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Nabiolahi A, Sedghi S, Aghili R, Nemati-Anaraki L. Personalization of health information prescription in diabetes clinical setting: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:103. [PMID: 34084850 PMCID: PMC8150073 DOI: 10.4103/jehp.jehp_688_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The prevalence of diabetes makes considerable costs for health-care organizations. The increase of patient's self-care abilities by use of personalizing health information prescription can reduce these costs. This study was conducted to explore the benefits and challenges related to personalizing health information prescription in diabetes clinical settings. MATERIALS AND METHODS The samples included diabetes education officials working in specialized diabetes clinics and Diabetes Research Centre managers of Iran and Tehran Universities of Medical Sciences. They were 21 cases and selected through purposeful sampling method. Semi-structured interview and focus discussion groups were used to collect the viewpoints of specialists. Interview guide, based on literature review and the documents of diabetes, was used in interviews and focus groups. Their validity was affirmed by specialists. The interview texts were coded in MAXQDA10 software and analyzed through content analysis method. RESULTS The most important benefits of personalizing health information prescription were classified into five themes as follows: medical services improvement, facilitation of consumers to information resources, improvement in patients' knowledge and awareness, increase in self-care ability and disease management, reinforcing the relation between physician and patient and keeping physician in the information prescription cycle. The challenges of personalizing of health information prescription were revealed as follows: Recognition of patients' personal characteristics at the turn of entering the system, systems' functional modifiers especially bilateral interaction and relation to patient's health file, content recognition, and creating suitable protocol. CONCLUSION This study showed that diabetes clinical settings face different organizational and process challenges for establishing the personalization of health information prescription. The most important challenges which should be considered in designing information prescription in diabetes clinical environments are as follows: reinforcing physicians' recognition of information prescription benefits, lack of integrative electronic health information system, and patient primary assessment in the first stage of entering the patient into the system in respect of clinical and personal aspects in information needs of consumer.
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Affiliation(s)
- Abdolahad Nabiolahi
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Sedghi
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rokhsareh Aghili
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Nemati-Anaraki
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Sittig S, Wang J, Iyengar S, Myneni S, Franklin A. Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes. JMIR Mhealth Uhealth 2020; 8:e15927. [PMID: 32175908 PMCID: PMC7105932 DOI: 10.2196/15927] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/13/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. Objective The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. Methods The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants’ classified usage of capABILITY. Results Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. Conclusions Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. Trial Registration ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089
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Affiliation(s)
- Scott Sittig
- School of Computing, University of South Alabama, Mobile, AL, United States
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Sriram Iyengar
- College of Medicine Phoenix, The University of Arizona, Phoenix, AZ, United States
| | - Sahiti Myneni
- School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Amy Franklin
- School of Biomedical Informatics, University of Texas Health Science Center Houston, Houston, TX, United States
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Wang X, He L, Zhu K, Zhang S, Xin L, Xu W, Guan Y. An integrated model to evaluate the impact of social support on improving self-management of type 2 diabetes mellitus. BMC Med Inform Decis Mak 2019; 19:197. [PMID: 31640691 PMCID: PMC6805520 DOI: 10.1186/s12911-019-0914-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 09/10/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is a chronic disease closely related to personal life style. Therefore, achieving effective self-management is one of the most important ways to control it. There is evidence that social support can help to improve the self-management ability of patients with T2DM, but which social support is more effective has been rarely explored. The purpose of this study is to construct an integrated model to analyze which social support has more significant impact on self-management of T2DM, and provide reasonable suggestions to health care providers on how to effectively play the role of social support. METHODS We established a social support indicator evaluation system and proposed an integrated model that combines ANP (Analytical Network Process) and CRITIC (CRiteria Importance through Intercriteria Correlation) methods to evaluate the impact of social support on T2DM self-management from both subjective and objective perspectives. The weights calculated by the model will serve as the basis for us to judge the importance of different social support indicators. RESULTS Informational support (weighting 49.26%) is the most important criteria, followed by tangible support (weighting 39.24%) and emotional support (weighting 11.51%). Among 11 sub-criteria, guidance (weighting 23.05%) and feedback (weighting 14.68%) are two most relevant with T2DM self-management. This result provides ideas and evidence for health care providers on how to offer more effective social support. CONCLUSION To our knowledge, this is the first study in which Multi-Criteria Decision Making (MCDM) tools, specifically ANP and CRITIC, are used to evaluate the impact of social support on improving self-management of type 2 diabetes. The study suggests that incorporating two sub-indicators of guidance and feedback into the diabetes care programs may have great potential to improve T2DM self-management and further control patient blood glucose and reduce complications.
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Affiliation(s)
- Xiaojia Wang
- Department of Information Management, School of Management, Hefei University of Technology, Mailbox 270, No. 193, Tunxi Road, Hefei, 230009 An Hui Province China
| | - Linglan He
- Department of Information Management, School of Management, Hefei University of Technology, Mailbox 270, No. 193, Tunxi Road, Hefei, 230009 An Hui Province China
| | - Keyu Zhu
- Department of Information Management, School of Management, Hefei University of Technology, Mailbox 270, No. 193, Tunxi Road, Hefei, 230009 An Hui Province China
| | - Shanshan Zhang
- Department of Clinical Teaching, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031 Anhui China
- The National Chinese Medicine Clinical Research Base- Key Disease of Diabetes Mellitus Study, Hefei, 230031 Anhui China
| | - Ling Xin
- The National Chinese Medicine Clinical Research Base- Key Disease of Diabetes Mellitus Study, Hefei, 230031 Anhui China
- Healthcare and Public health Information Center, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031 Anhui China
| | - Weiqun Xu
- The National Chinese Medicine Clinical Research Base- Key Disease of Diabetes Mellitus Study, Hefei, 230031 Anhui China
- Department of Endocrinology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031 Anhui China
| | - Yuxiang Guan
- The National Chinese Medicine Clinical Research Base- Key Disease of Diabetes Mellitus Study, Hefei, 230031 Anhui China
- Department of Endocrinology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031 Anhui China
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Aljuraiban GS. Use of Weight-Management Mobile Phone Apps in Saudi Arabia: A Web-Based Survey. JMIR Mhealth Uhealth 2019; 7:e12692. [PMID: 30794205 PMCID: PMC6406230 DOI: 10.2196/12692] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/08/2019] [Accepted: 01/25/2019] [Indexed: 01/23/2023] Open
Abstract
Background In recent years, the use of mobile phone weight-management apps has increased significantly. Weight-management apps have been found effective in promoting health and managing weight. However, data on user perception and on barriers to app usage are scarce. Objective This study aimed to investigate the use of weight-management apps and barriers to use as well as reasons for discontinuing use in a sample of mobile phone users in Saudi Arabia. Methods Mobile phone users aged 18 years and above from the general public in Saudi Arabia completed a Web-based survey. The survey included questions on weight-management app usage patterns, user perceptions concerning weight management, efficacy of weight-management apps, and reasons for discontinuing use. Participants were classified into normal weight (body mass index [BMI]: 18.5 to 24.9 kg/m2) and overweight or obese (BMI: ≥25.0 kg/m2). Results The survey included 1191 participants; 513 of them used weight-management apps. More overweight or obese respondents used these apps compared with normal weight respondents (319/513, 62.2% vs 194/513, 37.8%, respectively). App features that overweight or obese users were most interested in were mainly the possibility to be monitored by a specialist and barcode identification of calorie content, whereas normal weight users mostly preferred availability of nutrition information of food items. Reasons for discontinuing use among overweight or obese respondents were mainly that monitoring by a specialist was not offered (80/236, 33.9%) and the app was not in the local language (48/236, 20.3%). Among normal weight users, the main reason for noncontinuance was the app language (45/144, 31.3%) and difficulty of use (30/144, 20.8%). Conclusions To better address the needs of both normal weight and overweight or obese adults, improved app designs that offer monitoring by a specialist are needed. Developers may consider ways of overcoming barriers to use, such as language, by developing local language apps, which can improve the efficacy of such apps and help spread their use.
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Affiliation(s)
- Ghadeer S Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Ayatollahi H, Hasannezhad M, Fard HS, Haghighi MK. Type 1 diabetes self-management: developing a web-based telemedicine application. HEALTH INF MANAG J 2018; 45:16-26. [PMID: 28691565 DOI: 10.1177/1833358316639456] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management skills are essential for patients with diabetes mellitus to minimise the risks of complications from their condition. The aim of this research was to develop a web-based application for self-management of type 1 diabetes, suitable for use by patients, their carers and physicians. METHOD The study was comprised of two phases, the first being analysis of the kind of information and capabilities required by potential users of the system. Based on the results derived from the first phase of the study, the system prototype was designed and then evaluated using the 'think aloud' method and a standard questionnaire. The application was designed for use by patients, their carers and physicians. Patients could enter the level of blood glucose, insulin and activities on a daily basis, and physicians were able to supervise a patient's health status from a distance. RESULTS Users were generally satisfied with the final version of the system. People with a wide range of literacy skills were able to use the system effectively. CONCLUSION Patients or their carers could use the web-based application as a log book by entering the level of blood glucose and insulin doses on a regular basis, and as an educational resource to improve self-management skills. Physicians could use the system at any time convenient to them to support patients by giving medical advice. Further research is needed to report the effectiveness of the system in practice.
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Affiliation(s)
- Haleh Ayatollahi
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hasannezhad
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
| | - Hedieh Saneei Fard
- 2 Paediatric Endocrinology & Metabolism, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehran Kamkar Haghighi
- 1 Department of Health Information Management, Iran University of Medical Sciences, Tehran, Iran
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Pugatch J, Grenen E, Surla S, Schwarz M, Cole-Lewis H. Information Architecture of Web-Based Interventions to Improve Health Outcomes: Systematic Review. J Med Internet Res 2018; 20:e97. [PMID: 29563076 PMCID: PMC5978245 DOI: 10.2196/jmir.7867] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/06/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background The rise in usage of and access to new technologies in recent years has led to a growth
in digital health behavior change interventions. As the shift to digital platforms
continues to grow, it is increasingly important to consider how the field of information
architecture (IA) can inform the development of digital health interventions. IA is the
way in which digital content is organized and displayed, which strongly impacts users’
ability to find and use content. While many information architecture best practices
exist, there is a lack of empirical evidence on the role it plays in influencing
behavior change and health outcomes. Objective Our aim was to conduct a systematic review synthesizing the existing literature on
website information architecture and its effect on health outcomes, behavioral outcomes,
and website engagement. Methods To identify all existing information architecture and health behavior literature, we
searched articles published in English in the following databases (no date restrictions
imposed): ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and
PubMed. The search terms used included information terms (eg, information architecture,
interaction design, persuasive design), behavior terms (eg, health behavior, behavioral
intervention, ehealth), and health terms (eg, smoking, physical activity, diabetes). The
search results were reviewed to determine if they met the inclusion and exclusion
criteria created to identify empirical research that studied the effect of IA on health
outcomes, behavioral outcomes, or website engagement. Articles that met inclusion
criteria were assessed for study quality. Then, data from the articles were extracted
using a priori categories established by 3 reviewers. However, the limited health
outcome data gathered from the studies precluded a meta-analysis. Results The initial literature search yielded 685 results, which was narrowed down to three
publications that examined the effect of information architecture on health outcomes,
behavioral outcomes, or website engagement. One publication studied the isolated impact
of information architecture on outcomes of interest (ie, website use and engagement;
health-related knowledge, attitudes, and beliefs; and health behaviors), while the other
two publications studied the impact of information architecture, website features (eg,
interactivity, email prompts, and forums), and tailored content on these outcomes. The
paper that investigated IA exclusively found that a tunnel IA improved site engagement
and behavior knowledge, but it decreased users’ perceived efficiency. The first study
that did not isolate IA found that the enhanced site condition improved site usage but
not the amount of content viewed. The second study that did not isolate IA found that a
tailored site condition improved site usage, behavior knowledge, and some behavior
outcomes. Conclusions No clear conclusion can be made about the relationship between IA and health outcomes,
given limited evidence in the peer-reviewed literature connecting IA to behavioral
outcomes and website engagement. Only one study reviewed solely manipulated IA, and we
therefore recommend improving the scientific evidence base such that additional
empirical studies investigate the impact of IA in isolation. Moreover, information from
the gray literature and expert opinion might be identified and added to the evidence
base, in order to lay the groundwork for hypothesis generation to improve empirical
evidence on information architecture and health and behavior outcomes.
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Affiliation(s)
| | | | | | | | - Heather Cole-Lewis
- Johnson & Johnson Health and Wellness Solutions, Inc, New Brunswick, NJ, United States
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Crangle CE, Bradley C, Carlin PF, Esterhay RJ, Harper R, Kearney PM, Lorig K, McCarthy VJC, McTear MF, Tuttle MS, Wallace JG, Savage E. Soliciting and Responding to Patients' Questions about Diabetes Through Online Sources. Diabetes Technol Ther 2017; 19:194-199. [PMID: 28221815 DOI: 10.1089/dia.2016.0291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
When patients cannot get answers from health professionals or retain the information given, increasingly they search online for answers, with limited success. Researchers from the United States, Ireland, and the United Kingdom explored this problem for patients with type 2 diabetes mellitus (T2DM). In 2014, patients attending an outpatient clinic (UK) were asked to submit questions about diabetes. Ten questions judged representative of different types of patient concerns were selected by the researchers and submitted to search engines within trusted and vetted websites in the United States, Ireland, and the United Kingdom. Two researchers independently assessed if answers could be found in the three top-ranked documents returned at each website. The 2014 search was repeated in June, 2016, examining the two top-ranked documents returned. One hundred and sixty-four questions were collected from 120 patients during 12 outpatient clinics. Most patients had T2DM (95%). Most questions were about diabetes (N = 155) with the remainder related to clinic operation (N = 9). Of the questions on diabetes, 152 were about T2DM. The 2014 assessment found no adequate answers to the questions in 90 documents (10 questions, 3 websites, 3 top documents). In the 2016 assessment, 1 document out of 60 (10 questions, 3 websites, 2 top documents) provided an adequate answer relating to 1 of the 10 questions. Available online sources of information do not provide answers to questions from patients with diabetes. Our results highlight the urgent need to develop novel ways of providing answers to patient questions about T2DM.
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Affiliation(s)
- Colleen E Crangle
- 1 School of Public Health and Information Sciences, University of Louisville , Louisville, Kentucky
| | - Colin Bradley
- 2 Department of General Practice, University College Cork , Cork, Ireland
| | - Paul F Carlin
- 3 South Eastern Health and Social Care Trust , Research Office, Dundonald, Northern Ireland, United Kingdom
| | - Robert J Esterhay
- 1 School of Public Health and Information Sciences, University of Louisville , Louisville, Kentucky
| | - Roy Harper
- 4 Department of Endocrinology and Diabetes, The Ulster Hospital, South Eastern Health and Social Care Trust , Dundonald, Northern Ireland, United Kingdom
| | - Patricia M Kearney
- 5 Department of Epidemiology and Public Health, University College Cork , Cork, Ireland
| | - Kate Lorig
- 6 Patient Education Research Center, Stanford University School of Medicine , Stanford, California
| | - Vera J C McCarthy
- 7 School of Nursing and Midwifery, University College Cork , Cork, Ireland
| | - Michael F McTear
- 8 School of Computing and Mathematics, University of Ulster , Jordanstown, Northern Ireland, United Kingdom
| | | | - Jonathan G Wallace
- 8 School of Computing and Mathematics, University of Ulster , Jordanstown, Northern Ireland, United Kingdom
| | - Eileen Savage
- 7 School of Nursing and Midwifery, University College Cork , Cork, Ireland
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Development of a clinical decision support system for diabetes care: A pilot study. PLoS One 2017; 12:e0173021. [PMID: 28235017 PMCID: PMC5325565 DOI: 10.1371/journal.pone.0173021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 02/14/2017] [Indexed: 11/21/2022] Open
Abstract
Management of complex chronic diseases such as diabetes requires the assimilation and interpretation of multiple laboratory test results. Traditional electronic health records tend to display laboratory results in a piecemeal and segregated fashion. This makes the assembly and interpretation of results related to diabetes care challenging. We developed a diabetes-specific clinical decision support system (Diabetes Dashboard) interface for displaying glycemic, lipid and renal function results, in an integrated form with decision support capabilities, based on local clinical practice guidelines. The clinical decision support system included a dashboard feature that graphically summarized all relevant laboratory results and displayed them in a color-coded system that allowed quick interpretation of the metabolic control of the patients. An alert module informs the user of tests that are due for repeat testing. An interactive graph module was also developed for better visual appreciation of the trends of the laboratory results of the patient. In a pilot study involving case scenarios administered via an electronic questionnaire, the Diabetes Dashboard, compared to the existing laboratory reporting interface, significantly improved the identification of abnormal laboratory results, of the long-term trend of the laboratory tests and of tests due for repeat testing. However, the Diabetes Dashboard did not significantly improve the identification of patients requiring treatment adjustment or the amount of time spent on each case scenario. In conclusion, we have developed and shown that the use of the Diabetes Dashboard, which incorporates several decision support features, can improve the management of diabetes. It is anticipated that this dashboard will be most helpful when deployed in an outpatient setting, where physicians can quickly make clinical decisions based on summarized information and be alerted to pertinent areas of care that require additional attention.
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Weymann N, Dirmaier J, von Wolff A, Kriston L, Härter M. Effectiveness of a Web-based tailored interactive health communication application for patients with type 2 diabetes or chronic low back pain: randomized controlled trial. J Med Internet Res 2015; 17:e53. [PMID: 25736340 PMCID: PMC4376097 DOI: 10.2196/jmir.3904] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising. Patient empowerment is a key strategy in the management of chronic diseases. Patient empowerment can be fostered by Web-based interactive health communication applications (IHCAs) that combine health information with decision support, social support, and/or behavioral change support. Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness. Objective The main objective was to test the effectiveness of a Web-based, tailored, fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring (control condition) on patients’ knowledge and empowerment. Methods We performed a blinded randomized trial with a parallel design. In the intervention group, the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group, the sections of the text were presented in a content tree without any tailoring. Participants were recruited online and offline and were blinded to their group assignments. Measurements were taken at baseline (t0), directly after the first visit (t1), and at 3-month follow-up (t2). The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment (primary outcomes) than the control website. The secondary outcomes were decisional conflict and preparation for decision making. All measurements were conducted by online self-report questionnaires. Intention-to-treat (ITT) and available cases (AC) analyses were performed for all outcomes. Results A total of 561 users agreed to participate in the study. Of these, 179 (31.9%) had type 2 diabetes and 382 (68.1%) had chronic low back pain. Usage was significantly higher in the tailored system (mean 51.2 minutes) than in the control system (mean 37.6 minutes; P<.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in the ITT analysis. In the AC analysis, participants using the tailored system displayed significantly more knowledge at t1 (P=.02) and more emotional well-being (subscale of empowerment) at t2 (P=.009). The estimated mean difference between the groups was 3.9 (95% CI 0.5-7.3) points for knowledge and 25.4 (95% CI 6.3-44.5) points for emotional well-being on a 0-100 points scale. Conclusions The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes. Trial Registration International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitation.org/6WPO0lJwE).
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Weymann N, Härter M, Dirmaier J. Information and decision support needs in patients with type 2 diabetes. Health Informatics J 2014; 22:46-59. [PMID: 24916569 DOI: 10.1177/1460458214534090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes and its sequelae cause a growing burden of morbidity and mortality. For many patients living with diabetes, the Internet is an important source of health information and support. In the course of the development of an Interactive Health Communication Application, combining evidence-based information with behavior change and decision support, we assessed the characteristics, information, and decision support needs of patients with type 2 diabetes.The needs assessment was performed in two steps. First, we conducted semi-structured interviews with 10 patients and seven physicians. In the second step, we developed a self-assessment questionnaire based on the results of the interviews and administered it to a new and larger sample of diabetes patients (N = 178). The questionnaire comprised four main sections: (1) Internet use and Internet experience, (2) diabetes knowledge, (3) relevant decisions and decision preferences, and (4) online health information needs. Descriptive data analyses were performed.In the questionnaire study, the patient sample was heterogeneous in terms of age, time since diagnosis, and glycemic control. (1) Most participants (61.7%) have searched the web for health information at least once. The majority (62%) of those who have used the web use it at least once per month. (2) Diabetes knowledge was scarce: Only a small percentage (1.9%) of the respondents answered all items of the knowledge questionnaire correctly. (3) The most relevant treatment decisions concerned glycemic control, oral medication, and acute complications. The most difficult treatment decision was whether to start insulin treatment. Of the respondents, 69.4 percent thought that medical decisions should be made by them and their doctor together. (4) The most important information needs concerned sequelae of diabetes, blood glucose control, and basic diabetes information.The Internet seems to be a feasible way to reach people with type 2 diabetes. The heterogeneity of the sample, especially with respect to diabetes knowledge, makes it clear that the projected Interactive Health Communication Application should tailor the content to the individual user, taking account of individual characteristics and preferences. A wide range of topics should be covered. Special attention should be paid to the advantages and disadvantages of insulin treatment and the fears and hopes associated with it. These results were taken into account when developing the Interactive Health Communication Application that is currently being evaluated in a randomized controlled trial (International Clinical Trials Registry DRKS00003322).
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Affiliation(s)
- Nina Weymann
- University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Germany
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Germany
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Dirmaier J, Härter M, Weymann N. A tailored, dialogue-based health communication application for patients with chronic low back pain: study protocol of a randomised controlled trial. BMC Med Inform Decis Mak 2013; 13:66. [PMID: 23768119 PMCID: PMC3691598 DOI: 10.1186/1472-6947-13-66] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic low back pain is a common chronic condition whose treatment success can be improved by active involvement of patients. Patient involvement can be fostered by web-based applications combining health information with decision support or behaviour change support. These so-called Interactive Health Communication Applications (IHCAs) can reach great numbers of patients at low financial cost and provide information and support at the time, place and learning speed patients prefer. However, high attrition often seems to decrease the effects of web-based interventions. Tailoring content and tone of IHCAs to the individual patient ́s needs might improve usage and therefore effectiveness. This study aims to evaluate a tailored IHCA for people with chronic low back pain combining health information with decision support and behaviour change support. METHODS/DESIGN The tailored IHCA will be tested regarding effectiveness and usage against a standard website with identical content in a single-blinded randomized trial with a parallel design. The IHCA contains information on chronic low back pain and its treatment options including health behaviour change recommendations. In the intervention group the content is delivered in dialogue form, tailored to relevant patient characteristics (health literacy, coping style). In the control group there is no tailoring, a standard web-page is used for presenting the content. Participants are unaware of group assignment. Eligibility criteria are age ≥ 18 years , self- reported chronic low back pain, and Internet access. To detect the expected small effect (Cohen's d = 0.2), the sample aims to include 414 patients, with assessments at baseline, directly after the first on-page visit, and at 3-month follow-up using online self-report questionnaires. It is expected that the tailored IHCA has larger effects on knowledge and patient empowerment (primary outcomes) compared to a standard website. Secondary outcomes are website usage, preparation for decision making, and decisional conflict. DISCUSSION IHCAs can be a suitable way to promote knowledge about chronic low back pain and self-management competencies. Results of the study can increase the knowledge on how to develop IHCAs which are more useful and effective for people suffering from chronic low back pain. TRIAL REGISTRATION International Clinical Trials Registry DRKS00003322.
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Affiliation(s)
- Jörg Dirmaier
- Department of Medical Psychology (W 26), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Martin Härter
- Department of Medical Psychology (W 26), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Nina Weymann
- Department of Medical Psychology (W 26), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Weymann N, Härter M, Petrak F, Dirmaier J. Health information, behavior change, and decision support for patients with type 2 diabetes: development of a tailored, preference-sensitive health communication application. Patient Prefer Adherence 2013; 7:1091-9. [PMID: 24174871 PMCID: PMC3808151 DOI: 10.2147/ppa.s46924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patient involvement in diabetes treatment such as shared decision-making and patient self-management has significant effects on clinical parameters. As a prerequisite for active involvement, patients need to be informed in an adequate and preference-sensitive way. Interactive Health Communication Applications (IHCAs) that combine web-based health information for patients with additional support offer the opportunity to reach great numbers of patients at low cost and provide them with high-quality information and support at the time, place, and learning speed they prefer. Still, web-based interventions often suffer from high attrition. Tailoring the intervention to patients' needs and preferences might reduce attrition and should thereby increase effectiveness. The purpose of this study was to develop a tailored IHCA offering evidence-based, preference-sensitive content and treatment decision support to patients with type 2 diabetes. The content was developed based on a needs assessment and two evidence-based treatment guidelines. The delivery format is a dialogue-based, tunneled design tailoring the content and tone of the dialogue to relevant patient characteristics (health literacy, attitudes toward self-care, and psychological barriers to insulin treatment). Both content and tailoring were revised by an interdisciplinary advisory committee. CONCLUSION The World Wide Web holds great potential for patient information and self-management interventions. With the development and evaluation of a tailored IHCA, we complement face-to-face consultations of patients with their health care practitioners and make them more efficient and satisfying for both sides. Effects of the application are currently being tested within a randomized controlled trial.
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Nina Weymann, University Medical Center Hamburg-Eppendorf, Department of Medical Psychology (W 26), Martinistraße 52, 20246 Hamburg, Germany, Tel +49 0 40 7410 57134, Fax +49 0 40 7410 54965, Email
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Petrak
- Clinic of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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