1
|
Miao Y, Luo Y, Zhao Y, Liu M, Wang H, Wu Y. Effectiveness of eHealth Interventions in Improving Medication Adherence Among Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e58013. [PMID: 39008845 PMCID: PMC11287104 DOI: 10.2196/58013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/02/2024] [Accepted: 05/30/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Nonadherence to medication among patients with cardiovascular diseases undermines the desired therapeutic outcomes. eHealth interventions emerge as promising strategies to effectively tackle this issue. OBJECTIVE The aim of this study was to conduct a network meta-analysis (NMA) to compare and rank the efficacy of various eHealth interventions in improving medication adherence among patients with cardiovascular diseases (CVDs). METHODS A systematic search strategy was conducted in PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure Library (CNKI), China Science and Technology Journal Database (Weipu), and WanFang databases to search for randomized controlled trials (RCTs) published from their inception on January 15, 2024. We carried out a frequentist NMA to compare the efficacy of various eHealth interventions. The quality of the literature was assessed using the risk of bias tool from the Cochrane Handbook (version 2.0), and extracted data were analyzed using Stata16.0 (StataCorp LLC) and RevMan5.4 software (Cochrane Collaboration). The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS A total of 21 RCTs involving 3904 patients were enrolled. The NMA revealed that combined interventions (standardized mean difference [SMD] 0.89, 95% CI 0.22-1.57), telephone support (SMD 0.68, 95% CI 0.02-1.33), telemonitoring interventions (SMD 0.70, 95% CI 0.02-1.39), and mobile phone app interventions (SMD 0.65, 95% CI 0.01-1.30) were statistically superior to usual care. However, SMS compared to usual care showed no statistical difference. Notably, the combined intervention, with a surface under the cumulative ranking curve of 79.3%, appeared to be the most effective option for patients with CVDs. Regarding systolic blood pressure and diastolic blood pressure outcomes, the combined intervention also had the highest probability of being the best intervention. CONCLUSIONS The research indicates that the combined intervention (SMS text messaging and telephone support) has the greatest likelihood of being the most effective eHealth intervention to improve medication adherence in patients with CVDs, followed by telemonitoring, telephone support, and app interventions. The results of these network meta-analyses can provide crucial evidence-based support for health care providers to enhance patients' medication adherence. Given the differences in the design and implementation of eHealth interventions, further large-scale, well-designed multicenter trials are needed. TRIAL REGISTRATION INPLASY 2023120063; https://inplasy.com/inplasy-2023-12-0063/.
Collapse
Affiliation(s)
- Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuan Luo
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuhan Zhao
- School of Nursing, Capital Medical University, Beijing, China
| | - Mingxuan Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Huiying Wang
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Yogesh M, Makwana N, Trivedi N, Damor N. Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study. BMC Public Health 2024; 24:1833. [PMID: 38982428 PMCID: PMC11234527 DOI: 10.1186/s12889-024-19343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND India is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population. METHODS A community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person. RESULTS The prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02-1.09). Physical inactivity (AOR 1.68, 95% CI 1.027-2.77) and lack of social support (AOR 1.57, 95% CI 1.01-2.45) also increased the likelihood of multimorbidity. CONCLUSION There is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.
Collapse
Affiliation(s)
- M Yogesh
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India.
| | - Naresh Makwana
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Nidhi Trivedi
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | - Naresh Damor
- Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| |
Collapse
|
3
|
Højgaard HG, Frederiksen K, Høgh AL, Dahl M. First pill hardest to swallow: An evaluation study of cardiovascular nurse-led follow-up phone calls. JOURNAL OF VASCULAR NURSING 2024; 42:35-43. [PMID: 38555176 DOI: 10.1016/j.jvn.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/16/2023] [Accepted: 11/18/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Screening for cardiovascular disease (CVD) followed by preventive medication is expected to reduce CVD (2,3,5). However, insufficient medication adherence may affect screening effectiveness (11-12). It remains uncertain which interventions are suitable to support citizens in their decision-making about taking CVD preventive medication. OBJECTIVE We evaluated if and how three nurse-led telephone follow-up (TFU) calls supported citizens in making informed decisions regarding CVD preventive medication and thereby potentially strengthened their medication adherence. METHODS Employing a theory-based evaluation design inspired by Dahler-Larsen (39-41), we developed and tested a programme theory describing if and how the TFU calls supported medical decision-making and potentially improved medication adherence. Data were collected via telephone. FINDINGS We analysed 61 TFU calls collected between May 2017 and April 2019 and found that TFU calls supported participants' reflections on preventive medication. TFU calls supported informed decision-making regarding initiating medication, allowing participants to consider personal preferences and values, including both opting for and abstaining from medication. The content of the TFU calls revolved around four crucial themes: I) understanding the purpose of taking the medicine; II) meaningfulness and joint reflection support the decision; III) relation to healthcare professionals; and IV) taking medication for the first time. CONCLUSION TFU calls effectively supported citizens' understanding and addressed their needs. Trusted healthcare professionals' recommendations were preferred for decisional support. Initiating CVD preventive medication was particularly challenging for citizens who had not previously taken such medication. We recommend scheduling TFU calls early: the first after one week, the second after one month and the third after six months.
Collapse
Affiliation(s)
- Helen Gräs Højgaard
- Vascular Research Unit, Viborg Regional Hospital, Toldbodgade 12, 6th floor, 8800, Viborg Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark.
| | - Kirsten Frederiksen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 3rd floor, 8000, Aarhus C, Denmark
| | - Annette Langager Høgh
- Vascular Research Unit, Viborg Regional Hospital, Toldbodgade 12, 6th floor, 8800, Viborg Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark
| | - Marie Dahl
- Vascular Research Unit, Viborg Regional Hospital, Toldbodgade 12, 6th floor, 8800, Viborg Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark; Cardiac, Thoracic and Vascular Research Unit, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark
| |
Collapse
|
4
|
Kwon OY, Lee MK, Lee HW, Kim H, Lee JS, Jang Y. Mobile App-Based Lifestyle Coaching Intervention for Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial. J Med Internet Res 2024; 26:e49839. [PMID: 38358794 PMCID: PMC10905353 DOI: 10.2196/49839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/22/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Lifestyle modification in patients with nonalcoholic fatty liver disease (NAFLD) is key to improving health outcomes. Mobile health technologies may offer potential effective and efficient health care support to facilitate self-management. OBJECTIVE This study aims to develop a lifestyle coaching intervention using a mobile app for patients with NAFLD and evaluate physiological and psychological health outcomes for 6 months. METHODS This study was a randomized controlled trial. The personalized lifestyle coaching intervention using a mobile app was developed through established guidelines and literature reviews. This intervention consisted of information on NAFLD management, diet and physical activity self-monitoring, and coaching sessions based on patient records and SMS text messages. A total of 102 individuals were enrolled in the study and randomly assigned to the intervention group (n=48) or the control group (n=54). The outcomes were improvements in physiological (weight, liver fat score, aspartate aminotransferase, alanine transferase, and gamma-glutamyl transferase) and clinical outcomes (self-management, NAFLD self-management knowledge, self-efficacy, fatigue, depression, and quality of life). Data were analyzed using descriptive analysis and a linear mixed model to test the effects of the intervention. RESULTS All participants completed the study. The mean age of the participants was 48.9 (SD 13.74) years, 38.2% (39/102) were female participants, and 65.7% (67/102) were married. There were no differences in baseline demographic and clinical data between the intervention and control groups. Changes from baseline to 6 months were significant only within the intervention group for weight (P<.001), liver fat score (P=.01), aspartate aminotransferase (P=.03), alanine transferase (P=.002), gamma-glutamyl transferase (P=.04), self-management (P<.001), fatigue (P=.005), depression (P=.003), and quality of life (P<.001). The differences between the 2 groups for the changes over the 6 months were significant in self-management (P=.004), self-management knowledge (P=.04), fatigue (P=.004), depression (P=.04), and quality of life (P=.01). However, the intervention-by-time interaction was significantly effective only for self-management (P=.006) and fatigue (P=.02). CONCLUSIONS Nonpharmacological interventions using a mobile app may be effective in improving the physiological and psychological health outcomes of patients with NAFLD. TRIAL REGISTRATION Clinical Research Information Service KCT0005549; http://tinyurl.com/y2zb6usy.
Collapse
Affiliation(s)
- Oh Young Kwon
- College of Nursing, Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Mi Kyung Lee
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Republic of Korea
| | - Hye Won Lee
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Hyerang Kim
- Department of Nursing Science, VISION College of Jeonju, Jeollabuk-Do, Republic of Korea
| | - Jae Seung Lee
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
5
|
Harper RC, Sheppard S, Stewart C, Clark CJ. Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e45947. [PMID: 38032694 PMCID: PMC10722367 DOI: 10.2196/45947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/01/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. OBJECTIVE We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. METHODS We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. RESULTS Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT "prompts and cues." Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. CONCLUSIONS Digital "prompts and cues" are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital "prompts and cues" on PFMT adherence in women can be conducted.
Collapse
Affiliation(s)
- Rosie C Harper
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
- National Institute of Health Research ARC Wessex, Southampton, United Kingdom
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Sally Sheppard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
- University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Carly Stewart
- Faculty of Science and Technology, Bournemouth University, Bournemouth, United Kingdom
| | - Carol J Clark
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| |
Collapse
|
6
|
Aovare P, Abdulai K, Laar A, van der Linden EL, Moens N, Richard E, Moll van Charante EP, Agyemang C. Assessing the Effectiveness of mHealth Interventions for Diabetes and Hypertension Management in Africa: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2023; 11:e43742. [PMID: 37646291 PMCID: PMC10477453 DOI: 10.2196/43742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/28/2023] [Accepted: 06/09/2023] [Indexed: 09/01/2023] Open
Abstract
Background Mobile health (mHealth) interventions are effective in improving chronic disease management, mainly in high-income countries. However, less is known about the efficacy of mHealth interventions for the reduction of cardiovascular risk factors, including for hypertension and diabetes, which are rapidly increasing in low- and middle-income countries. Objective This study aimed to assess the efficacy of mHealth interventions for diabetes and hypertension management in Africa. Methods We searched PubMed, Cochrane Library, Google Scholar, African Journals Online, and Web of Science for relevant studies published from inception to July 2022. The main outcomes of interest were changes in hemoglobin A1c (HbA1c), systolic blood pressure, and diastolic blood pressure. The random or fixed effect model was used for the meta-analysis, and the I2 statistic was used to gauge study heterogeneity. Z tests and P values were used to evaluate the effect of mHealth interventions on HbA1c and blood pressure levels. Results This review included 7 studies (randomized controlled trials) with a total of 2249 participants. Two studies assessed the effect of mHealth on glycemic control, and 5 studies assessed the effect of mHealth on blood pressure control. The use of mHealth interventions was not associated with significant reductions in HbA1c levels (weighted mean difference [WMD] 0.20, 95% CI -0.40 to 0.80; P=.51) among patients with diabetes and systolic blood pressure (WMD -1.39, 95% CI -4.46 to 1.68; P=.37) and diastolic blood pressure (WMD 0.36, 95% CI -1.37 to 2.05; P=.69) among patients with hypertension. After conducting sensitivity analyses using the leave-one-out method, the Kingue et al study had an impact on the intervention, resulting in a 2 mm Hg reduction in systolic blood pressure (WMD -2.22, 95% CI -3.94 to -0.60; P=.01) but was nonsignificant for diastolic blood pressure and HbA1c levels after omitting the study. Conclusions Our review provided no conclusive evidence for the effectiveness of mHealth interventions in reducing blood pressure and glycemic control in Africa among persons with diabetes and hypertension. To confirm these findings, larger randomized controlled trials are required.
Collapse
Affiliation(s)
- Pearl Aovare
- Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Kasim Abdulai
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Amos Laar
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana
| | - Eva L van der Linden
- Department of Vascular Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolaas Moens
- Department of Economics, eHealth, and Digital Transformation, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Edo Richard
- Department of Neurology, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Eric P Moll van Charante
- Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands
- Department of General Practice, University of Amsterdam, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
7
|
Clay-Williams R, Hibbert P, Carrigan A, Roberts N, Austin E, Fajardo Pulido D, Meulenbroeks I, Nguyen HM, Sarkies M, Hatem S, Maka K, Loy G, Braithwaite J. The diversity of providers' and consumers' views of virtual versus inpatient care provision: a qualitative study. BMC Health Serv Res 2023; 23:724. [PMID: 37400807 DOI: 10.1186/s12913-023-09715-x] [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: 10/05/2022] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND A broad-based international shift to virtual care models over recent years has accelerated following COVID-19. Although there are increasing numbers of studies and reviews, less is known about clinicians' and consumers' perspectives concerning virtual modes in contrast to inpatient modes of delivery. METHODS We conducted a mixed-methods study in late 2021 examining consumers' and providers' expectations of and perspectives on virtual care in the context of a new facility planned for the north-western suburbs of Sydney, Australia. Data were collected via a series of workshops, and a demographic survey. Recorded qualitative text data were analysed thematically, and surveys were analysed using SPSS v22. RESULTS Across 12 workshops, 33 consumers and 49 providers from varied backgrounds, ethnicities, language groups, age ranges and professions participated. Four advantages, strengths or benefits of virtual care reported were: patient factors and wellbeing, accessibility, better care and health outcomes, and additional health system benefits, while four disadvantages, weaknesses or risks of virtual care were: patient factors and wellbeing, accessibility, resources and infrastructure, and quality and safety of care. CONCLUSIONS Virtual care was widely supported but the model is not suitable for all patients. Health and digital literacy and appropriate patient selection were key success criteria, as was patient choice. Key concerns included technology failures or limitations and that virtual models may be no more efficient than inpatient care models. Considering consumer and provider views and expectations prior to introducing virtual models of care may facilitate greater acceptance and uptake.
Collapse
Affiliation(s)
- Robyn Clay-Williams
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia.
| | - Peter Hibbert
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
- Centre for Elite Performance, Macquarie University, Expertise & Training, Sydney, NSW, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Graeme Loy
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
8
|
Roberts N, Carrigan A, Clay-Williams R, Hibbert PD, Mahmoud Z, Pomare C, Fajardo Pulido D, Meulenbroeks I, Knaggs GT, Austin EE, Churruca K, Ellis LA, Long JC, Hutchinson K, Best S, Nic Giolla Easpaig B, Sarkies MN, Francis Auton E, Hatem S, Dammery G, Nguyen MT, Nguyen HM, Arnolda G, Rapport F, Zurynski Y, Maka K, Braithwaite J. Innovative models of healthcare delivery: an umbrella review of reviews. BMJ Open 2023; 13:e066270. [PMID: 36822811 PMCID: PMC9950590 DOI: 10.1136/bmjopen-2022-066270] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. DESIGN Umbrella review. SETTING Interventions delivered inside and outside of acute care settings. PARTICIPANTS Children and adults with one or more identified acute or chronic health conditions. DATA SOURCES PsycINFO, Ovid MEDLINE and CINAHL. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. RESULTS A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. CONCLUSIONS A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/PS6ZU.
Collapse
Affiliation(s)
- Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- LEMNA, F-44000, Universite de Nantes, Nantes, France
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mai-Tran Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Li Z, Long Y, Yang Q, Liu J, Wang Y. Smartphone-based interventions in the secondary prevention of cardiovascular disease: A meta-analysis. Technol Health Care 2023; 31:1935-1948. [PMID: 37125588 DOI: 10.3233/thc-230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND A variety of reviews have indicated the effectiveness of smartphone-based interventions in preventing secondary cardiovascular disease (CVD). However, few studies have focused on clinical outcomes. OBJECTIVE This meta-analysis aimed to evaluate the potential benefits of application interventions and short message service (SMS) interventions on CVD outcomes. METHODS Electronic databases were searched to identify randomized controlled trials (RCT) investigating an application or SMS intervention for secondary CVD prevention. Primary outcomes included major adverse cardiovascular events (MACE), cardiovascular death, and cardiac hospitalization. Secondary outcomes were cardiovascular risk factors (BMI, blood pressure, and cholesterol). RESULTS A total of 26 RCTs were included, with 16 investigating applications and 10 assessing SMS. Overall, there was no significant difference in MACE, cardiovascular death, and cardiac hospitalization when comparing application interventions with usual care, as well as comparing SMS with usual care. Subgroup analysis revealed that patients who received applications without a medical interface had a significantly lower incidence of MACE (OR = 0.56; 95% CI: 0.33, 0.98). Participants who received applications with a medical interface showed a tendency towards higher rates of cardiac hospitalization (OR = 2.03; 95% CI: 0.85, 4.87). Significant reduction in waist circumference (SMD =-0.80; 95% CI: -1.58, -0.03) was found in application interventions compared to usual care; while significant reductions in SBP (SMD =-0.08; 95% CI: -0.15, -0.01) and TC (SMD =-0.31; 95% CI: -0.57, -0.08) were found in SMS interventions compared to usual care. CONCLUSION Smartphone-based interventions, including applications and SMS, have the potential to benefit the secondary prevention of CVD. Applications may reduce the incidence of cardiovascular-related adverse events, while SMS interventions may improve cardiovascular risk factors.
Collapse
Affiliation(s)
- Zishuo Li
- Department of Administrative Office, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yanli Long
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Qing Yang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Jing Liu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yahong Wang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| |
Collapse
|
10
|
Uddin MF, Molyneux S, Muraya K, Jemutai J, Berkley JA, Walson JL, Hossain MA, Islam MA, Zakayo SM, Njeru RW, Ahmed T, Chisti MJ, Sarma H. Treatment-seeking and recovery among young undernourished children post-hospital discharge in Bangladesh: A qualitative study. PLoS One 2022; 17:e0274996. [PMID: 36149880 PMCID: PMC9506605 DOI: 10.1371/journal.pone.0274996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Post-hospital discharge mortality is high among undernourished children in many low and middle-income countries. Although a number of quantitative studies have highlighted a range of potential socio-cultural, economic and health system factors influencing paediatric post-discharge treatment-seeking and recovery, few studies have explored family and provider perspectives of the post-discharge period in-depth. METHODS This work was part of a large, multi-country prospective cohort study, the Childhood Acute Illness and Nutrition (CHAIN) Network. We conducted a qualitative sub-study to understand the post-discharge treatment-seeking and recovery experiences of families of undernourished children aged 2-23 months admitted in a rural and urban icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) hospital. Methods included repeat in-depth interviews (73 interviews in total) with 29 family members of 17 purposively selected children. These data were supplemented by interviews with 33 health workers, and by observations in hospitals and homes. RESULTS Important drivers of treatment-seeking perceived to support recovery included advice provided to family members while in hospital, media campaigns on hygiene practice, availability of free treatment, and social and financial support from family members, relatives and neighbours. Key perceived challenges included low household incomes, mothers having to juggle multiple responsibilities in addition to caring for the sick child, lack of support (sometimes violence) from the child's father, and family members' preference for relatively accessible drug shops, physicians or healers over hospital admission. CONCLUSION Development of interventions that address the challenges that families face is essential to support post-discharge adherence to medical advice and recovery. Potential interventions include strengthening information giving during hospitalization on what post-discharge care is needed and why, reducing direct and indirect costs associated with hospital visits, engaging fathers and other 'significant others' in post-discharge advice, and building mobile phone-based support for follow-up care.
Collapse
Affiliation(s)
- Md. Fakhar Uddin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sassy Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Julie Jemutai
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A. Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Judd L. Walson
- Department of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Md. Alamgir Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Aminul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Haribondhu Sarma
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
11
|
Chapel B, Alexandre F, Heraud N, Ologeanu-Taddei R, Cases AS, Bughin F, Hayot M. Standardization of the assessment process within telerehabilitation in chronic diseases: a scoping meta-review. BMC Health Serv Res 2022; 22:984. [PMID: 35918690 PMCID: PMC9344755 DOI: 10.1186/s12913-022-08370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases. Aims and objectives The aim of this study was to identify domains of assessment in TR and to qualitatively and quantitatively analyze how and when they are examined to gain an overview of assessment in chronic disease. Methods A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", “evaluation", “chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis. Results Among the 7412 identified articles, 80 studies met the inclusion criteria and addressed at least one of the noncommunicable diseases (NCD) categories of cardiovascular disease (cardiovascular accidents), cancer, chronic respiratory disease, diabetes, and obesity. Regarding the domains of assessment, the most frequently occurring were “social aspect” (n = 63, 79%) (e.g., effects on behavioral changes) and “clinical efficacy” (n = 53, 66%), and the least frequently occurring was “safety aspects” (n = 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and post-implementation phases. Conclusions Through the HTA model, this scoping meta-review highlighted 10 assessment domains which have not been studied with the same degree of interest in the recent literature. We showed that each of these assessment domains could appear at different phases of TR development and proposed a new cross-disciplinary and comprehensive method for assessing TR interventions. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR, and it will be interesting to extend this assessment framework to other chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08370-y.
Collapse
Affiliation(s)
- Blandine Chapel
- University of Montpellier, Montpellier Research of Management, Montpellier, France.
| | - François Alexandre
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | - Nelly Heraud
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | | | - Anne-Sophie Cases
- University of Montpellier, Montpellier Research of Management, Montpellier, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
| |
Collapse
|
12
|
Bhattarai P, Shrestha A, Xiong S, Peoples N, Ramakrishnan C, Shrestha S, Yin R, Karmacharya B, Yan LL, Jafar TH. Strengthening urban primary healthcare service delivery using electronic health technologies: A qualitative study in urban Nepal. Digit Health 2022; 8:20552076221114182. [PMID: 35898291 PMCID: PMC9309786 DOI: 10.1177/20552076221114182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Nepal is a South Asian country with a high burden of non-communicable diseases. Electronic health technologies are a promising strategy to mitigate the rising burden of non-communicable diseases by strengthening primary healthcare center service delivery. However, electronic health implementation in Nepal is limited. Furthermore, electronic health use at the primary healthcare center level is chronically understudied. This qualitative study seeks to understand the perceived awareness, benefits, and determinants of electronic health uptake in Nepal, focusing on primary healthcare center-level non-communicable disease management. Methods We conducted in-depth interviews with 27 participants including policymakers, health experts, facility administrators, providers, and non-communicable diseases patients in 2019. We selected six urban primary healthcare center facilities via cluster convenience sampling for recruiting facility administrators, providers, and patients, and used convenience sampling to recruit policymakers and experts. We conducted thematic data analysis inductively and deductively using the electronic health readiness assessment framework to understand perceived barriers and facilitators of electronic health implementation. Results While there was general awareness and acceptance of electronic health, multiple barriers impede readiness for implementation. These include policy making gaps, language barriers, low user technical literacy, concerns of overreliance on technology, and inadequate training for administrators and providers. Stakeholder suggestions include creating electronic health interfaces that meet the needs of end users (providers and patients), providing training to enable end users to effectively use electronic health technologies, and strong policy support at the national level. Conclusion We identify several determinants for effectively promoting the use of electronic health for non-communicable diseases service delivery at the primary healthcare center level in Nepal.
Collapse
Affiliation(s)
- Prayog Bhattarai
- Yale-NUS College, Singapore,Biraj Karmacharya, Department of Community
Programs, Kathmandu University School of Medical Sciences (KUSMS), Nepal.
Lijing L. Yan, Global Health Research
Center, Duke Kunshan University, China.
| | - Abha Shrestha
- Kathmandu University School of Medical
Sciences (KUSMS), Nepal
| | - Shangzhi Xiong
- Duke Kunshan University, ChinaThe George Institute for Global Health, University
of New South Wales, Australia
| | | | | | | | - Ruoyu Yin
- Department of Family Medicine and Primary Care, Nanyang Technological
University, Singapore
| | - Biraj Karmacharya
- Department of Community Programs, Kathmandu University School of
Medical Sciences (KUSMS), Nepal
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
| | | |
Collapse
|
13
|
Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
Lin J, Wang W, Tang H, Huo J, Gu Y, Liu R, Chen P, Yuan Y, Yang X, Xu J, Sun D, Li N, Jiang S, Chen Y, Wang C, Yang L, Liu X, Yang D, Zhang W, Chen Z, Lin Q, Liu C, Zhou J, Zhou X, Hu C, Jiang P, Zhou W, Zhang J, Cai S, Qiu C, Huang M, Huang Y, Liu H. Asthma Management Using the Mobile Asthma Evaluation and Management System in China. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:85-98. [PMID: 34983109 PMCID: PMC8724822 DOI: 10.4168/aair.2022.14.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE As stated in the Global Initiative for Asthma, there are still some asthmatic patients who have not achieved asthma control. Mobile is a useful tool for asthma management. We aimed to compare the advantages of mobile management with traditional management in improving adherence and control of asthma. METHODS In this prospective, multicentre, randomized, controlled and parallel-group study, we enrolled patients with poor adherence and uncontrolled asthma at 32 hospitals in 28 provinces in China. Patients were randomly assigned to the mobile management or traditional management groups for 12 months. The primary endpoint was the proportion of patients with good adherence (Medication Adherence Report Scale for Asthma [MARS-A] score ≥ 45) for 6 months. This study is registered at ClinicalTrials.gov (NCT02917174). RESULTS Between April 2017 and April 2018, 923 patients were eligible for randomization (mobile group, n = 461; traditional group, n = 462). Dropout was 84 (18.2%) in the mobile management group and 113 (24.4%) patients in the traditional management group. The proportion of patients with good adherence was significantly higher in the mobile management group than in the traditional management group (66.0% vs. 58.99%, P = 0.048). The mobile management group showed higher mean MARS-A score (at 1, 6, 9, and 12 months) and asthma control test scores (at 6 and 9 months), and lower total lost rate to follow-up within 12 months than the traditional management group. CONCLUSIONS Mobile asthma management can improve adherence and asthma control compared to traditional management. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02917174.
Collapse
Affiliation(s)
- Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China.
| | - Wenya Wang
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Huaping Tang
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Jianmin Huo
- Department of Respiratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhai Gu
- Department of Respiratory Medicine, Qinghai Provincial People's Hospital, Xi'ning, China
| | - Rongyu Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ping Chen
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yadong Yuan
- Department of Respiratory Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaohong Yang
- Department of Pulmonary and Critical Care Medicine, Xinjiang Uiger Municipal People's Hospital, Urumqi, China
| | - Jianying Xu
- Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi, China
| | - Dejun Sun
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China
| | - Najia Li
- Department of Respiratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Shujuan Jiang
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital, Jinan, China
| | - Yiqiang Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Changzheng Wang
- Department of Respiratory Medicine, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Lan Yang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoju Liu
- Department of Geriatric Respiration, The First Hospital of Lanzhou University, Lanzhou, China
| | - Dong Yang
- Department of Respiration, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhuochang Chen
- Department of Respiratory Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qichang Lin
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Xiamen, China
| | - Chuntao Liu
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, The First Hospital of Zhejiang Province, Hangzhou, China
| | - Xin Zhou
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary and Critical Care Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Ping Jiang
- Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Wei Zhou
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Shaoxi Cai
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern University of Science and Technology, Guangzhou, China
| | - Chen Qiu
- Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Mao Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yijiang Huang
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan, China
| | - Huiguo Liu
- Department of Respiratory Medicine, Tongji Hospital, Tongji Medical college Huazhong University of Science and Technology, Wuhan, China
| | | |
Collapse
|
15
|
Validation of a Virtual Assistant for Improving Medication Adherence in Patients with Comorbid Type 2 Diabetes Mellitus and Depressive Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212056. [PMID: 34831811 PMCID: PMC8620667 DOI: 10.3390/ijerph182212056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 12/30/2022]
Abstract
Virtual assistants are programs that interact with users through text or voice messages simulating a human-based conversation. The development of healthcare virtual assistants that use messaging platforms is rapidly increasing. Still, there is a lack of validation of these assistants. In particular, this work aimed to validate the effectiveness of a healthcare virtual assistant, integrated within messaging platforms, with the aim of improving medication adherence in patients with comorbid type 2 diabetes mellitus and depressive disorder. For this purpose, a nine-month pilot study was designed and subsequently conducted. The virtual assistant reminds patients about their medication and provides healthcare professionals with the ability to monitor their patients. We analyzed the medication possession ratio (MPR), measured the level of glycosylated hemoglobin (HbA1c), and obtained the patient health questionnaire (PHQ-9) score in the patients before and after the study. We also conducted interviews with all participants. A total of thirteen patients and five nurses used and evaluated the proposed virtual assistant using the messaging platform Signal. Results showed that on average, the medication adherence improved. In the final interview, 69% of the patients agreed with the idea of continuing to use the virtual assistant after the study.
Collapse
|
16
|
Peoples N, Gong E, Gautam K, Khanal SN, Kohrt BA, Koirala S, Amatya A, Xiong S, Østbye T, Moe J, Long Q, Yan LL. Perception and Use of Primary Healthcare Services Among People With Cardiometabolic Diseases in Two Resource-Limited Areas in Nepal: A Mixed Methods Study. Front Public Health 2021; 9:698030. [PMID: 34631643 PMCID: PMC8494788 DOI: 10.3389/fpubh.2021.698030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Nepal is a country in south Asia with a high burden of cardiometabolic diseases (CMDs). Strengthening primary healthcare (PHC) is a key strategy to mitigate this increasing burden and achieve universal health coverage. While previous studies in Nepal have assessed PHC use among the elderly, none have specifically explored PHC use among people with CMDs. Therefore, this mixed-methods study aimed to assess the use and perception of PHC services in Nepal among people living with CMDs for primary and secondary prevention of cardiovascular disease. We used a quantitative survey followed-up by semi-structured qualitative interviews. The sampling frame comprised five PHC facilities in Sindhuli district (rural; eastern Nepal) and five in Kailali district (urban; western Nepal), with participants selected from each facility via convenience sampling. 114 people (mean age: 54.5 ± 14.7, sex ratio 1.04) with CMDs participated in the survey. Survey data showed general dissatisfaction with PHC services. Medicine cost was rated "too expensive" by 52 and 63% of rural and urban participants, respectively. Interview data showed that perceived poor bedside manner was tied to negative perceptions of PHC quality, and vice versa. Lack of resources and excessive barriers to care was mentioned by every interviewee. In conclusion, PHC use was high but overall satisfaction relatively low. Our results suggest that bedside manner is a practical target for future research. Additionally, we identified several barriers to care, and, based on existing literature, we suggest electronic-health interventions may have potential to mitigate these challenges.
Collapse
Affiliation(s)
- Nicholas Peoples
- Baylor College of Medicine, Houston, TX, United States
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Shree N. Khanal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- George Washington University, Department of Psychiatry and Behavioral Science, Washington, DC, United States
| | - Suraj Koirala
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Archana Amatya
- Institute of Medicine, Department of Community Medicine and Public Health, Tribhuvan University, Kathmandu, Nepal
| | - Shangzhi Xiong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Truls Østbye
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Jeffrey Moe
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| |
Collapse
|
17
|
Horsham C, Baade P, Kou K, O'Hara M, Sinclair C, Loescher LJ, Soyer HP, Janda M. Optimizing Texting Interventions for Melanoma Prevention and Early Detection: A Latin Square Crossover RCT. Am J Prev Med 2021; 61:348-356. [PMID: 34419232 DOI: 10.1016/j.amepre.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Text messaging is an effective way to reach large populations with health promotion support. This study aims to establish the optimal text messaging intervention to achieve behavior change in young adults at risk of skin cancer. STUDY DESIGN Latin square crossover RCT. SETTING/PARTICIPANTS Participants were women and men aged 18-40 years living in Queensland, Australia who owned a smartphone and had ≥2 skin cancer risk factors. INTERVENTION Participants were enrolled from December 2018 to February 2019 and completed an eligibility survey. Eligible participants were randomized to 4 different text message interventions using a Latin square design with varying personalization, interactivity, and message frequency (February 2019‒July 2019). Each intervention lasted for 1 month; between interventions, participants had a 1-week washout period in which they completed an online questionnaire. Participants completed a 6-month follow-up online survey in January 2020. MAIN OUTCOME MEASURES Measures included self-reported sun protection habits and sunburns. RESULTS A total of 277 (71.2% response rate) participants completed the 6-month follow-up. The sun protection habits index was significantly higher in all the 4 text messaging interventions (p<0.01 for each intervention) than at baseline, with similar sun protection habits improvements among all interventions (p=0.27). Sunburn rates decreased significantly over time (p<0.01 each intervention), with all the 4 interventions achieving reductions in sunburn rates during the intervention periods (p=0.78). Overall, the sunburn rates decreased from 40.3% at baseline to 7.0% at the end of the intervention, and at 6-month follow-up, it remained significantly below baseline levels at 23.5% (p<0.01). CONCLUSIONS Regular text messaging interventions result in significantly increased sun protection and decreased sunburn in young adults. TRIAL REGISTRATION This study is registered at the Australian and New Zealand Clinical Trials Registry ACTRN12618001299291.
Collapse
Affiliation(s)
- Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Baade
- Cancer Council Queensland, Brisbane, Australia
| | - Kou Kou
- Cancer Council Queensland, Brisbane, Australia
| | - Montana O'Hara
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| |
Collapse
|
18
|
Young MF, Baik D, Reinsma K, Gosdin L, Rogers HP, Oy S, Invong W, Hen H, Ouk S, Chhorvann C. Evaluation of mobile phone-based Positive Deviance/Hearth child undernutrition program in Cambodia. MATERNAL AND CHILD NUTRITION 2021; 17:e13224. [PMID: 34414653 PMCID: PMC8476410 DOI: 10.1111/mcn.13224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Child undernutrition in Cambodia is a persistent public health problem requiring low‐cost and scalable solutions. Rising cellphone use in low‐resource settings represents an opportunity to replace in‐person counselling visits with phone calls; however, questions remain on relative effectiveness. Our objective was to evaluate the impact of two options for delivering a World Vision infant and young child feeding (IYCF) counselling programme: (1) traditional Positive Deviance/Hearth (PDH) programme with in‐person visits or (2) PDH with Interactive Voice Calling (PDH‐IVC) which integrates phone calls to replace 62.5% of face‐to‐face interaction between caregivers and volunteers, compared to the standard of care (SOC). We conducted a longitudinal cluster‐randomised controlled trial in 361 children 6–23 months. We used an adjusted difference‐in‐difference approach using baseline, midline (3 months) and endline (12 months) surveys to evaluate the impact on child growth among the three groups. At baseline, nearly a third of children were underweight, and over half were food insecure. At midline the PDH group and the PDH‐IVC groups had improved weight‐for‐age z‐scores (0.13 DID, p = 0.011; 0.13 DID, p = 0.02, respectively) and weight‐for‐height z‐score (0.16 DID, p = 0.038; 0.24 DID, p = 0.002), relative to SOC. There were no differences in child height‐for‐age z‐scores. At endline, the impact was sustained only in the PDH‐IVC group for weight‐for‐age z‐score (0.14 DID, p = 0.049), and the prevalence of underweight declined by 12.8 percentage points (p = 0.036), relative to SOC. Integration of phone‐based IYCF counselling is a potentially promising solution to reduce the burden of in‐person visits; however, the modest improvements suggest the need to combine it with other strategies to improve child nutrition.
Collapse
Affiliation(s)
- Melissa F Young
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Diane Baik
- Technical Service Organization, World Vision International, Monrovia, California, United States
| | - Kathryn Reinsma
- Technical Service Organization, World Vision International, Monrovia, California, United States
| | - Lucas Gosdin
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Hannah Paige Rogers
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sreymom Oy
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Heang Hen
- World Vision International-Cambodia, Phnom Penh, Cambodia
| | - Sopheap Ouk
- World Vision International-Cambodia, Phnom Penh, Cambodia
| | | |
Collapse
|
19
|
Akerele A, Uba B, Aduloju M, Etamesor S, Umar JA, Adeoye OB, Enyojo A, Josiah F, Ayandipo E, Olaoye I, Adegoke OJ, Sidney S, Bagana M, Bassey O, Ghiselli ME, Ndadilnasiya W, Bolu O, Shuaib F. Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria. PLoS One 2021; 16:e0255563. [PMID: 34411136 PMCID: PMC8376034 DOI: 10.1371/journal.pone.0255563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.
Collapse
Affiliation(s)
| | - Belinda Uba
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Jamila A. Umar
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Ameh Enyojo
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Itse Olaoye
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Sampson Sidney
- Sydani Initiative for International Development, Abuja, Nigeria
| | - Murtala Bagana
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Okposen Bassey
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| |
Collapse
|
20
|
Text Messaging in Cancer-Supportive Care: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143542. [PMID: 34298756 PMCID: PMC8307703 DOI: 10.3390/cancers13143542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
The global cancer disease burden is substantial, resulting in increased economic and clinical strain on our healthcare systems. A proposed solution is text-based communication, which can be used for cancer-supportive care. We conducted a systematic review to synthesize and describe the use of text-based communications for cancer-supportive care. Our population of interest included adult patients with cancer. A total of 18 studies were included in the review: 9 RCTs and 9 non-randomized interventional/observational studies. Patients were largely satisfied with text-based communication during their cancer care. Compared to controls, results for other outcomes including symptoms and quality of life were largely mixed; however, no harms were observed. Furthermore, positive outcomes were seen for specific interventions, such as text message medication reminders. These findings should be considered with caution due to the considerable heterogeneity observed between studies regarding their design and reported outcomes and the high risk of bias associated with 6/18 studies. Overall, this review suggests that text-based communication may be a complementary tool for cancer-supportive care; however, more research is needed to examine the feasibility of implementation and use.
Collapse
|
21
|
Chioma Ebuenyi M, Schnoor K, Versluis A, Meijer E, Chavannes NH. Short message services interventions for chronic disease management: A systematic review. CLINICAL EHEALTH 2021. [DOI: 10.1016/j.ceh.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
22
|
Geldof M, Thiombiano BA, Wagner N. "When I receive the message, it is a sign of love": symbolic connotations of SMS messages for people living with HIV in Burkina Faso. AIDS Care 2020; 33:810-817. [PMID: 32449365 DOI: 10.1080/09540121.2020.1769832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mobile health (mHealth) has gained considerable interest recently due to its potential to improve health outcomes in developing countries with high outreach yet low costs. Several studies have explored the use of short message service (SMS) reminders to improve antiretroviral (ARV) retention and adherence, with mixed results. The majority of these studies has a quantitative nature and employs randomized designs, which do not provide further qualitative insights about other possible impacts of the messages. Based on the qualitative assessment of an SMS intervention in Burkina Faso, which complemented a (quantitative) Randomized Controlled Trial (RCT), we show that beyond the functional role of improving ARV retention and adherence, SMS messages can also play important symbolic roles in offering psychosocial support to people living with HIV (PLHIV) and improving their perception of life. Concomitantly, we show that sufficient (ICT) literacy skills cannot be taken for granted in resource-poor settings. Yet, regardless of (ICT) literacy skills, the symbolism of care was perceived. Furthermore, we highlight the importance of complementing quantitative evidence of mHealth interventions with qualitative assessments.
Collapse
Affiliation(s)
- Marije Geldof
- International Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
| | - Boundia Alexandre Thiombiano
- Institut du Développement Rural (IDR), Université Nazi Boni (former Université Polytechnique de Bobo-Dioulasso), Bobo-Dioulasso, Burkina Faso
| | - Natascha Wagner
- International Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
| |
Collapse
|
23
|
Affiliation(s)
- Laura Martinengo
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Pier Spinazze
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| |
Collapse
|
24
|
Ni Z, Atluri N, Shaw RJ, Tan J, Khan K, Merk H, Ge Y, Shrestha S, Shrestha A, Vasudevan L, Karmacharya B, Yan LL. Evaluating the Feasibility and Acceptability of a Mobile Health-Based Female Community Health Volunteer Program for Hypertension Control in Rural Nepal: Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e15419. [PMID: 32149712 PMCID: PMC7091025 DOI: 10.2196/15419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/29/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a major modifiable risk factor for cardiovascular disease, the world's leading cause of death. The prevalence of hypertension is disproportionately higher in South Asian countries than in other regions of the world. Screening for hypertension in primary care settings remains a challenge in many South Asian countries, including Nepal. Nepal is located in the Himalayan Mountains region, posing significant geographical challenges for its rural citizens to access primary health care and service delivery. This barrier increases the costs and inconvenience for rural Nepalis to access hypertension screening and treatment. As a result, the prevalence of hypertension in Nepal tripled in the last 25 years to 22.4%-38.6%. Nepal's Ministry of Health and Population relies on female community health volunteers to link health centers and communities to provide basic health services. Over 50,000 of these volunteers in Nepal have received basic health care training and are assigned to take care of maternal and child health. Due to limited health care resources, adopting new methods to control hypertension is an urgent need in Nepal. Several recent studies in Nepal have recommended extending the role of female community health volunteers to include hypertension management through blood pressure monitoring and home-based education. OBJECTIVE The goal of this study was to assess if a mobile health-based female community health volunteer approach of combining the traditional community health volunteer program with digital technologies would be feasible and acceptable in rural Nepal. METHODS In this study, we recruited 17 female community health volunteers and extended their role from maternal and child health to hypertension management through screening blood pressures. RESULTS All 17 female community health volunteers successfully measured 1113 rural Nepalis' blood pressures, identified 169 hypertensive patients, and collected health behaviors data of the 169 hypertensive patients. Among the 169 patients, 70% of them had a mobile phone, and 92% were interested in receiving health-related information via a mobile phone. Among those who were interested in receiving information via a mobile phone, 84% preferred voice calls, and 7% and 1% preferred texting and apps, respectively. CONCLUSIONS Results from this study indicate that a digital health intervention that leverages feature-phones combined with female community health volunteers may be an acceptable and pragmatic way to implement an evidence-based program to reduce hypertension in rural Nepal.
Collapse
Affiliation(s)
- Zhao Ni
- Duke University, Durham, NC, United States
| | | | | | | | - Kinza Khan
- Duke University, Durham, NC, United States
| | | | - Yunfan Ge
- Duke Kunshan University, Kunshan, China
| | | | | | | | | | | |
Collapse
|
25
|
Son YJ, Lee Y, Lee HJ. Effectiveness of Mobile Phone-Based Interventions for Improving Health Outcomes in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1749. [PMID: 32156074 PMCID: PMC7084843 DOI: 10.3390/ijerph17051749] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
Mobile phone-based interventions are increasingly used to prevent adverse health outcomes in heart failure patients. However, the effects of mobile phone-based interventions on the health outcomes of heart failure patients remain unclear. Our review aims to synthesize the randomized controlled trials (RCT) of mobile phone-based interventions for heart failure patients and identify the intervention features that are most effective. Electronic searches of RCTs published from January 2000 to July 2019 were conducted. Primary outcomes included all-cause mortality, readmission, emergency department visits, length of hospital stays, and quality of life. Secondary outcomes were self-care behaviors, including medication adherence and other clinical outcomes. A total of eight studies with varying methodological quality met the inclusion criteria and were analyzed. Voice call intervention was more frequently used compared with telemonitoring and short message services. Our meta-analysis showed that voice call interventions had significant effects on the length of hospital stays. However, no significant effects on all-cause mortality, readmission, emergency department visits, or quality of life were found. Compared to other mobile phone-based interventions, voice calls were more effective in reducing the length of hospital stay. Future studies are needed to identify which features of mobile phone-based intervention most effectively improve health outcomes.
Collapse
Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - Yaelim Lee
- College of Nursing, The Catholic University of Korea, Seoul 06591, Korea;
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, Korea
| |
Collapse
|
26
|
Williams SK, Johnson BA, Tobin JN, Luque AE, Sanders M, Carroll JK, Cassells A, Holder T, Fiscella K. Protocol paper: Stepped wedge cluster randomized trial translating the ABCS into optimizing cardiovascular care for people living with HIV. Prog Cardiovasc Dis 2020; 63:125-133. [PMID: 32035124 DOI: 10.1016/j.pcad.2020.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/29/2022]
Abstract
People living with HIV (PWH) are at higher risk for cardiovascular disease (CVD) and stroke in comparison to their non-infected counterparts. The ABCS (aspirin-blood pressure control-cholesterol control-smoking cessation) reduce atherosclerotic (ASCVD) risk in the general population, but little is known regarding strategies for promoting the ABCS among PWH. Guided by the Consolidated Framework for Implementation Research (CFIR), we designed multilevel implementation strategies that target PWH and their clinicians to promote appropriate use of the ABCS based on a 10-year estimated ASCVD risk. Implementation strategies include patient coaching, automated texting, peer phone support, academic detailing and audit and feedback for the patient's clinician. We are evaluating implementation through a stepped wedge cluster randomized trial based on the Reach-Effectiveness-Adoption-Maintenance/Qualitative-Evaluation-for-Systematic-Translation (RE-AIM/QuEST) mixed methods framework that integrates quantitative and qualitative assessments. The primary outcome is change in ASCVD risk. Findings will have important implications regarding strategies for reducing ASCVD risk among PWH.
Collapse
Affiliation(s)
- Stephen K Williams
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), Community-Engaged Research, The Rockefeller University Center for Clinical and Translational Science, New York, NY
| | - Amneris Esther Luque
- Infectious Diseases and Geographic Medicine, HIV Program at Parkland Health and Hospital System, Community Prevention and Intervention Unit, UT Southwestern Medical Center, Dallas, TX
| | - Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tameir Holder
- Clinical Directors Network, Inc. (CDN), New York, NY
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY.
| |
Collapse
|
27
|
Gong E, Gu W, Luo E, Tan L, Donovan J, Sun C, Yang Y, Zang L, Bao P, Yan LL. Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study. JMIR Mhealth Uhealth 2019; 7:e15758. [PMID: 31845901 PMCID: PMC6938591 DOI: 10.2196/15758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rural China has experienced an increasing health burden because of stroke. Stroke patients in rural communities have relatively poor awareness of and adherence to evidence-based secondary prevention and self-management of stroke. Mobile technology represents an innovative way to influence patient behaviors and improve their self-management. OBJECTIVE This study is part of the System-Integrated Technology-Enabled Model of Care (the SINEMA trial) to improve the health of stroke patients in resource-poor settings in China. This study aimed to develop and pilot-test a mobile phone message-based package, as a component of the SINEMA intervention. METHODS The SINEMA trial was conducted in Nanhe County, Hebei Province, China. A total of 4 villages were selected for pretrial contextual research and pilot study. The 5 stages for developing the mobile phone messages were as follows: (1) conducting literature review on existing message banks and analyzing the characteristics of these banks; (2) interviewing stroke patients and caregivers to identify their needs; (3) drafting message contents and designing dispatching algorithms for a 3-month pilot testing; (4) collecting feedback from pilot participants through questionnaire survey and in-depth interviews on facilitators and barriers related to their acceptance and understanding of messages; and (5) finalizing the message-based intervention based on participants' feedback for the SINEMA trial. RESULTS On the basis of 5 existing message banks screened out of 120 papers and patients' needs identified from 32 in-depth interviews among stroke patients and caregivers, we developed a message bank containing 224 messages for a pilot study among 54 community-dwelling stroke patients from 4 villages. Of 54 participants, 51 (response rate: 94.4%) completed the feedback survey after receiving daily messages for 3 months. Participants' mean age was 68 years (SD 9.2), and about half had never been to school. We observed a higher proportion of participants who were in favor of voice messages (23/42, 54%) than text messages (14/40, 35%). Among participants who received voice messages (n=43) and text messages (n=40), 41 and 30, respectively, self-reported a full or partial understanding of the contents, and 39 (39/43, 91%) and 32 (32/40, 80%), respectively, rated the messages as helpful. Analyses of the 32 interviews further revealed that voice messages containing simple and single-theme content, in plain language, with a repeated structure, a slow playback speed, and recorded in local dialect, were preferred by rural stroke patients. In addition, the dispatching algorithm and tools may also influence the acceptance of message-based interventions. CONCLUSIONS By applying multiple methodologies and conducting a pilot study, we designed and fine-tuned a voice message-based intervention package for promoting secondary prevention among community-dwelling stroke patients in rural China. Design of the content and dispatching algorithm should engage both experts and end users and adequately consider the needs and preferences of recipients.
Collapse
Affiliation(s)
- Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Erdan Luo
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
| | - Liwei Tan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Public Health, Fudan University, Shanghai, China
| | - Julian Donovan
- Northumbria Healthcare National Health Service Foundation Trust, Wallsend, United Kingdom
| | - Cheng Sun
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Ying Yang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Longkai Zang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Second School of Clinical Medicine, Wuhan University, Wuhan, China
| | - Peng Bao
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Ningxia Medical University, Yinchuan, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Durham, NC, United States
| |
Collapse
|
28
|
Schwarz PEH, Timpel P, Harst L, Greaves CJ, Ali MK, Lambert J, Weber MB, Almedawar MM, Morawietz H. Reprint of: Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series. J Am Coll Cardiol 2019; 72:3071-3086. [PMID: 30522637 DOI: 10.1016/j.jacc.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023]
Abstract
The primary objective of this study was to analyze the most up-to-date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review. Three separate, systematic literature searches identified 2,343 papers in total. Overall, 44 studies were included for data extraction and analysis. The included systematic reviews and meta-analyses published between January 1, 2016, and December 31, 2017, were of good to very good quality (median Overview Quality Assessment Questionnaire score = 17). Identified evidence suggests that cardiovascular disease (CVD) prevention services should consider regulation of blood glucose as a key target for intervention. Furthermore, the recommendations for effective intervention and service development/training described here for prevention of CVD should be adopted into evidence-based practice guidelines. Multidisciplinary teams should be formed to deliver multicomponent interventions in community-based settings. There may be substantial opportunities for integrating CVD and diabetes prevention services.
Collapse
Affiliation(s)
- Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Colin J Greaves
- School for Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, United Kingdom
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey Lambert
- The Institute of Health Research, Primary Care, University of Exeter Medical School, Exeter, United Kingdom
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohamad M Almedawar
- Dresden International Graduate School for Biomedicine and Bioengineering, Technische Universität Dresden, Dresden, Germany; Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
29
|
Schwarz PEH, Timpel P, Harst L, Greaves CJ, Ali MK, Lambert J, Weber MB, Almedawar MM, Morawietz H. Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series. J Am Coll Cardiol 2019; 72:1829-1844. [PMID: 30286928 DOI: 10.1016/j.jacc.2018.07.081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
The primary objective of this study was to analyze the most up-to-date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review. Three separate, systematic literature searches identified 2,343 papers in total. Overall, 44 studies were included for data extraction and analysis. The included systematic reviews and meta-analyses published between January 1, 2016, and December 31, 2017, were of good to very good quality (median Overview Quality Assessment Questionnaire score = 17). Identified evidence suggests that cardiovascular disease (CVD) prevention services should consider regulation of blood glucose as a key target for intervention. Furthermore, the recommendations for effective intervention and service development/training described here for prevention of CVD should be adopted into evidence-based practice guidelines. Multidisciplinary teams should be formed to deliver multicomponent interventions in community-based settings. There may be substantial opportunities for integrating CVD and diabetes prevention services.
Collapse
Affiliation(s)
- Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Colin J Greaves
- School for Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, United Kingdom
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey Lambert
- The Institute of Health Research, Primary Care, University of Exeter Medical School, Exeter, United Kingdom
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohamad M Almedawar
- Dresden International Graduate School for Biomedicine and Bioengineering, Technische Universität Dresden, Dresden, Germany; Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
30
|
Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza-Albarrán AA, Ramaiya KL. Diabetes in developing countries. J Diabetes 2019; 11:522-539. [PMID: 30864190 DOI: 10.1111/1753-0407.12913] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/24/2022] Open
Abstract
There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.
Collapse
Affiliation(s)
- Anoop Misra
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
- Diabetes Foundation (India), New Delhi, India
- Fortis C-DOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India
| | - Hema Gopalan
- National-Diabetes, Obesity and Cholesterol Foundation, Safdarjung Development Area, New Delhi, India
| | | | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Mario Soares
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alfredo A Reza-Albarrán
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | |
Collapse
|
31
|
Moyano D, Morelli D, Santero M, Belizan M, Irazola V, Beratarrechea A. Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study. JMIR Diabetes 2019; 4:e10350. [PMID: 30882362 PMCID: PMC6441856 DOI: 10.2196/10350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/27/2018] [Accepted: 12/28/2018] [Indexed: 01/25/2023] Open
Abstract
Background Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. Objective The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. Methods A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. Results Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient’s learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. Conclusions Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients.
Collapse
Affiliation(s)
- Daniela Moyano
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Daniela Morelli
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Belizan
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| |
Collapse
|
32
|
Le Fur Bonnabesse A, Cabon M, L’Heveder G, Kermarrec A, Quinio B, Woda A, Marchand S, Dubois A, Giroux-Metges MA, Rannou F, Misery L, Bodéré C. Impact of a specific training programme on the neuromodulation of pain in female patient with fibromyalgia (DouFiSport): a 24-month, controlled, randomised, double-blind protocol. BMJ Open 2019; 9:e023742. [PMID: 30782715 PMCID: PMC6352822 DOI: 10.1136/bmjopen-2018-023742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The main symptom of fibromyalgia (FM) is diffuse pain. There is currently no aetiological treatment for FM. However, all pain associations and best practice guidelines strongly advocate the practice of aerobic physical activity to improve the symptoms of FM subjects. The mechanisms of dysfunctional pain are mostly central and related to stress axis dysfunction (autonomic nervous system and corticotropic axis). Our main objective is to assess the efficacy of a specific training programme on endogenous pain control mechanisms in female patients with FM. Further aims include rebalancing the autonomic neurovegetative system, improving quality of life and sleep quality, and reintegrating patients into society and work. METHODS AND ANALYSIS 110 female patients with FM diagnosed on American College of Rheumatology 2010 criteria, aged 18-65 years and meeting inclusion conditions will be recruited and randomised into two groups (active and semiactive). The training programme will consist of three 45 min sessions per week of supervised, individualised physical activity over 2 years. Only the intensity of the exercises will differ between the two groups (moderate intensity vs low intensity).All outcome measures will be conducted at baseline (T0), after 6-9 months of training (T6-9) and after 24 months of training (T24). The primary endpoint will be an improvement of pain modulation (activation of diffuse noxious inhibitory control) evaluated by the stimulation test. The secondary endpoint will be relief of pain, anxiety, depression, stress, sleep disorders, pain impact on life quality, and improved heart rate, blood pressure and salivary cortisol. ETHICS AND DISSEMINATION This study is approved by the Committee for the Protection of Persons West VI. The results will be published in specialised scientific journals and will be presented at scientific meetings on pain and/or physical activity. TRIAL REGISTRATION NUMBER NCT02486965; Pre-results.
Collapse
Affiliation(s)
- Anais Le Fur Bonnabesse
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
- Dental Faculty, University of Western Brittany (UBO), Brest, France
| | - Mathilde Cabon
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
| | - Gildas L’Heveder
- Neurological Functional Explorations, University Hospital of Brest, Brest, France
| | - Aurélie Kermarrec
- Physiotherapy Training Institute, University Hospital of Brest, Brest, France
| | - Bertrand Quinio
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
| | - Alain Woda
- Odontology Department, University Clermont Auvergne, CROC and Teaching Hospital EA3847, Clermont-Ferrand, France
| | - Serge Marchand
- Department of Surgery, Universite de Sherbrooke Faculte de Medecine et des Sciences de la Sante, Sherbrooke, Quebec, Canada
| | - Amandine Dubois
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Cognition, Behaviour, Communication (LP3C), EA1285, Laboratoire de Psychologie, Rennes, France
- Département de Psychologie, University of Western Brittany (UBO), Brest, France
| | - Marie-Agnes Giroux-Metges
- ORPHY EA4324, Optimisation of Physiological Regulations, EA4324, Faculty of Medicine and Health Sciences, University of Western Brittany (UBO), Brest, France
- Respiratory Functional Exploration Unit, University Hospital of Brest, Brest, France
| | - Fabrice Rannou
- ORPHY EA4324, Optimisation of Physiological Regulations, EA4324, Faculty of Medicine and Health Sciences, University of Western Brittany (UBO), Brest, France
- Respiratory Functional Exploration Unit, University Hospital of Brest, Brest, France
| | - Laurent Misery
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
| | - Céline Bodéré
- LIEN, EA4685, University of Western Brittany (UBO), Brest, France
- Pain Assessment and Treatment Centre, University Hospital of Brest, Brest, France
- Dental Faculty, University of Western Brittany (UBO), Brest, France
| |
Collapse
|
33
|
Timpel P, Cesena FHY, da Silva Costa C, Soldatelli MD, Gois E, Castrillon E, Díaz LJJ, Repetto GM, Hagos F, Castillo Yermenos RE, Pacheco-Barrios K, Musallam W, Braid Z, Khidir N, Romo Guardado M, Roepke RML. Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial. Ther Adv Endocrinol Metab 2018; 9:167-176. [PMID: 29854386 PMCID: PMC5956638 DOI: 10.1177/2042018818770938] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months. METHOD The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated. DISCUSSION The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement.
Collapse
Affiliation(s)
- Patrick Timpel
- Prevention and Care of Diabetes Mellitus, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, Dresden 01307, Germany
| | | | | | - Matheus Dorigatti Soldatelli
- Department of Radiology, Hospital das Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Emanuel Gois
- Department of Surgery, State University of Londrina, Brazil; Pontifical University of Parana, Brazil
| | - Eduardo Castrillon
- Departamento de Clínicas Médicas, Pontificia Universidad Javeriana de Cali, Cali, Colombia
| | | | - Gabriela M. Repetto
- Center for Genetics and Genomics, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Fanah Hagos
- Department of Palliative and Hospice Care Liaison for CD at Emerson Hospital, Concord, MA, USA
| | - Raul E. Castillo Yermenos
- Centro de Investigaciones Biomédicas y Clínicas ‘Dr Sergio Bencosme’ (CINBIOCLI), Santiago de Los Caballeros, República Dominicana
| | - Kevin Pacheco-Barrios
- Neuroscience and Behavior Laboratory, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Wafaa Musallam
- Family Medicine Specialist, Primary Health Care Corporation, Doha, Qatar
| | - Zilda Braid
- Departament of Pediatrics, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, São Paulo, SP, Brazil
| | - Nesreen Khidir
- Bariatric and Metabolic Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Roberta Muriel Longo Roepke
- Disciplina de Emergencias Clínicas, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
34
|
Anstey Watkins J, Goudge J, Gómez-Olivé FX, Huxley C, Dodd K, Griffiths F. mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review. BMJ Glob Health 2018. [PMID: 29527356 PMCID: PMC5841508 DOI: 10.1136/bmjgh-2017-000543] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Routine monitoring by patients and healthcare providers to manage chronic disease is vital, though this can be challenging in low-resourced health systems. Mobile health (mHealth) has been proposed as one way to improve management of chronic diseases. Past mHealth reviews have proposed the need for a greater understanding around how the theoretical constructs in mHealth interventions actually work. In response, we synthesised evidence from primary studies on monitoring of chronic diseases using two-way digital text or voice communication between a patient and health worker. We did this in order to understand the important considerations for the design of mHealth interventions. Method Articles retrieved were systematically screened and analysed to elicit explanations of mHealth monitoring interventions. These explanations were consolidated into programme theory and compared with existing theory and frameworks. We identified variation in outcomes to understand how context moderates the outcome. Results Four articles were identified—monitoring of hypertension and HIV/AIDS from: Kenya, Pakistan, Honduras and Mexico and South Africa. Six components were found in all four interventions: reminders, patient observation of health state, motivational education/advice, provision of support communication, targeted actions and praise and encouragement. Intervention components were mapped to existing frameworks and theory. Variation in outcome identified in subgroup analysis suggests greater impact is achieved with certain patient groups, such as those with low literacy, those with stressful life events or those early in the disease trajectory. There was no other evidence in the included studies of the effect of context on the intervention and outcome. Conclusion mHealth interventions for monitoring chronic disease in low-resource settings, based on existing frameworks and theory, can be effective. A match between what the intervention provides and the needs or social factors relevant to specific patient group increases the effect. It was not possible to understand the impact of context on intervention and outcome beyond these patient-level measures as no evidence was provided in the study reports.
Collapse
Affiliation(s)
- Jocelyn Anstey Watkins
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Huxley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Dodd
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.,Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
35
|
Bobrow K, Farmer A, Cishe N, Nwagi N, Namane M, Brennan TP, Springer D, Tarassenko L, Levitt N. Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control. BMC Health Serv Res 2018; 18:33. [PMID: 29361934 PMCID: PMC5782371 DOI: 10.1186/s12913-017-2808-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description. Methods We used a non-sequential and flexible approach guided by the 2008 MRC Framework for the development and evaluation of complex interventions. Results We reviewed published literature and established a multi-disciplinary expert group to guide the development process. We selected health psychology theory and behaviour change techniques that have been shown to be important in adherence and persistence with chronic medications. Semi-structured interviews and focus groups with various stakeholders identified ways in which treatment adherence could be supported and also identified key features of well-regarded messages: polite tone, credible information, contextualised, and endorsed by identifiable member of primary care facility staff. Direct and indirect user testing enabled us to refine the intervention including refining use of language and testing of interactive components. Conclusions Our experience shows that using a formal intervention development process is feasible in a low-resource multi-lingual setting. The process enabled us to pre-test assumptions about the intervention and the evaluation process, allowing the improvement of both. Describing how a multi-component intervention was developed including standardised descriptions of content aimed to support behaviour change will enable comparison with other similar interventions and support development of new interventions. Even in low-resource settings, funders and policy-makers should provide researchers with time and resources for intervention development work and encourage evaluation of the entire design and testing process. Trial registration The trial of the intervention is registered with South African National Clinical Trials Register number (SANCTR DOH-27-1212-386; 28/12/2012); Pan Africa Trial Register (PACTR201411000724141; 14/12/2013); ClinicalTrials.gov (NCT02019823; 24/12/2013).
Collapse
Affiliation(s)
- Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, South Africa. .,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa. .,Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, OX2 6GG, UK.
| | - Andrew Farmer
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nomazizi Cishe
- Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ntobeko Nwagi
- Women's Health Research Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mosedi Namane
- Western Cape Province Department of Health, Cape Town, South Africa
| | - Thomas P Brennan
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - David Springer
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
36
|
Mobile phone use among patients and health workers to enhance primary healthcare: A qualitative study in rural South Africa. Soc Sci Med 2018; 198:139-147. [PMID: 29335160 DOI: 10.1016/j.socscimed.2018.01.011] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
Mobile phones have the potential to improve access to healthcare information and services in low-resourced settings. This study investigated the use of mobile phones among patients with chronic diseases, pregnant women, and health workers to enhance primary healthcare in rural South Africa. Qualitative research was undertaken in Mpumalanga in 2014. Semi structured in-depth interviews were conducted with 113 patients and 43 health workers from seven primary healthcare clinics and one district hospital. Data were thematically analysed. We found that some health workers and patients used their own mobile phones for healthcare, bearing the cost themselves. Patients used their mobile phones to remind themselves to take medication or attend their clinic visits, and they appreciated receiving voice call reminders. Some patients and health workers accessed websites and used social media to gather health information, but lacked web search strategies. The use of the websites and social media was intermittent due to lack of financial ability to afford airtime among these patients and health workers. Many did not know what to search for and where to search. Doctors have developed their own informal mobile health solutions in response to their work needs and lack of resources due to their rurality. Physical and social factors influence the usability of mobile phones for healthcare, and this can shape communication patterns such as poor eyesight. The bottom-up use of mobile phones has been evolving to fill the gaps to augment primary care services in South Africa; however, barriers to access remain, such as poor digital infrastructure and low digital literacy.
Collapse
|
37
|
Examining the Acceptability of mHealth Technology in HIV Prevention Among High-Risk Drug Users in Treatment. AIDS Behav 2017; 21:3100-3110. [PMID: 28025735 DOI: 10.1007/s10461-016-1637-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite promising trends of the efficacy of mobile health (mHealth) based strategies to a broad range of health conditions, very few if any studies have been done in terms of the examining the use of mHealth in HIV prevention efforts among people who use drugs in treatment. Thus, the goal of this study was to gain insight into the real-world acceptance of mHealth approaches among high-risk people who use drugs in treatment. A convenience sample of 400 HIV-negative drug users, who reported drug- and/or sex-related risk behaviors, were recruited from a methadone clinic in New Haven, Connecticut. Participants completed standardized assessments of drug- and sex-related risk behaviors, neurocognitive impairment (NCI), and measures of communication technology access and utilization, and mHealth acceptance. We found a high prevalence of current ownership and use of mobile technologies, such as cell phone (91.5%) including smartphone (63.5%). Participants used mobile technologies to communicate mostly through phone calls (M = 4.25, SD = 1.24), followed by text messages (M = 4.21, SD = 1.29). Participants expressed interest in using mHealth for medication reminders (72.3%), receive information about HIV (65.8%), and to assess drug-related (72.3%) and sex-related behaviors (64.8%). Furthermore, participants who were neurocognitively impaired were more likely to use cell phone without internet and show considerable interest in using mHealth as compared to those without NCI. The findings from this study provide empirical evidence that mHealth-based programs, specifically cell phone text messaging-based health programs, may be acceptable to this high-risk population.
Collapse
|
38
|
Haramiova Z, Stasko M, Hulin M, Tesar T, Kuzelova M, Morisky DM. The effectiveness of daily SMS reminders in pharmaceutical care of older adults on improving patients' adherence to antihypertensive medication (SPPA): study protocol for a randomized controlled trial. Trials 2017; 18:334. [PMID: 28720121 PMCID: PMC5516377 DOI: 10.1186/s13063-017-2063-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/26/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite a variety of efficient and cost-effective antihypertensive medication, hypertension remains a serious health and economic burden. High consumption of cardiovascular drugs in the Slovak Republic does result neither in better hypertension control nor in significant decrease in cardiovascular mortality. At the same time, Slovakia has alarmingly low patients' adherence to medication intake. Studies have shown the efficiency of short messaging service (SMS) reminders to improve patients' adherence and health outcomes at low costs. Since SMS is popular among Slovaks, this approach may be feasible also in Slovakia. The primary objective is to assess if daily SMS reminders of antihypertensive medication intake provided by pharmacists in addition to the standard pharmaceutical care increase the proportion of adherent older hypertensive ambulatory patients. METHODS The SPPA trial is a pragmatic randomized parallel group (1:1) trial in 300 older hypertensive patients carried out in community pharmacies in Slovakia. Trial pharmacies will be selected from all main regions of Slovakia. Trial intervention comprises daily personalized SMS reminders of medication intake embedded into usual pharmaceutical practice. The primary outcome is a combined adherence endpoint consisting of subjective self-reported medication adherence via the eight-item Morisky Medication Adherence Scale (MMAS-8) and objective pill count rate. Secondary outcomes include: change in the MMAS-8; comparison of adherence rates using pill count; change in systolic blood pressure; and patient satisfaction. Also, direct treatment costs will be evaluated and a cost-effectiveness analysis will be carried out. DISCUSSION The SPPA trial engages community pharmacists and mobile health (mHealth) technologies via evidence-based pharmaceutical care to efficiently and cost-effectively addresses current main healthcare challenges: high prevalence of hypertension; overconsumption of cardiovascular medicines; low adherence to medication treatment; and resulting uncontrolled blood pressure. The results may identify new possibilities and capacities in healthcare with low additional costs and high value to patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03105687 . Registered on 07 March 2017.
Collapse
Affiliation(s)
- Zuzana Haramiova
- Department of Organization and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Kalinciakova 8, 832 32 Bratislava, Slovak Republic
| | - Michal Stasko
- Department of Organization and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Kalinciakova 8, 832 32 Bratislava, Slovak Republic
| | - Martin Hulin
- Research Institute for Child Psychology and Pathopsychology, Cyprichova 42, 831 05 Bratislava, Slovak Republic
| | - Tomas Tesar
- Department of Organization and Management of Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Kalinciakova 8, 832 32 Bratislava, Slovak Republic
| | - Magdalena Kuzelova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, 832 32 Bratislava, Slovak Republic
| | - Donald M. Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, 46-071 CHS, Los Angeles, CA 90095-1772 USA
| |
Collapse
|
39
|
Abstract
BACKGROUND Despite its proven efficacy in improving symptoms and reducing exacerbations, many patients with asthma are not fully adherent to their steroid inhaler. Suboptimal adherence leads to poorer clinical outcomes and increased health service utilisation, and has been identified as a contributing factor to a third of asthma deaths in the UK. Reasons for non-adherence vary, and a variety of interventions have been proposed to help people improve treatment adherence. OBJECTIVES To assess the efficacy and safety of interventions intended to improve adherence to inhaled corticosteroids among people with asthma. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 18 November 2016. SELECTION CRITERIA We included parallel and cluster randomised controlled trials of any duration conducted in any setting. We included studies reported as full-text articles, those published as abstracts only and unpublished data. We included trials of adults and children with asthma and a current prescription for an inhaled corticosteroid (ICS) (as monotherapy or in combination with a long-acting beta2-agonist (LABA)). Eligible trials compared an intervention primarily aimed at improving adherence to ICS versus usual care or an alternative intervention. DATA COLLECTION AND ANALYSIS Two review authors screened the searches, extracted study characteristics and outcome data from included studies and assessed risk of bias. Primary outcomes were adherence to ICS, exacerbations requiring at least oral corticosteroids and asthma control. We graded results and presented evidence in 'Summary of findings' tables for each comparison.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all using a random-effects model. We described skewed data narratively. We made no a priori assumptions about how trials would be categorised but conducted meta-analyses only if treatments, participants and the underlying clinical question were similar enough for pooling to make sense. MAIN RESULTS We included 39 parallel randomised controlled trials (RCTs) involving adults and children with asthma, 28 of which (n = 16,303) contributed data to at least one meta-analysis. Follow-up ranged from two months to two years (median six months), and trials were conducted mainly in high-income countries. Most studies reported some measure of adherence to ICS and a variety of other outcomes such as quality of life and asthma control. Studies generally were at low or unclear risk of selection bias and at high risk of biases associated with blinding. We considered around half the studies to be at high risk for attrition bias and selective outcome reporting.We classified studies into four comparisons: adherence education versus control (20 studies); electronic trackers or reminders versus control (11 studies); simplified drug regimens versus usual drug regimens (four studies); and school-based directly observed therapy (three studies). Two studies are described separately.All pooled results for adherence education, electronic trackers or reminders and simplified regimens showed better adherence than controls. Analyses limited to studies using objective measures revealed that adherence education showed a benefit of 20 percentage points over control (95% confidence interval (CI) 7.52 to 32.74; five studies; low-quality evidence); electronic trackers or reminders led to better adherence of 19 percentage points (95% CI 14.47 to 25.26; six studies; moderate-quality evidence); and simplified regimens led to better adherence of 4 percentage points (95% CI 1.88 to 6.16; three studies; moderate-quality evidence). Our confidence in the evidence was reduced by risk of bias and inconsistency.Improvements in adherence were not consistently translated into observable benefit for clinical outcomes in our pooled analyses. None of the intervention types showed clear benefit for our primary clinical outcomes - exacerbations requiring an oral corticosteroid (OCS) (evidence of very low to low quality) and asthma control (evidence of low to moderate quality); nor for our secondary outcomes - unscheduled visits (evidence of very low to moderate quality) and quality of life (evidence of low to moderate quality). However, some individual studies reported observed benefits for OCS and use of healthcare services. Most school or work absence data were skewed and were difficult to interpret (evidence of low quality, when graded), and most studies did not specifically measure or report adverse events.Studies investigating the possible benefit of administering ICS at school did not measure adherence, exacerbations requiring OCS, asthma control or adverse events. One study showed fewer unscheduled visits, and another found no differences; data could not be combined. AUTHORS' CONCLUSIONS Pooled results suggest that a variety of interventions can improve adherence. The clinical relevance of this improvement, highlighted by uncertain and inconsistent impact on clinical outcomes such as quality of life and asthma control, is less clear. We have low to moderate confidence in these findings owing to concerns about risk of bias and inconsistency. Future studies would benefit from predefining an evidence-based 'cut-off' for acceptable adherence and using objective adherence measures and validated tools and questionnaires. When possible, covert monitoring and some form of blinding or active control may help disentangle effects of the intervention from effects of inclusion in an adherence trial.
Collapse
Affiliation(s)
- Rebecca Normansell
- St George's, University of LondonCochrane Airways, Population Health Research InstituteLondonUKSW17 0RE
| | - Kayleigh M Kew
- BMJ Knowledge CentreBritish Medical Journal Technology Assessment Group (BMJ‐TAG)BMA HouseTavistock SquareLondonUKWC1H 9JR
| | - Elizabeth Stovold
- St George's, University of LondonPopulation Health Research InstituteCranmer TerraceTootingLondonUKSW17 0RE
| | | |
Collapse
|
40
|
Affiliation(s)
- Hugo Saner
- Department for Preventive Cardiology and Sports Medicine, Bern University Hospital, Bern, Switzerland
| | - Enno van der Velde
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|