1
|
Sun L, Yang B, Kindt E, Chu J. Privacy Barriers in Health Monitoring: Scoping Review. JMIR Nurs 2024; 7:e53592. [PMID: 38723253 PMCID: PMC11117136 DOI: 10.2196/53592] [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: 10/11/2023] [Revised: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Health monitoring technologies help patients and older adults live better and stay longer in their own homes. However, there are many factors influencing their adoption of these technologies. Privacy is one of them. OBJECTIVE The aim of this study was to provide an overview of the privacy barriers in health monitoring from current research, analyze the factors that influence patients to adopt assisted living technologies, provide a social psychological explanation, and propose suggestions for mitigating these barriers in future research. METHODS A scoping review was conducted, and web-based literature databases were searched for published studies to explore the available research on privacy barriers in a health monitoring environment. RESULTS In total, 65 articles met the inclusion criteria and were selected and analyzed. Contradictory findings and results were found in some of the included articles. We analyzed the contradictory findings and provided possible explanations for current barriers, such as demographic differences, information asymmetry, researchers' conceptual confusion, inducible experiment design and its psychological impacts on participants, researchers' confirmation bias, and a lack of distinction among different user roles. We found that few exploratory studies have been conducted so far to collect privacy-related legal norms in a health monitoring environment. Four research questions related to privacy barriers were raised, and an attempt was made to provide answers. CONCLUSIONS This review highlights the problems of some research, summarizes patients' privacy concerns and legal concerns from the studies conducted, and lists the factors that should be considered when gathering and analyzing people's privacy attitudes.
Collapse
Affiliation(s)
- Luyi Sun
- Department of Information Security and Communication Technology, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Bian Yang
- Department of Information Security and Communication Technology, Faculty of Information Technology and Electrical Engineering, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Els Kindt
- Centre for IT & IP Law, Faculty of Law and Criminology, KU Leuven, Leuven, Belgium
| | - Jingyi Chu
- Administrative Law, Faculty of Law, China University of Political Science and Law, Beijing, China
| |
Collapse
|
2
|
Groom LL, Schoenthaler AM, Mann DM, Brody AA. Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-focused Digital Health and Implementation Research. PLOS DIGITAL HEALTH 2024; 3:e0000509. [PMID: 38776354 PMCID: PMC11111026 DOI: 10.1371/journal.pdig.0000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024]
Abstract
Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objective of this study is expand an implementation model with recommendations on the equitable implementation of new digital health technologies. The Digital Health Equity-Focused Implementation Research (DH-EquIR) conceptual model was developed based on a rigorous review of digital health implementation and health equity literature. The Equity-Focused Implementation Research for Health Programs (EquIR) model was used as a starting point and merged with digital equity and digital health implementation models. Existing theoretical frameworks and models were appraised as well as individual equity-sensitive implementation studies. Patient and program-related concepts related to digital equity, digital health implementation, and assessment of social/digital determinants of health were included. Sixty-two articles were analyzed to inform the adaption of the EquIR model for digital health. These articles included digital health equity models and frameworks, digital health implementation models and frameworks, research articles, guidelines, and concept analyses. Concepts were organized into EquIR conceptual groupings, including population health status, planning the program, designing the program, implementing the program, and equity-focused implementation outcomes. The adapted DH-EquIR conceptual model diagram was created as well as detailed tables displaying related equity concepts, evidence gaps in source articles, and analysis of existing equity-related models and tools. The DH-EquIR model serves to guide digital health developers and implementation specialists to promote the inclusion of health-equity planning in every phase of implementation. In addition, it can assist researchers and product developers to avoid repeating the mistakes that have led to inequities in the implementation of digital health across populations.
Collapse
Affiliation(s)
- Lisa L. Groom
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
| | - Antoinette M. Schoenthaler
- Institute for Excellence in Health Equity, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Devin M. Mann
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Abraham A. Brody
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, New York, United States of America
| |
Collapse
|
3
|
Thompson D, Callender C, Dave JM, Jibaja-Weiss ML, Montealegre JR. Health equity in action: using community-engaged research to update an intervention promoting a healthy home food environment to Black/African American families. Cancer Causes Control 2024; 35:311-321. [PMID: 37736870 DOI: 10.1007/s10552-023-01753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Describe the method for conducting community-engaged research to identify needed changes for an existing evidence-based intervention, and prepare it for implementation in a community setting within the Dan L Duncan Comprehensive Cancer Center catchment area in an effort to achieve more equitable outcomes in diet-related disease risk factors. METHODS The intervention, Family Eats, was developed over 10 years ago. It works directly with parents of Black/African American 9-12 year old children to create a healthy home food environment to support prevention of obesity and related cancers. Data collection with community stakeholders occurred through a series of Community Advisory Board (CAB) meetings guided by the Delphi Technique, an iterative approach for gaining group consensus on a topic. RESULTS Key information on needed changes and potential implementation strategies were identified. Perceived level of engagement among CAB members was high overall and in terms of both quantity and quality. CONCLUSION The Delphi Technique shows promise as a method for conducting community-engaged research that promotes engagement and identifies key information needed to adapt and implement an existing intervention in a community setting.
Collapse
Affiliation(s)
- Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Chishinga Callender
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jayna M Dave
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
4
|
Boeijen JA, van de Pol AC, van Uum RT, Venekamp RP, Smit K, Kaasjager KAH, van den Broek R, Bijsterbosch W, Schoonhoven L, Rutten FH, Zwart DLM. Home-based management of hypoxaemic COVID-19 patients: design of the Therapy@Home pilot study. BMJ Open 2024; 14:e079778. [PMID: 38296291 PMCID: PMC10828874 DOI: 10.1136/bmjopen-2023-079778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, hospital capacity was strained. Home-based care could relieve the hospital care system and improve patient well-being if safely organised.We designed an intervention embedded in a regional collaborative healthcare network for the home-based management of acutely ill COVID-19 patients requiring oxygen treatment. Here, we describe the design and pilot protocol for the evaluation of the feasibility of this complex intervention. METHODS AND ANALYSIS Following a participatory action research approach, the intervention was designed in four consecutive steps: (1) literature review and establishment of an expert panel; (2) concept design of essential intervention building blocks (acute medical care, acute nursing care, remote monitoring, equipment and technology, organisation and logistics); (3) safety assessments (prospective risk analysis and a simulation patient evaluation) and (4) description of the design of the pilot (feasibility) study aimed at including approximately 15-30 patients, sufficient for fine-tuning for a large-scale randomised intervention. ETHICS AND DISSEMINATION All patients will provide written, informed consent. The study was approved by the Medical Ethics Review Committee of the University Medical Center Utrecht, the Netherlands (protocol NL77421.041.21). The preparatory steps (1-4) needed to perform the pilot are executed and described in this paper. The findings of the pilot will be published in academic journals. If we consider the complex intervention feasible, we aim to continue with a large-scale randomised controlled study evaluating the clinical effectiveness, safety and implementation of the complex intervention.
Collapse
Affiliation(s)
- Josi A Boeijen
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Alma C van de Pol
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Rick T van Uum
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Roderick P Venekamp
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Karin Smit
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Karin A H Kaasjager
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Robert van den Broek
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wilma Bijsterbosch
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lisette Schoonhoven
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Frans H Rutten
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Dorien L M Zwart
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| |
Collapse
|
5
|
Baumeister A, Aldin A, Chakraverty D, Hübner C, Adams A, Monsef I, Skoetz N, Kalbe E, Woopen C. Interventions for improving health literacy in migrants. Cochrane Database Syst Rev 2023; 11:CD013303. [PMID: 37963101 PMCID: PMC10645402 DOI: 10.1002/14651858.cd013303.pub2] [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] [Indexed: 11/16/2023]
Abstract
BACKGROUND Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health. OBJECTIVES To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions. SEARCH METHODS We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier). SELECTION CRITERIA We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information). DATA COLLECTION AND ANALYSIS We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis. MAIN RESULTS We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence. AUTHORS' CONCLUSIONS Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.
Collapse
Affiliation(s)
- Annika Baumeister
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Digo Chakraverty
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| |
Collapse
|
6
|
Creber A, Leo DG, Buckley BJR, Chowdhury M, Harrison SL, Isanejad M, Lane DA. Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis. BMC Cardiovasc Disord 2023; 23:469. [PMID: 37726655 PMCID: PMC10510185 DOI: 10.1186/s12872-023-03486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology. METHOD A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease). RESULTS Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used. CONCLUSION Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.
Collapse
Affiliation(s)
- Anna Creber
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Mahin Chowdhury
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Stephanie L Harrison
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Masoud Isanejad
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Musculoskeletal Ageing, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
7
|
Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
Collapse
Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
8
|
Garcia D, Fortney CA, Gerhardt CA, Baughcum AE, Slaughter JL, Rodriguez EM. Inclusion of Spanish-Speaking Families in NICU Symptom Research Using a Community Advisory Board. Adv Neonatal Care 2023; 23:212-219. [PMID: 36912673 DOI: 10.1097/anc.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Admission rates of Hispanic/Latinx families to the neonatal intensive care unit (NICU) are rising, yet knowledge regarding their experiences is limited. Non-English-speaking families are often excluded from research because study measures are not available in their language. The inclusion of these families in NICU research is crucial to understand the impact of cultural and language barriers in infant and family care, and the translation of study measures into Spanish could better ensure that these families' perspectives are included. However, previous research has utilized the standard translation-backtranslation method with which problems have been noted. PURPOSE This article describes the planning, preparation, and action phases that were completed with the use of a community advisory board (CAB) to prepare and transcreate research study materials from English to Spanish for pilot testing. METHODS Community members of interest were invited to form the CAB, and 2 meetings were held to review study materials in the English and Spanish versions. Prior to the second meeting, a professional translation company translated study materials from English to Spanish. RESULTS Feedback from the CAB ensured consistent content and reading levels, and culturally appropriate language usage. The CAB also provided suggestions to the research protocol and advised sensitive methods of recruitment and measure administration. IMPLICATIONS FOR PRACTICE AND RESEARCH More accurate and culturally appropriate transcreation of study measures can reduce barriers to research participation and facilitate better communication with non-English-speaking families in health equity research to better inform evidence-based interventions and clinical practices across diverse groups.
Collapse
Affiliation(s)
- Dana Garcia
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Ms Garcia and Drs Fortney, Gerhardt, Baughcum, and Slaughter); The Ohio State University, Columbus, Ohio (Drs Fortney, Gerhardt, and Baughcum); and The University of Texas at Austin, Austin (Dr Rodriguez)
| | | | | | | | | | | |
Collapse
|
9
|
Randomized Controlled Trial of Home Telemonitoring of Blood Pressure with an Adapted Tensiometer with SMS Capability. Eur J Investig Health Psychol Educ 2023; 13:440-449. [PMID: 36826217 PMCID: PMC9954846 DOI: 10.3390/ejihpe13020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Despite being a public health problem, less than a third of hypertensive patients manage to control blood pressure (BP). In this paper, we conducted a two-arm randomized controlled trial to investigate the efficacy of an SMS-based home BP telemonitoring system compared to usual care in patients with uncontrolled hypertension from a primary care center. This study was conducted between April and August 2018. Participants in the intervention arm used a custom-designed telemonitoring device for two weeks and were followed up for two additional weeks; controls were followed for 4 weeks. The main objective of this study is to evaluate the impact on blood pressure of a telemonitoring system using a blood pressure monitor adapted to send data via SMS to health providers in primary care centers for 4 weeks. In this trial, 38 patients were included in the analysis (18 in each arm), 68% were women, and the mean age was 68.1 [SD: 10.8 years], with no differences between arms. Among the results we found was that There was no significant difference in the change in systolic BP values between the control and intervention arm (-7.2 [14.9] mmHg vs. -16.3 [16.7] mmHg; p = 0.09). However, we found a significant difference in the change of diastolic BP (-1.2 [6.4] mmHg vs. -7.2 [9.8] mmHg; for the control and intervention arms, respectively p = 0.03). With all this, we conclude that an SMS-based home BP telemonitoring system is effective in reducing diastolic BP by working in conjunction with primary care centers. Our findings represent one of the first interventions of this type in our environment, being an important alternative for the control of high blood pressure.
Collapse
|
10
|
MacEntee K, Lee EOJ, Oudshoorn A, Abramovich A, Kiptui R, Ayuku D, Van Berkum A, Saarela O, Tang TS, Apondi E, Wachira J, MacDonald SA, Braitstein P. Using scenario videos with Theatre Testing method to adapt a peer navigation model to improve street-connected youth's access to HIV care in Kenya and Canada. Front Public Health 2022; 10:975117. [PMID: 36408034 PMCID: PMC9669244 DOI: 10.3389/fpubh.2022.975117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Theatre testing (TT) method demonstrates whole or portions of an evidence-based intervention to stakeholders to elicit feedback on context-specific adaptations and future implementation. The Peer Navigator Project (PNP) studied the adaptation and implementation of Peer Navigators in five urban sites to increase street-connected youth (SCY) access to HIV prevention, testing, and treatment in Canada and Kenya. TT was used with SCY, healthcare providers, and community stakeholders to collect feedback on the optimal characteristics of the PNs (e.g., social identities) and their professional activities and responsibilities in each site. Sites scripted unique scenarios of PNs supporting SCY and interacting with social service providers. Local actors were employed, and the scenarios were filmed and edited into videos alongside audience discussion questions. Videos were screened to separate audiences of SCY (n = 40), healthcare providers (n = 12), and community stakeholders (n = 59). Facilitated discussion about the scenarios were recorded as data, and transcripts were analyzed thematically by the research team. The scenario videos are presented as a unique adaptation to the TT method. The adaptations were time-consuming and limited the ability to present responsive changes while presenting the method to different audiences. They were also effective at maintaining presentation fidelity and eliciting diverse and meaningful responses from different stakeholder groups. One site successfully adapted the method for use in a physically distanced manner that complied with COVID-19 public health regulations. TT using video scenarios is an engaging approach that garners rich responses from diverse stakeholder groups about the adaptation of evidence-based interventions preparing for implementation in international settings.
Collapse
Affiliation(s)
- Katie MacEntee
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada,*Correspondence: Katie MacEntee
| | - Edward Ou Jin Lee
- École de Travail Social, Université de Montréal, Montréal, QC, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Reuben Kiptui
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya
| | - David Ayuku
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya,Department of Mental Health and Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Amy Van Berkum
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thai-Son Tang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edith Apondi
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya,Department of Mental Health and Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Sue-Ann MacDonald
- École de Travail Social, Université de Montréal, Montréal, QC, Canada
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Epidemiology and Biostatistics, School of Public Health, Moi University, Eldoret, Kenya
| |
Collapse
|
11
|
Saadi A, Mendizabal A, Mejia NI. Teleneurology and Health Disparities. Semin Neurol 2022; 42:60-66. [PMID: 35576930 DOI: 10.1055/s-0041-1742194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The disparate access to, and use of, telemedicine reflects those of in-person health. These disparities are perpetuated as a result of individual, social, and structural factors like low digital literacy, unequal availability of broadband services, and systemic racism. This review focuses on extant literature on disparities in teleneurology, including racial or ethnic disparities, language inequities, and the global context. Understanding social and structural barriers to equitable access to quality teleneurology is critical to addressing and preventing health disparities, ensuring effective and equitable neurological care for all patients.
Collapse
Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Adys Mendizabal
- Department of Neurology, University of California Los Angeles, Los Angeles, California
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|