, The Central Hospital of Wuhan, No. 26, Shengli Street, Jiang'an District, Wuhan, 430000, Hubei Province, China
| | - Ting He
- Department of Endocrinology, The Central Hospital of Wuhan, No. 26, Shengli Street, Jiang'an District, Wuhan, 430000, Hubei Province, China
| | - Sha Tang
- Department of Endocrinology, The Central Hospital of Wuhan, No. 26, Shengli Street, Jiang'an District, Wuhan, 430000, Hubei Province, China
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13
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Braune K, Gajewska KA, Thieffry A, Lewis DM, Froment T, O'Donnell S, Speight J, Hendrieckx C, Schipp J, Skinner T, Langstrup H, Tappe A, Raile K, Cleal B. Why #WeAreNotWaiting-Motivations and Self-Reported Outcomes Among Users of Open-source Automated Insulin Delivery Systems: Multinational Survey. J Med Internet Res 2021; 23:e25409. [PMID: 34096874 PMCID: PMC8218212 DOI: 10.2196/25409] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/19/2020] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background Automated insulin delivery (AID) systems have been shown to be safe and effective in reducing hyperglycemia and hypoglycemia but are not universally available, accessible, or affordable. Therefore, user-driven open-source AID systems are becoming increasingly popular. Objective This study aims to investigate the motivations for which people with diabetes (types 1, 2, and other) or their caregivers decide to build and use a personalized open-source AID. Methods A cross-sectional web-based survey was conducted to assess personal motivations and associated self-reported clinical outcomes. Results Of 897 participants from 35 countries, 80.5% (722) were adults with diabetes and 19.5% (175) were caregivers of children with diabetes. Primary motivations to commence open-source AID included improving glycemic outcomes (476/509 adults, 93.5%, and 95/100 caregivers, 95%), reducing acute (443/508 adults, 87.2%, and 96/100 caregivers, 96%) and long-term (421/505 adults, 83.3%, and 91/100 caregivers, 91%) complication risk, interacting less frequently with diabetes technology (413/509 adults, 81.1%; 86/100 caregivers, 86%), improving their or child’s sleep quality (364/508 adults, 71.6%, and 80/100 caregivers, 80%), increasing their or child’s life expectancy (381/507 adults, 75.1%, and 84/100 caregivers, 84%), lack of commercially available AID systems (359/507 adults, 70.8%, and 79/99 caregivers, 80%), and unachieved therapy goals with available therapy options (348/509 adults, 68.4%, and 69/100 caregivers, 69%). Improving their own sleep quality was an almost universal motivator for caregivers (94/100, 94%). Significant improvements, independent of age and gender, were observed in self-reported glycated hemoglobin (HbA1c), 7.14% (SD 1.13%; 54.5 mmol/mol, SD 12.4) to 6.24% (SD 0.64%; 44.7 mmol/mol, SD 7.0; P<.001), and time in range (62.96%, SD 16.18%, to 80.34%, SD 9.41%; P<.001). Conclusions These results highlight the unmet needs of people with diabetes, provide new insights into the evolving phenomenon of open-source AID technology, and indicate improved clinical outcomes. This study may inform health care professionals and policy makers about the opportunities provided by open-source AID systems. International Registered Report Identifier (IRRID) RR2-10.2196/15368
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Affiliation(s)
- Katarina Braune
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Katarzyna Anna Gajewska
- #dedoc° Diabetes Online Community, Berlin, Germany.,Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Axel Thieffry
- Novo Nordisk Center for Biosustainability, Technical University of Denmark, Copenhagen, Denmark
| | | | | | - Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
| | - Jasmine Schipp
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Langstrup
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Klemens Raile
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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14
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Hossain SN, Jaglal SB, Shepherd J, Perrier L, Tomasone JR, Sweet SN, Luong D, Allin S, Nelson MLA, Guilcher SJT, Munce SEP. Web-Based Peer Support Interventions for Adults Living With Chronic Conditions: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e14321. [PMID: 34032572 PMCID: PMC8188320 DOI: 10.2196/14321] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/27/2020] [Accepted: 04/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. Objective The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. Methods This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results. Results After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment. Conclusions There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.
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Affiliation(s)
- Saima N Hossain
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Shane N Sweet
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada
| | - Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Michelle L A Nelson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Sara J T Guilcher
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute - Rumsey Centre, University Health Network, Toronto, ON, Canada
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15
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Kamalpour M, Rezaei Aghdam A, Watson J, Tariq A, Buys L, Eden R, Rehan S. Online health communities, contributions to caregivers and resilience of older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:328-343. [PMID: 33278312 DOI: 10.1111/hsc.13247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/06/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
The aim of this paper is twofold. Firstly, to investigate the potential benefits of online health communities (OHCs) for informal caregivers by conducting a systematic literature review. Secondly, to identify the relationship between the potential benefits of OHCs and resilience factors of older adults. Performing a thematic analysis, we identified the potential benefits of OHCs for informal caregivers of older adults, including two salient themes: (a) caregivers sharing and receiving social support and (b) self and moral empowerment of caregivers. Then, we uncovered how these potential benefits can support resilience of older adults. Our findings show that sharing and receiving of social support by informal caregivers, and self and moral empowerment of informal caregivers in OHCs, can support four resilience factors among older adults, including self-care, independence, altruism and external connections. This review enables a better understanding of OHCs and Gerontology, and our outcomes also challenge the way healthcare and aged-care service providers view caregivers and older adults. Furthermore, the identified gap and opportunities would provide avenues for further research in OHCs.
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Affiliation(s)
| | | | - Jason Watson
- Queensland University of Technology, Brisbane, Australia
| | - Amina Tariq
- Queensland University of Technology, Brisbane, Australia
| | - Laurie Buys
- University of Queensland, Brisbane, Australia
| | - Rebekah Eden
- Queensland University of Technology, Brisbane, Australia
| | - Syed Rehan
- Queensland University of Technology, Brisbane, Australia
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16
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Mogul DB, Bowring MG, Lau J, Babin E, Bridges JFP, Harpavat S, Miloh T. Role for Social Media in Pediatric Liver Disease: Caregiver and Provider Perspectives. Pediatr Gastroenterol Hepatol Nutr 2020; 23:548-557. [PMID: 33215026 PMCID: PMC7667231 DOI: 10.5223/pghn.2020.23.6.548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/17/2020] [Accepted: 06/16/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To better understand the benefits and harms of engagement with online pediatric liver disease communities within social media. METHODS We conducted a survey of caregivers of children with liver disease participating in online pediatric liver disease communities within social media, as well as a survey of healthcare providers (e.g., physicians, surgeons, nurse coordinators) from this field to better understand the perceived benefits and harms of participation. RESULTS Among 138 caregivers of children with liver disease that completed the survey, 97.8% agreed social media was a good place to learn about patient experiences and 88% agreed it was a good source of general information. Among caregivers, 84.8% agreed social media helps them to better advocate for their child. While 18% agreed that the information over social media was equal to the information from their healthcare team and 19% neither agreed/disagreed, only 3% indicated they would use this information to change care without telling their provider; in contrast, among 217 healthcare providers, 55% believed social media may lead caregivers to change management without telling their team. CONCLUSION Engagement with online disease-specific communities in social media yields several benefits for caregivers and, in contrast to healthcare providers' concerns, participation is unlikely to lead to problems including caregivers changing the treatment plan without first discussing these plans with their team. Openness between caregivers and medical teams about the role for social media can help to improve trust and maximize the potential benefits of engagement with these groups.
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Affiliation(s)
- Douglas B Mogul
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Sanjiv Harpavat
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Tamir Miloh
- Department of Pediatrics, University of Miami, Miami, FL, USA
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17
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Abstract
BACKGROUND The do-it-yourself (DIY) artificial pancreas system (APS) community is led by people with diabetes (PWD) and their families. In contrast to standard models of care, in which health care professionals are responsible for the education and training of PWD and their families, within the DIY APS, community users are reliant on their peers for education and training. The provision of this support has not previously been studied. This article focuses on the role of mentors within the DIY APS community. METHOD Semistructured interviews were conducted with mentors (n = 9) who were identified with assistance from the DIY APS community. Thematic analysis was undertaken. Results were presented to select participants who endorsed the results as an accurate description of mentoring in the DIY APS community. RESULTS Mentors' primary motivation was altruism. An empathetic, process-focused approach was modeled by prominent mentors. The use of online forums as the primary source of user support was perceived to be an effective method for sharing the workload. Key challenges for mentors included the frequency with which users asked questions that were answered in the existing documentation, dealing with conflict and managing workload. Most participants did not perceive mentoring to be risky, but did take steps to ensure that users were taking responsibility for their own systems. CONCLUSION This study is the first to examine the role of mentors within the DIY APS community and also within the broader diabetes online community. Future research might seek to quantify the empathetic, process-focused approach to mentoring.
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Affiliation(s)
- Hamish Crocket
- Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
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18
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Rivard L, Lehoux P, Alami H. "It's not just hacking for the sake of it": a qualitative study of health innovators' views on patient-driven open innovations, quality and safety. BMJ Qual Saf 2020; 30:731-738. [PMID: 32938774 DOI: 10.1136/bmjqs-2020-011254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/04/2020] [Accepted: 08/19/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Open do-it-yourself (DIY) health innovations raise new dilemmas for patient-oriented and service-oriented scholars and healthcare providers. Our study aimed to generate practical insights into quality and safety issues to patient care raised by two volunteer-run, open DIY solutions: Nightscout Project (patient-driven, open-source software for type 1 diabetes management) and e-NABLE (volunteers who design and three-dimensionally print upper-limb assistive devices). To this end, we examined the views of health innovators who are knowledgeable about medical devices standards and regulations. METHODS We applied a multimedia-based, data-elicitation technique to conduct indepth interviews with a diversified sample of 31 health innovators practising in two Canadian provinces (Quebec and Ontario). An exploratory thematic analysis approach was used to identify respondents' reasoning processes and compare their overall judgements of Nightscout and e-NABLE. RESULTS Respondents pondered the following quality and safety issues: importance of the need addressed; accessibility; volunteers' ability to develop and maintain a safe solution of good quality; risks involved for users; consequences of not using the solution; and liability. Overall, innovators see Nightscout as a high-risk DIY solution that requires expert involvement and e-NABLE as a low-risk one that fills a hard-to-meet gap. CONCLUSION Health innovators generally support patient-driven initiatives but also call for the involvement of professionals who possess complementary skills and knowledge. Our findings provide a list of issues healthcare providers may discuss with patients during clinical consultations to document potential risks and benefits of open DIY solutions. To inform new policy approaches, we propose the development of publicly funded umbrella organisations to act as intermediaries between open DIY solutions and regulatory bodies to help them meet quality and safety standards.
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Affiliation(s)
- Lysanne Rivard
- Center for Public Health Research, Université de Montréal, Montréal, Québec, Canada
| | - Pascale Lehoux
- Center for Public Health Research, Université de Montréal, Montréal, Québec, Canada
| | - Hassane Alami
- Center for Public Health Research, Université de Montréal, Montréal, Québec, Canada
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19
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Ng M, Borst E, Garrity A, Hirschfeld E, Lee J. Evolution of Do-It-Yourself Remote Monitoring Technology for Type 1 Diabetes. J Diabetes Sci Technol 2020; 14:854-859. [PMID: 31893941 PMCID: PMC7753857 DOI: 10.1177/1932296819895537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Nightscout Project is a leading example of patient-designed, do-it-yourself (DIY), open-source technology innovations to support type 1 diabetes management. We are unaware of studies that have described the evolution of patient-driven innovations from the Nightscout Project to date. METHODS We identified patient-driven, DIY innovations from posts and comments in the "CGM in the Cloud" private Facebook group as well as data from Twitter, GitHub, and the Nightscout website. For each innovation, we described its intent or its unaddressed need as well as the associated features and improvements. We conducted a thematic analysis to identify overarching patterns among the innovations, features, and improvements, and compared the timeline of innovations in the DIY space with the timing of similar innovations in the commercial space. RESULTS We identified and categorized innovations in Nightscout with the most commonly appearing themes of: visualization improvements, equipment improvements, and user experience improvements. Other emerging themes included: Care Portal support, safety, remote monitoring, decision support, international support, artificial pancreas, pushover notifications, and open-source collaboration. CONCLUSIONS This rapid development of patient-designed DIY innovations driven by unmet needs in the type 1 diabetes community reflects a revolutionary, bottom-up approach to medical innovation. Nightscout users accessed features earlier than if they had waited for commercial products, and they also personalized their tools and devices, empowering them to become the experts of their own care.
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Affiliation(s)
- Michelle Ng
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Emily Borst
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Joyce Lee
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
- Joyce Lee, MD, MPH, Pediatric Endocrinology and Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, 300 North Ingalls Building, Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-5456, USA.
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20
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Kesavadev J, Srinivasan S, Saboo B, Krishna B M, Krishnan G. The Do-It-Yourself Artificial Pancreas: A Comprehensive Review. Diabetes Ther 2020; 11:1217-1235. [PMID: 32356245 PMCID: PMC7261300 DOI: 10.1007/s13300-020-00823-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes technology (DT) has accomplished tremendous progress in the past decades, aiming to convert these technologies as viable treatment options for the benefit of patients with diabetes (PWD). Despite the advances, PWD face multiple challenges with the efficient management of type 1 diabetes. Most of the promising and innovative technological developments are not accessible to a larger proportion of PWD. The slow pace of development and commercialization, overpricing, and lack of peer support are few such factors leading to inequitable access to the innovations in DT. Highly motivated and tech-savvy members of the diabetes community have therefore come up with the #WeAreNotWaiting movement and started developing their own do-it-yourself artificial pancreas systems (DIYAPS) integrating continuous glucose monitoring (CGM), insulin pumps, and smartphone technology to run openly shared algorithms to achieve appreciable glycemic control and quality of life (QoL). These systems use tailor-made interventions to achieve automated insulin delivery (AID) and are not commercialized or regulated. Online social network megatrends such as GitHub, CGM in the Cloud, and Twitter have been providing platforms to share these open source technologies and user experiences. Observational studies, anecdotal evidence, and real-world patient stories revealed significant improvements in time in range (TIR), time in hypoglycemia (TIHypo), HbA1c levels, and QoL after the initiation of DIYAPS. But this unregulated do-it-yourself (DIY) approach is perceived with great circumspection by healthcare professionals (HCP), regulatory bodies, and device manufacturers, making users the ultimate risk-bearers. The use of the regularized CGM and insulin pump with unauthorized algorithms makes them off-label and has been a matter of great concern. Besides these, lack of safety data, funding or insurance coverage, ethical, and legal issues are roadblocks to the unanimous acceptance of these systems among patients with type 1 diabetes (T1D). A multi-agency approach is necessary to evaluate the risks, and to delineate the incumbency and liability of clinicians, regulatory bodies, and manufacturers associated with the use of DIYAPS. Understanding the potential of DIYAPS as the need of the present time, many regional and international agencies have come with strategies to appraise its safety as well as to support education and training on its use. Here we provide a comprehensive description of the DIYAPS-including their origin, existing literature, advantages, and disadvantages that can help the industry leaders, clinicians, and PWD to make the best use of these systems.
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Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India.
| | - Seshadhri Srinivasan
- Kalasalingam Academy of Research and Education, Srivilliputtur, Tamil Nadu, India
| | | | - Meera Krishna B
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
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21
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Kesavadev J, Saboo B, Krishna MB, Krishnan G. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. Diabetes Ther 2020; 11:1251-1269. [PMID: 32410184 PMCID: PMC7261311 DOI: 10.1007/s13300-020-00831-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 12/24/2022] Open
Abstract
The year 2021 will mark 100 years since the discovery of insulin. Insulin, the first medication to be discovered for diabetes, is still the safest and most potent glucose-lowering therapy. The major challenge of insulin despite its efficacy has been the occurrence of hypoglycemia, which has resulted in sub-optimal dosages being prescribed in the vast majority of patients. Popular devices used for insulin administration are syringes, pens, and pumps. An artificial pancreas (AP) with a closed-loop delivery system with > 95% time in range is believed to soon become a reality. The development of closed-loop delivery systems has gained momentum with recent advances in continuous glucose monitoring (CGM) and computer algorithms. This review discusses the evolution of syringes, disposable, durable pens and connected pens, needles, tethered and patch insulin pumps, bionic pancreas, alternate controller-enabled infusion (ACE) pumps, and do-it-yourself artificial pancreas systems (DIY-APS).
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Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India.
| | | | - Meera B Krishna
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
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Elnaggar A, Ta Park V, Lee SJ, Bender M, Siegmund LA, Park LG. Patients' Use of Social Media for Diabetes Self-Care: Systematic Review. J Med Internet Res 2020; 22:e14209. [PMID: 32329745 PMCID: PMC7210496 DOI: 10.2196/14209] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background Patient engagement with diabetes self-care is critical to reducing morbidity and mortality. Social media is one form of digital health that is available for diabetes self-care, although its use for peer-to-peer communication has not been systematically described, and its potential to support patient self-care is unclear. Objective The primary aim of this systematic review was to describe the use of social media among patients (peer-to-peer) to manage diabetes and cardiovascular disease (CVD). The secondary aim was to assess patients’ clinical outcomes, behavioral outcomes, quality of life, and self-efficacy resulting from peer-to-peer social media use. Methods We conducted a literature search in the following databases: PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO (January 2008 through April 2019). The inclusion criteria were quantitative studies that included peer-to-peer use of social media for self-care of diabetes mellitus (with all subtypes) and CVD, including stroke. Results After an initial yield of 3066 citations, we selected 91 articles for a full-text review and identified 7 papers that met our inclusion criteria. Of these, 4 studies focused on type 1 diabetes, 1 study included both type 1 and 2 diabetes, and 2 studies included multiple chronic conditions (eg, CVD, diabetes, depression, etc). Our search did not yield any individual studies on CVD alone. Among the selected papers, 2 studies used commercial platforms (Facebook and I Seek You), 3 studies used discussion forums developed specifically for each study, and 2 surveyed patients through different platforms or blogs. There was significant heterogeneity in the study designs, methodologies, and outcomes applied, but all studies showed favorable results on either primary or secondary outcomes. The quality of studies was highly variable. Conclusions The future landscape of social media use for patient self-care is promising. However, current use is nascent. Our extensive search yielded only 7 studies, all of which included diabetes, indicating the most interest and demand for peer-to-peer interaction on diabetes self-care. Future research is needed to establish efficacy and safety in recommending social media use among peers for diabetes self-care and other conditions.
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Affiliation(s)
- Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Sei J Lee
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Melinda Bender
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Lee Anne Siegmund
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
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Liang D, Fan G. Social Support and User Characteristics in Online Diabetes Communities: An In-Depth Survey of a Large-Scale Chinese Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082806. [PMID: 32325783 PMCID: PMC7216204 DOI: 10.3390/ijerph17082806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023]
Abstract
:Objective: To determine the characteristics of members of online diabetes communities as well as those factors affecting the provision and acceptance of social support. Methods: A cross-sectional STAR questionnaire survey was conducted among patients with diabetes who were members of online diabetes groups. Univariate and multivariate binary logistic regression analysis were adopted to explore the relative analysis of providing and accepting social support compared with the characteristics of members in virtual diabetics' groups. Results: A total of 1297 respondents were collected. The map distribution of patients in China was mainly located in the Guangdong, Jiangsu, Shandong, Henan, and Hebei provinces. As for their demographic characteristics, respondents had diabetes or prediabetes and were between the ages of 21 and 50 years (Median age was 35.0 (interquartile range from 28.0 to 44.0)). Most respondents were married and lived in cities. The education level of patients was mainly distributed throughout junior high, technical secondary, high school, junior college, and undergraduate levels. Age, marital status, and education level varied by gender, and the total score of the patients aged 41 to 50 for social support had a statistical significance between male and female. In addition, when group members were in junior high school or below, or were undergraduate students, their total social support scores varied by gender. Binary logistic regression showed that in 21 independent variables the total score and the total score grade of relationship intensity in the online group and reorganize of age were significant. The patients' social support acceptance of the map of respondents score grading of relationship intensity in the online group was 5.420 times higher than that of the lower score grading of relationship intensity in the group. At the same time, the patients' social support acceptance of the patients at the age of less than or equal to 31 years old was 19.608 times higher than that of group members aged more than 31 years old. Conclusion: Age and education background of the patients affects scores of social supports between males and females. The higher the total score and the score grade of relationship intensity in the online group, the higher the patients' social support acceptance. The younger patients had a better utilization of social support.
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Affiliation(s)
- Dan Liang
- MPH Education Center, Shantou University Medical College, 22 Xin Ling Road, Shantou 515041, China;
| | - Guanhua Fan
- Shantou University Medical College, 22 Xin Ling Road, Shantou 515041, China
- Correspondence: ; Tel.: +86-13726500757
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Oser TK, Oser SM, Parascando JA, Hessler-Jones D, Sciamanna CN, Sparling K, Nease D, Litchman ML. Social Media in the Diabetes Community: a Novel Way to Assess Psychosocial Needs in People with Diabetes and Their Caregivers. Curr Diab Rep 2020; 20:10. [PMID: 32080765 DOI: 10.1007/s11892-020-1294-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Diabetes is a chronic disease that, regardless of type, requires intensive, ongoing self-management. As a result, people with diabetes (PWD) often have complex environmental, social, behavioral, and informational needs, many of which are unmet in healthcare settings and systems. To help meet these needs, many PWD interact with diabetes online communities (DOCs), including platforms such as Facebook, Twitter, and blogs, to share real-life support, problems, and concerns with other PWD, offering a rich source of data on patient-reported outcomes. This article reviews recent psychosocial needs and outcomes identified by studies of DOCs and/or their users. RECENT FINDINGS Participation in DOCs appears driven by a need for psychosocial support, unmet by providers and the healthcare system, as well as a sense of duty to provide it to others. The most common activities observed in DOCs are giving and receiving various types of support: psychosocial, technical, informational, and self-management. General and specific challenges (e.g., continuous glucose monitoring) as well as frustrations and worries associated with those challenges are commonly expressed, leading to reciprocal sharing, support, and encouragement, in a judgment-free manner, from other PWD. This leads users to feel more understood, empowered, validated, less alone, and more supported. Negative findings were reported very rarely and focused more on how other participants used social media rather than on the exchange of misplaced or dangerous information or advice. Diabetes online communities have grown from unmet needs for problem-solving and psychosocial support for living with a complex condition and from the availability of a new communications medium (i.e., social media). This has enabled communities of peers to both seek and receive support for living with diabetes, providing an important supplement to what is provided in healthcare settings and offering valuable information about what is most important to PWD and their families, with the potential to improve psychosocial care.
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Affiliation(s)
- Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop F496, Aurora, CO, 80045, USA.
| | - Sean M Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop F496, Aurora, CO, 80045, USA
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Danielle Hessler-Jones
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Christopher N Sciamanna
- Departments of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Kerri Sparling
- SixUntilMe.com and KerriSparling.com, Narragansett, RI, USA
| | - Donald Nease
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop F496, Aurora, CO, 80045, USA
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Litchman ML, Edelman LS. Perceptions of the Diabetes Online Community's Credibility, Social Capital, and Help and Harm: Cross-Sectional Comparison Between Baby Boomers and Younger Adults. JMIR Aging 2019; 2:e10857. [PMID: 31573907 PMCID: PMC6787528 DOI: 10.2196/10857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/01/2019] [Accepted: 04/04/2019] [Indexed: 01/05/2023] Open
Abstract
Background The use of online health communities such as the diabetes online community (DOC) is growing. Individuals who engage in the DOC are able to interact with peers who have the same medical condition. It is not known if older adults are perceiving the DOC differently compared with younger adults. Objective The purpose of this study was to explore and understand how the DOC is perceived in terms of social capital, source credibility, and help and harm. The findings from this study will shed light on how users of different age groups (baby boomers and younger adult counterparts) perceive DOC use. Methods This study represents a subset of participants from a larger study of DOC users. Baby boomers and younger adults with diabetes were recruited from the DOC to participate in a cross-sectional survey. Demographics, electronic health use (reasons to join the DOC, DOC intensity, DOC engagement, internet social capital, and help or harm from the DOC), source credibility, health-related quality of life, and diabetes self-care data were collected. We examined the differences between baby boomer and younger adult responses. Results The participants included baby boomers (N=76) and younger adult counterparts (N=102). Participants scored their diabetes health care team (mean 33.5 [SD 8]) significantly higher than the DOC (mean 32 [SD 6.4]) with regard to competence (P<.05) and trustworthiness (diabetes health care team mean 36.3 [SD 7.1]; DOC mean 33.6 [SD 6.2]; P<.001). High bonding and bridging social capital correlated with high DOC intensity (r=.629; P<.001 and r=.676; P<.001, respectively) and high DOC engagement (r=.474; P<.01 and r=.507; P≤.01, respectively). The greater majority (69.8%) reported the DOC as being helpful, and 1.8% reported that the DOC had caused minor harm. Baby boomers perceived DOC credibility, social capital, help, and harm similarly to their younger adult counterparts. Conclusions Baby boomers are using and perceiving the DOC similarly to younger adults. DOC users find the DOC to be credible; however, they scored their health care team higher with regard to competence and trustworthiness. The DOC is beneficial with low risk and may augment current diabetes care.
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Affiliation(s)
| | - Linda S Edelman
- University of Utah, College of Nursing, Salt Lake City, UT, United States
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26
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Nass EMA, Marcon SS, Teston EF, Reis PD, Peruzzo HE, Monteschio LVC, Bega AG, Haddad MDCFL. Perspectiva de jovens com diabetes sobre intervenção educativa na rede social Facebook®. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Apreender a perspectiva de jovens com diabetes mellitus sobre a participação em um grupo de estimulo ao autocuidado na rede social Facebook®. Métodos Estudo descritivo e exploratório, junto a 35 jovens com diabetes mellitus tipo 1 que participaram de um grupo no Facebook®. Os dados foram coletados por meio de entrevista semi-esturuada e após submetidos à análise de conteúdo, modalidade temática. Resultados Foram identificadas três categorias: assistência convencional oferecida aos jovens com diabetes mellitus; vantagens da utilização do Facebook® para inovação da assistência à saúde, e espírito de comunidade e fortalecimento a partir do Facebook®, as quais mostram que, na perspectiva de jovens com diabetes, a participação no grupo favoreceu o desenvolvimento do espírito de comunidade e o fortalecimento de vínculo entre os pares, além de auxiliar no processo de aceitação da doença e na formação de uma rede de suporte. Além disso, observou-se avaliação positiva sobre a participação, uma vez que os jovens manifestaram o desejo de que outros grupos com características semelhantes fossem implementados. Conclusão Ações educativas na rede social Facebook® são bem aceitas por jovens e pode constituir uma estratégia importante para aproximá-los dos serviços de saúde e auxiliá-los nas ações de autocuidado.
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Oser TK, Minnehan KA, Wong G, Parascando J, McGinley E, Radico J, Oser SM. Using Social Media to Broaden Understanding of the Barriers and Facilitators to Exercise in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2019; 13:457-465. [PMID: 30862185 PMCID: PMC6501539 DOI: 10.1177/1932296819835787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Many people with type 1 diabetes (T1D) do not achieve levels of exercise recommended by the American Diabetes Association, often due to unique barriers, including fear of hypoglycemia. This study aimed to broaden the understanding of barriers and facilitators to exercise among adults with T1D by exploring social media-specifically T1D-themed blogs-in addition to more traditional interviews and journals. METHODS Data sources included exercise-focused T1D blog posts (n = 67) and associated comments (n = 717), as well as interviews of and journals kept by adults with T1D (n = 10). Data were analyzed using a qualitative inductive thematic approach. Shared and unique themes were identified among the three data sources. Content mapping illustrates these relationships and interplay. RESULTS Three metathemes were identified: (1) exercise with T1D requires significant planning, (2) hypoglycemia often interrupts or causes alteration to exercise, and (3) "ordinary" activities can cause greater insulin sensitivity and hypoglycemia, much like planned exercise, but are often unrecognized as exercise. Unique themes found only in the blogs, only in interviews, or only in journals are also reported. CONCLUSIONS Social media such as blogs can be a valuable addition to qualitative research, especially when combined with other sources of data. This study suggests a need for providing adults with T1D with more instruction on preventing hypoglycemia during exercise, as well as links to organized or online activities that can provide support and education. Health care providers may wish to consider strategies to help adults with T1D recognize glycemic impact from daily activities not typically recognized as exercise.
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Affiliation(s)
- Tamara K. Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | - Glenna Wong
- Penn State College of Medicine, Hershey, PA, USA
| | - Jessica Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Erin McGinley
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Julie Radico
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Sean M. Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
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Litchman ML, Walker HR, Ng AH, Wawrzynski SE, Oser SM, Greenwood DA, Gee PM, Lackey M, Oser TK. State of the Science: A Scoping Review and Gap Analysis of Diabetes Online Communities. J Diabetes Sci Technol 2019; 13:466-492. [PMID: 30854884 PMCID: PMC6501517 DOI: 10.1177/1932296819831042] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Individuals with diabetes are using online resources to engage in diabetes online communities to find diabetes-related support and information. The benefits and consequences of DOC (diabetes online community) use are unclear. This scoping review aims to map existing research focused on organic DOCs in which individuals affected by diabetes are interacting with peers. METHOD A scoping review was conducted to comprehensively report and synthesize relevant literature published prior to 2018. Attention was paid to variations in study design, DOC user and platform characteristics, and potential or actual benefits and consequences. RESULTS Of the 14 486 titles identified, 47 articles met the inclusion criteria and were included in this scoping review. No overt definition of the DOC could be identified. Perceived or actual benefits associated with DOC use can be broadly categorized as clinical, behavioral, psychosocial and community outcomes. Perceived, potential, or actual consequences associated with DOC use were categorized as quality of information, risky behavior exploration, acute concerns, psychosocial, privacy, and inactivity. CONCLUSIONS The results of this review strongly suggest DOC use is highly beneficial with relatively few negative consequences. DOC use is an emerging area of research and research gaps exist. Future research should seek to identify benefits and consequences to DOC use in experimental trials.
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Affiliation(s)
- Michelle L. Litchman
- College of Nursing, University of Utah,
Salt Lake City, Utah, USA
- Utah Diabetes and Endocrinology Center,
Salt Lake City, Utah, USA
| | - Heather R. Walker
- College of Applied Health Sciences,
University of Illinois at Chicago, Chicago, IL, USA
| | - Ashley H. Ng
- Department of Dietetics, Nutrition and
Sport, La Trobe University, Bundoora, VIC, Australia
| | | | - Sean M. Oser
- Department of Family and Community
Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | - Perry M. Gee
- College of Nursing, University of Utah,
Salt Lake City, Utah, USA
- Intermountain Healthcare, Nursing
Research, Salt Lake City, UT, USA
| | - Mellanye Lackey
- Spencer S. Eccles Health Sciences
Library, University of Utah, Salt Lake City, Utah, USA
| | - Tamara K. Oser
- Department of Family and Community
Medicine, Penn State College of Medicine, Hershey, PA, USA
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Abstract
BACKGROUND Caregivers and individuals living with type 1 diabetes (T1D) who are members of CGM in the Cloud, a Facebook group associated with the Nightscout Project, were interviewed to assess how the online community impacted peer support. METHODS Semistructured qualitative interviews were conducted with caregivers and patients who are part of CGM in the Cloud Facebook group. Interview transcripts were analyzed to identify various themes related to peer support in the online group. RESULTS Members of the CGM in the Cloud Facebook group identified peer support through giving and receiving technical, emotional, and medical support, as well as giving back to the larger community by paying it forward. Peer support also extended beyond the online forum, connecting people in person, whether they were local or across the country. CONCLUSIONS An online community can provide many avenues for peer support through emotional and technical support, as well as serve as a tool of empowerment. The community as a whole also had a spirit of altruism that bolstered confidence in others as well as those who paid it forward.
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Affiliation(s)
- Valerie Gavrila
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Breann Edwards
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
- Joyce M. Lee, MD, MPH, Child Health Evaluation and Research Center, University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-5456, USA.
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30
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Oser SM, Stuckey HL, Parascando JA, McGinley EL, Berg A, Oser TK. Glycated Hemoglobin Differences Among Blog-Reading Adults With Type 1 Diabetes Compared With Those Who Do Not Read Blogs: Cross-Sectional Study. JMIR Diabetes 2019; 4:e13634. [PMID: 30938693 PMCID: PMC6465975 DOI: 10.2196/13634] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Of the estimated 23.1 million individuals diagnosed with diabetes, approximately 5% have type 1 diabetes (T1D). It has been proposed that this number will triple by 2050. With increases in technology use and resources available, many individuals are using insulin pumps and continuous glucose monitors (CGMs) to help manage their T1D. They are also using online resources such as social media to find more information and advice based on real-life experiences from peers. Blogs are a particular social media modality often used by people with T1D but have not been widely investigated. OBJECTIVE The purpose of this study was to assess glycated hemoglobin (HbA1c) differences between blog readers and blog nonusers in a population of adults with T1D. This study also looked at differences in technology use in these two groups, as well as HbA1c differences in blog use and technology subgroups. METHODS Participants were recruited both by mail and by online T1D-themed blog postings. Respondents completed a secure online eligibility assessment and were asked questions related to their T1D, blog and internet use, and insulin pump and CGM use. Demographics were also collected. Differences between blog readers and blog nonusers were tested via chi-square and t tests. Mann-Whitney U tests, Fisher exact tests, and analyses of variance (ANOVA) were used to test for differences in self-reported HbA1c between groups and subgroups. RESULTS A total of 282 eligible participants completed the survey (214 blog readers, 68 blog nonusers). Average duration of diabetes was 21.2 years, 77.7% (219/282) were female, 81.2% (229/282) used an insulin pump, 66.3% (187/282) used a CGM, and 95.7% (270/282) were white. HbA1c was lower for blog readers (7.0%) than blog nonusers (7.5%), P=.006; for insulin pump users (7.0%) than multiple daily injections (7.7%), P=.001; and for CGM users (7.0%) than CGM nonusers (7.5%), P=.001. After adjusting for significant covariates, the association between blog use and HbA1c remained significant (P=.04). ANOVA modeling also demonstrated significant differences in HbA1c between blog users and nonusers among subgroups by pump use and CGM use (P<.001). CONCLUSIONS These results suggest that reading blogs is associated with lower HbA1c values. While association does not prove causation, blog readers have the benefit of learning information from peers and having 24/7 access to a community of individuals with similar daily life struggles, where they are able to ask questions and seek advice.
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Affiliation(s)
- Sean M Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Heather L Stuckey
- Department of Internal Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Erin L McGinley
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Arthur Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Tamara K Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
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Årsand E, Bradway M, Gabarron E. What Are Diabetes Patients Versus Health Care Personnel Discussing on Social Media? J Diabetes Sci Technol 2019; 13:198-205. [PMID: 30636445 PMCID: PMC6399792 DOI: 10.1177/1932296818821649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Use of social media is increasing rapidly, also in health care and diabetes. However, patients, health care personnel, and patient organizations discuss diabetes on social media very differently. This has led to a lack of common ground when these stakeholders communicate about diabetes and a gap in understanding one another's point of view. Social media have a potential for improved communication if each stakeholder group knows about, acknowledges, and accepts one another's perspective. METHOD We extracted and analyzed posts from three Norwegian Facebook groups representing patients, patients' organization, and health care personnel. Qualitative content analysis was done to find the distribution of main categories, followed by a thematic analysis of subcategories that were posted and discussed. RESULTS The patient organization's posts are the most equally distributed over the four main identified categories: scientific content, health care services, self-management, and diabetes awareness. The closed patient group's posts were dominated by self-management; the open diabetes nurses' group was dominated by diabetes awareness. The three social media groups differed substantially in what and how they posted and discussed within the main topics. The nurses' open group had percentage-wise both the most liked and commented post, and the posts on self-management had the highest average number of comments. CONCLUSIONS There is a big discrepancy in posted information and discussions on social media, between patient closed group, patient organization open group, and health care personnel open group. To reach the aim of using social media for better health, there is a need for more information of what is posted and discussed in the other groups, to harmonize and ensure safe and accurate dissemination of information.
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Affiliation(s)
- Eirik Årsand
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Meghan Bradway
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elia Gabarron
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Litchman ML, Lewis D, Kelly LA, Gee PM. Twitter Analysis of #OpenAPS DIY Artificial Pancreas Technology Use Suggests Improved A1C and Quality of Life. J Diabetes Sci Technol 2019; 13:164-170. [PMID: 30198751 PMCID: PMC6399802 DOI: 10.1177/1932296818795705] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient-driven innovation in diabetes management has resulted in a group of people with type 1 diabetes who choose to build and share knowledge around a do-it-yourself (DIY) open source artificial pancreas systems (OpenAPS). The purpose of this study was to examine Twitter data to understand how patients, caregivers, and care partners perceive OpenAPS, the personal and emotional ramifications of using OpenAPS, and the influence of OpenAPS on daily life. METHODS Qualitative netnography was used to analyze #OpenAPS on Twitter over a two-year period. RESULTS There were 328 patients, caregivers, and care partners who generated 3347 tweets. One overarching theme, OpenAPS changes lives, and five subthemes emerged from the data: (1) OpenAPS use suggests self-reported A1C and glucose variability improvement, (2) OpenAPS improves sense of diabetes burden and quality of life, (3) OpenAPS is perceived as safe, (4) patient/caregiver-provider interaction related to OpenAPS, and (5) technology adaptation for user needs. CONCLUSIONS As users of a patient-driven technology, OpenAPS users are self-reporting improved A1C, day-to-day glucose levels, and quality of life. Safety features important to individuals with diabetes are perceived to be embedded into OpenAPS technology. Twitter analysis provides insight on a patient population driving an innovative solution to improve their quality of diabetes care.
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Affiliation(s)
- Michelle L. Litchman
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Utah Diabetes and Endocrinology Center, Salt Lake City, UT, USA
- Michelle L. Litchman, PhD, FNP-BC, FAANP, College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA.
| | | | - Lesly A. Kelly
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Perry M. Gee
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- Dignity Health, San Francisco, CA, USA
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Kebede MM, Schuett C, Pischke CR. The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey. J Clin Med 2019; 8:jcm8010109. [PMID: 30658463 PMCID: PMC6352012 DOI: 10.3390/jcm8010109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Abstract
Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.
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Affiliation(s)
- Mihiretu M Kebede
- Health Sciences, University of Bremen, Grazerstrasse 2, D-28359 Bremen, Germany.
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Po.box-196 Gondar, Ethiopia.
| | - Cora Schuett
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
| | - Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitätsstrasse 1, D-40225 Duesseldorf, Germany.
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Petruzelkova L, Soupal J, Plasova V, Jiranova P, Neuman V, Plachy L, Pruhova S, Sumnik Z, Obermannova B. Excellent Glycemic Control Maintained by Open-Source Hybrid Closed-Loop AndroidAPS During and After Sustained Physical Activity. Diabetes Technol Ther 2018; 20:744-750. [PMID: 30285476 DOI: 10.1089/dia.2018.0214] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Officially licensed hybrid closed-loop systems are not currently available worldwide; therefore, open-source systems have become increasingly popular. Our aim was to assess the safety, feasibility, and efficacy of an open-source hybrid closed-loop system (AndroidAPS) versus SmartGuard® technology for day-and-night glucose control in children under extreme sports conditions. RESEARCH DESIGN AND METHODS Twenty-two children (16 girls, 6-15 years of age, median HbA1c 56 ± 9 mmol/mol) were enrolled in this pivotal winter sports camp study. The participants were divided into two groups using either the AndroidAPS or SmartGuard technology. Physical exertion was represented by all-day alpine skiing. The primary endpoints were mean glucose level, time below the threshold of 3.9 mmol/L, and time within the target range of 3.9 to 10 mmol/L. RESULTS The children using the AndroidAPS had significantly lower mean glycemia levels (7.2 ± 2.7 vs. 7.7 ± 2.8 mmol/L; 129.6 ± 49 vs. 138.6 ± 50 mg/dL, P < 0.042) than the children using the SmartGuard. The proportion of time below the target (median 5.0% ± 2.5% vs. 3.0% ± 2.3%, P = 0.6) and in the target zone (63% ± 9.5% vs. 63% ± 18%, P = 0.5) did not significantly differ. The AndroidAPS group experienced more frequent malfunctions of the cannula set (median 0.8 ± 0.4 vs. 0.2 ± 0.4, P = 0.02), which could have affected the results. No significant difference was found in the amount of carbohydrates consumed for the prevention and treatment of hypoglycemia [median 40 ± 23 vs. 25 ± 29 g/(patient ·3 days)]. No episodes of severe hypoglycemia or other serious adverse events were noted. CONCLUSIONS This pilot study showed that the AndroidAPS system was a safe and feasible alternative to the SmartGuard Technology.
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Affiliation(s)
- Lenka Petruzelkova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Jan Soupal
- 2 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Veronika Plasova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Pavlina Jiranova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Vit Neuman
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Lukas Plachy
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Stepanka Pruhova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Zdenek Sumnik
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
| | - Barbora Obermannova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Prague, Czech Republic
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