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Prince G, Rees Lewis D, Pollack T, Karam S, Touma E, Khorzad R, Cooper Bailey S, Gatchell D, Ankenman B, Kravarusic J, Sabol T, Holl J, Wallia A. Employing user-centered design and education sciences to inform training of diabetes survival skills. J Clin Transl Endocrinol 2024; 37:100364. [PMID: 39247534 PMCID: PMC11380392 DOI: 10.1016/j.jcte.2024.100364] [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: 05/14/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024] Open
Abstract
Background Patients newly diagnosed with diabetes mellitus (diabetes), who require insulin must acquire diabetes "survival" skills prior to discharge home. COVID-19 revealed considerable limitations of traditional in-person, time-intensive delivery of diabetes education and survival skills training (diabetes survival skills training). Furthermore, diabetes survival skills training has not been designed to meet the specific learning needs of patients with diabetes and their caregivers, particularly if delivered by telehealth. The objective of the study was to identify and understand the needs of users (patients newly prescribed insulin and their caregivers) to inform the design of a diabetes survival skills training, specifically for telehealth delivery, through the application of user-centered design and adult learning and education principles. Methods Users included patients newly prescribed insulin, their caregivers, and laypersons without diabetes. In semi-structured interviews, users were asked about experienced or perceived challenges in learning diabetes survival skills. Interviews were audio-recorded and transcribed. Investigators performed iterative rounds of coding of interview transcripts utilizing a constant comparative method to identify themes describing the dominant challenges users experienced. Themes were then mapped to adult learning and education principles to identify novel educational design solutions that can be applied to telehealth-based learning. Results We interviewed 18 users: patients (N = 6, 33 %), caregivers (N = 4, 22 %), and laypersons (N = 8, 44 %). Users consistently described challenges in understanding diabetes survival skills while hospitalized; in preparing needed supplies to execute diabetes survival skills; and in executing diabetes survival skills at home. The challenges mapped to three educational strategies: (1) spiral learning; (2) repetitive goal directed practice and feedback, which have the potential to translate into design solutions supporting remote/virtual learning; and (3) form fits function organizer, which supports safe organization and use of supplies to execute diabetes survival skills independently. Conclusion Learning complex tasks, such as diabetes survival skills, requires time, repetition, and continued support. The combination of a user-centered design approach to uncover learning needs as well as identification of relevant adult learning and education principles could inform the design of more user-centered, feasible, effective, and sustainable diabetes survival skills training for telehealth delivery.
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Affiliation(s)
- Grace Prince
- Virginia Commonwealth University, Richmond, VA, USA
| | | | - Teresa Pollack
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Susan Karam
- Ochsner Medical Center, New Orleans, LA, USA
| | - Emilie Touma
- University of Kentucky School of Medicine, Lexington, KY, USA
| | | | | | | | | | | | - Terri Sabol
- Northwestern School of Education and Social Policy, Chicago, IL, USA
| | - Jane Holl
- University of Chicago Biological Science Division, Chicago, IL, USA
| | - Amisha Wallia
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
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Griefahn A, Zalpour C, Luedtke K. Identifying the risk of exercises, recommended by an artificial intelligence for patients with musculoskeletal disorders. Sci Rep 2024; 14:14472. [PMID: 38914582 PMCID: PMC11196744 DOI: 10.1038/s41598-024-65016-1] [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: 08/09/2023] [Accepted: 06/16/2024] [Indexed: 06/26/2024] Open
Abstract
Musculoskeletal disorders (MSDs) impact people globally, cause occupational illness and reduce productivity. Exercise therapy is the gold standard treatment for MSDs and can be provided by physiotherapists and/or also via mobile apps. Apart from the obvious differences between physiotherapists and mobile apps regarding communication, empathy and physical touch, mobile apps potentially offer less personalized exercises. The use of artificial intelligence (AI) may overcome this issue by processing different pain parameters, comorbidities and patient-specific lifestyle factors and thereby enabling individually adapted exercise therapy. The aim of this study is to investigate the risks of AI-recommended strength, mobility and release exercises for people with MSDs, using physiotherapist risk assessment and retrospective consideration of patient feedback on risk and non-risk exercises. 80 patients with various MSDs received exercise recommendations from the AI-system. Physiotherapists rated exercises as risk or non-risk, based on patient information, e.g. pain intensity (NRS), pain quality, pain location, work type. The analysis of physiotherapists' agreement was based on the frequencies of mentioned risk, the percentage distribution and the Fleiss- or Cohens-Kappa. After completion of the exercises, the patients provided feedback for each exercise on an 11-point Likert scale., e.g. the feedback question for release exercises was "How did the stretch feel to you?" with the answer options ranging from "painful (0 points)" to "not noticeable (10 points)". The statistical analysis was carried out separately for the three types of exercises. For this, an independent t-test was performed. 20 physiotherapists assessed 80 patient examples, receiving a total of 944 exercises. In a three-way agreement of the physiotherapists, 0.08% of the exercises were judged as having a potential risk of increasing patients' pain. The evaluation showed 90.5% agreement, that exercises had no risk. Exercises that were considered by physiotherapists to be potentially risky for patients also received lower feedback ratings from patients. For the 'release' exercise type, risk exercises received lower feedback, indicating that the patient felt more pain (risk: 4.65 (1.88), non-risk: 5.56 (1.88)). The study shows that AI can recommend almost risk-free exercises for patients with MSDs, which is an effective way to create individualized exercise plans without putting patients at risk for higher pain intensity or discomfort. In addition, the study shows significant agreement between physiotherapists in the risk assessment of AI-recommended exercises and highlights the importance of considering individual patient perspectives for treatment planning. The extent to which other aspects of face-to-face physiotherapy, such as communication and education, provide additional benefits beyond the individualization of exercises compared to AI and app-based exercises should be further investigated.Trial registration: 30.12.2021 via OSF Registries, https://doi.org/10.17605/OSF.IO/YCNJQ .
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Affiliation(s)
- Annika Griefahn
- Department of Physiotherapy, Institute of Health Sciences, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- Faculty Business Management and Social Sciences, University of Applied Science Osnabrueck, Albrechtstraße 30, 49076, Osnabrück, Germany.
- medicalmotion GmbH, Blütenstraße 15, 80799, Munich, Germany.
| | - Christoff Zalpour
- Faculty Business Management and Social Sciences, University of Applied Science Osnabrueck, Albrechtstraße 30, 49076, Osnabrück, Germany
| | - Kerstin Luedtke
- Department of Physiotherapy, Institute of Health Sciences, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Adepoju OE, Singh M, Tipton M, Peperone G, Trujillo M, Ojinnaka C. Access to technology, internet usage, and online health information-seeking behaviors in a racially diverse, lower-income population. Front Public Health 2024; 12:1328544. [PMID: 38450126 PMCID: PMC10914988 DOI: 10.3389/fpubh.2024.1328544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024] Open
Abstract
Background This study examined access to technology, internet usage, and online health information-seeking behaviors, in a racially diverse, lower-income population. Methods Data were obtained via a cross-sectional survey of low-income communities in Houston, Los Angeles, and New York between April and August 2023. Binary responses to the following online health information-seeking behaviors, internet and technology access, were examined: using the internet to (i) understand a medical diagnosis, (ii) fill a prescription, (iii) schedule a healthcare appointment, (iv) email communication with a healthcare provider, and (v) access electronic health records and medical notes. Results 41% of survey respondents identified as non-Hispanic Black individuals, 33% as non-Hispanic White individuals, and 22% as Hispanic individuals. 69% reported a pre-tax annual household income of less than $35,000. 97% reported ownership/access to a smart device; 97% reported access to reliable internet. In the past year, only 59% reported using the internet to better understand their medical diagnosis, 36% reported filling a prescription online, 47% scheduled a medical appointment online, 47% viewed electronic health records online, and 56% emailed healthcare providers. Female sex, higher incomes, and having at least a bachelor's degree were significantly associated with all five online health information-seeking attributes. Conclusion Despite high technology adoption rates, we observed suboptimal online health information-seeking behaviors. This underutilization has potential adverse implications for healthcare access and use given the documented advantage of HIT. Efforts to increase health information-seeking behaviors should explore the identification of HIT barriers, and patient education to increase familiarity and usage in this population.
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Affiliation(s)
- Omolola E. Adepoju
- Department of Health Systems and Population Health Sciences, University of Houston, Houston, TX, United States
- Humana Integrated Health System Sciences Institutes, University of Houston, Houston, TX, United States
| | - Maya Singh
- Humana Integrated Health System Sciences Institutes, University of Houston, Houston, TX, United States
| | - Mary Tipton
- Department of Health Systems and Population Health Sciences, University of Houston, Houston, TX, United States
- Humana Integrated Health System Sciences Institutes, University of Houston, Houston, TX, United States
| | - Gerard Peperone
- Spring Branch Community Health Center, Houston, TX, United States
| | - Marlen Trujillo
- Spring Branch Community Health Center, Houston, TX, United States
| | - Chinedum Ojinnaka
- College of Health Solutions, Arizona State University, Tempe, AZ, United States
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Graybeal AJ, Brandner CF, Tinsley GM. Evaluation of automated anthropometrics produced by smartphone-based machine learning: a comparison with traditional anthropometric assessments. Br J Nutr 2023; 130:1077-1087. [PMID: 36632007 PMCID: PMC10442791 DOI: 10.1017/s0007114523000090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/10/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
Automated visual anthropometrics produced by mobile applications are accessible and cost effective with the potential to assess clinically relevant anthropometrics without a trained technician present. Thus, the aim of this study was to evaluate the precision and agreement of smartphone-based automated anthropometrics against reference tape measurements. Waist and hip circumference (WC; HC), waist:hip ratio (WHR) and waist:height ratio (W:HT) were collected from 115 participants (69 F) using a tape measure and two smartphone applications (MeThreeSixty®, myBVI®) across multiple smartphone types. Precision metrics were used to assess test-retest precision of the automated measures. Agreement between the circumferences produced by each mobile application and the reference were assessed using equivalence testing and other validity metrics. All mobile applications across smartphone types produced reliable estimates for each variable with intraclass correlation coefficients ≥ 0·93 (all P < 0·001) and root mean square coefficient of variation between 0·5 and 2·5 %. Precision error for WC and HC was between 0·5 and 1·9 cm. WC, HC, and W:HT estimates produced by each mobile application demonstrated equivalence with the reference tape measurements using 5 % equivalence regions. Mean differences via paired t-tests were significant for all variables across each mobile application (all P < 0·050) showing slight underestimation for WC and slight overestimation for HC which resulted in a lack of equivalence for WHR compared with the reference tape measure. Overall, the results of our study support the use of WC and HC estimates produced from automated mobile applications, but also demonstrates the importance of accurate automation for WC and HC estimates given their influence on other anthropometric assessments and clinical health markers.
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Affiliation(s)
- Austin J. Graybeal
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS39406, USA
| | - Caleb F. Brandner
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS39406, USA
| | - Grant M. Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX79409, USA
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Ailawadhi S, Ailawadhi M, Dutta N, Parrondo RD, Roy V, Sher T, Baksh M, Rasheed A, Das S, Fernandez AJ, Paulus A, Chanan‐Khan AA. The digital divide: Racial disparities in adoption and utilization of health information technology among patients with lymphoid cancers. Cancer Med 2023; 12:19013-19020. [PMID: 37587868 PMCID: PMC10557846 DOI: 10.1002/cam4.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Health information technology (HIT) has the potential to improve healthcare delivery and engagement. Studying racial-ethnic disparities in HIT engagement will help understand and overcome challenges to healthcare utilization. METHODS We undertook a patient-reported survey among patients with lymphoid malignancies at two campuses of Mayo Clinic, Florida to explore HIT-related disparities. Variables between Whites and non-Whites, and non-Whites from the two campuses were compared. RESULTS The survey was completed by 1004 respondents, with 71% whites, 27% non-Whites (race-ethnicity not reported by 2%). Non-Whites included 30% responders at the main campus and 64% at an inner-city campus. Whites were significantly older and had higher education, while non-Whites had lesser access to a computer. Only 51% of non-Whites were registered to use electronic medical records (EMR) as compared to 72% Whites (p < 0.001) and significantly lesser number of non-Whites even knew that EMR existed (81% vs. 92%, p < 0.001). Encouragingly, a higher number of non-Whites wanted to engage in EMR. Non-Whites from the main campus were older, more educated and had more access to a computer as compared to those from the inner-city campus. Similar disparate factors were noted among minorities from the two campuses, suggesting impact of socioeconomic backgrounds on EMR usage among non-Whites. Linguistic barriers were more striking among inner-city campus non-Whites. CONCLUSIONS Non-Whites continue to struggle with suboptimal utilization of the healthcare system and barriers related to integration in HIT, including disparities representing socioeconomic differences. Efforts need to be made at several levels to help racial-ethnic minorities overcome awareness, access, and linguistic barriers to HIT utilization.
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Affiliation(s)
- Sikander Ailawadhi
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| | - Meghna Ailawadhi
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Navnita Dutta
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Vivek Roy
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Taimur Sher
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Mizba Baksh
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Ahsan Rasheed
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Saurav Das
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | | | - Aneel Paulus
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
| | - Asher A. Chanan‐Khan
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
- Division of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
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McCall MP, Anton MT, Highlander A, Loiselle R, Forehand R, Khavjou O, Jones DJ. Technology-Enhanced Behavioral Parent Training: The Relationship Between Technology Use and Efficiency of Service Delivery. Behav Modif 2023; 47:1094-1114. [PMID: 37086169 PMCID: PMC10403959 DOI: 10.1177/01454455231165937] [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] [Indexed: 04/23/2023]
Abstract
Behavior disorders (BDs) are common and, without treatment, can have long-term impacts on child and family health. Behavioral Parent Training (BPT) is the standard of care intervention for early-onset BDs; however, structural socioeconomic barriers hinder treatment outcomes for low-income families. While digital technologies have been proposed as a mechanism to improve engagement in BPT, research exploring the relationship between technology use and outcomes is lacking. Thus, this study with 34 low-income families examined the impact of parents' use of adjunctive mobile app components on treatment efficiency in one technology-enhanced (TE-) BPT program, Helping the Noncompliant Child (HNC). While parent use of the TE-HNC app and its impact on the efficiency of service delivery varied across specific components, increased app use significantly reduced the number of weeks required for families to achieve skill mastery. Implications for the design and development of behavior intervention technologies in general, as well as for BPT in particular, are discussed.
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Affiliation(s)
| | | | | | - Raelyn Loiselle
- The University of North Carolina at Chapel Hill, USA
- NYU Langone Health, New York City, NY, USA
| | | | - Olga Khavjou
- RTI International Research Institute, Triangle Park, NC, USA
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Xiao J, Kopycka-Kedzierawski D, Ragusa P, Mendez Chagoya LA, Funkhouser K, Lischka T, Wu TT, Fiscella K, Kar KS, Al Jallad N, Rashwan N, Ren J, Meyerowitz C. Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study. JMIR Hum Factors 2023; 10:e45418. [PMID: 37594795 PMCID: PMC10474507 DOI: 10.2196/45418] [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: 12/30/2022] [Revised: 04/17/2023] [Accepted: 06/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP). OBJECTIVE This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic. METHODS This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model. RESULTS A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos. Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients' conditions. CONCLUSIONS The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health-promoting behaviors.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | | | - Patricia Ragusa
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | | | | | - Tamara Lischka
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Kumari Saswati Kar
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Noha Rashwan
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Johana Ren
- River Campus, University of Rochester, Rochester, NY, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
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Yee LM, Leziak K, Jackson J, Niznik C, Saber R, Yeh C, Simon MA. SweetMama: Usability Assessment of a Novel Mobile Application Among Low-Income Pregnant People to Assist With Diabetes Management and Support. Diabetes Spectr 2023; 36:171-181. [PMID: 37193207 PMCID: PMC10182966 DOI: 10.2337/ds22-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Mobile health tools may be effective strategies to improve engagement, education, and diabetes-related health during pregnancy. We developed SweetMama, a patient-centered, interactive mobile application (app) designed to support and educate low-income pregnant people with diabetes. Our objective was to evaluate the SweetMama user experience and acceptability. Methods SweetMama is a mobile app with static and dynamic features. Static features include a customized homepage and resource library. Dynamic features include delivery of a theory-driven diabetes-specific curriculum via 1) motivational, tip, and goal-setting messages aligning with treatment and gestational age; 2) appointment reminders; and 3) ability to mark content as "favorite." In this usability assessment, low-income pregnant people with gestational or type 2 diabetes used SweetMama for 2 weeks. Participants provided qualitative feedback (via interviews) and quantitative feedback (via validated usability/satisfaction measures) on their experience. User analytic data detailed the duration and type of interactions users had with SweetMama. Results Of 24 individuals enrolled, 23 used SweetMama and 22 completed exit interviews. Participants were mostly non-Hispanic Black (46%) or Hispanic (38%) individuals. Over the 14-day period, users accessed SweetMama frequently (median number of log-ins 8 [interquartile range 6-10]), for a median of 20.5 total minutes, and engaged all features. A majority (66.7%) rated SweetMama as having moderate or high usability. Participants emphasized design and technical strengths and beneficial effects on diabetes self-management and also identified limitations of the user experience. Conclusion Pregnant people with diabetes found SweetMama to be user-friendly, informative, and engaging. Future work must study its feasibility for use throughout pregnancy and its efficacy to improve perinatal outcomes.
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Affiliation(s)
- Lynn M. Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karolina Leziak
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jenise Jackson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charlotte Niznik
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Chen Yeh
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melissa A. Simon
- Departments of Obstetrics and Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Parent J, Jones DJ, DiMarzio K, Yang Y, Wright KL, Sullivan ADW, Forehand R. The Effects of Young Children's Callous-Unemotional Traits on Behaviorally Observed Outcomes in Standard and Technology-Enhanced Behavioral Parent Training. Res Child Adolesc Psychopathol 2023; 51:165-175. [PMID: 36344876 DOI: 10.1007/s10802-022-00979-1] [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] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Behavioral Parent Training (BPT) remains the current standard of care for early onset behavior disorders (BD); however, problem behaviors characterized by relatively high callous unemotional (CU) traits are linked to poorer treatment outcomes, highlighting the need for novel interventions. This study examined the relation of baseline child CU traits to changes in observed parent and child (3 to 8 years old) behavior in 101 families with low-income randomized to either a standard (Helping the Noncompliant Child, HNC) or technology-enhanced BPT program (TE-HNC). Assessments occurred at baseline, post-intervention, and at a three-month follow-up. Treatment group moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up but only in the standard program (HNC). This is the first intervention study to behaviorally assess the differential impact of CU traits in standard, relative to technology-enhanced, BPT and suggests the promise of a technology-enhanced treatment model.
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Affiliation(s)
- Justin Parent
- Department of Psychiatry and Human Behavior, Brown University, Providence, USA.
- Warren Alpert Medical School, Brown University, 1 Hoppin St #204, Providence, RI, USA.
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karissa DiMarzio
- Department of Psychology, Florida International University, Miami, USA
| | - Yexinyu Yang
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kat L Wright
- Department of Psychology, University of Kentucky, Lexington, USA
| | | | - Rex Forehand
- Department of Psychological Science, University of Vermont, Burlington, USA
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Wi CI, King KS, Ryu E, Natoli TL, Miller RP, Spiten MJ, Borah BJ, Takahashi PY, Yao X, Noseworthy PA, Pignolo RJ, Juhn YJ. Application of Innovative Subject Recruitment System for Batch Enrollment: A Pilot Study. J Prim Care Community Health 2023; 14:21501319231194967. [PMID: 37646152 PMCID: PMC10467239 DOI: 10.1177/21501319231194967] [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: 05/16/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Using a digital process that leverages electronic health records (EHRs) can ease many of the challenges presented by the traditional enrollment process for clinical trials. We tested if automated batch enrollment using a technology-enabled subject recruitment system (TESRS) enhances recruitment while preserving representation of research subjects for the study population in our study setting. METHODS An ongoing community-based prospective adult cohort study was used to randomize 600 subjects who were eligible by age and residential address to TESRS (n = 300) and standard mailing method (n = 300), respectively, for 3 months. Then, TESRS was initiated and included automatic identification of patients' preference for being contacted (online patient portal vs postal mail) from EHRs and automatic sending out of invitation letters followed by completion of a short online survey for checking eligibility and the digital consent process if eligible. We compared (1) median time to consent from invitation sent out per subject and total subjects recruited after a 3-month recruitment period, (2) the estimated study staff's time, and (3) representation of sociodemographic characteristics (e.g., age, sex, race, SES measured by HOUSES index, and rural residence) between subjects recruited via TESRS and those via traditional mailing methods. RESULTS Median age of randomized subjects (n = 600) was 63 years with 52.0% female and 89.2% non-Hispanic White. Over a 3-month period, results showed consent rate via TESRS was 13% (39/297) similar to 11% (31/295) via standard mailing. However, recruitment was significantly faster with the TESRS approach (median 7 vs 26 days) given the study staff's effort. Study staff's time saved by using TESRS compared to standard mailing approach was estimated at 40 min per subject (equivalent to 200 h for 300 subjects). No significant differences in characteristics of research subjects from the study population were found. CONCLUSION Our study demonstrated the utility of TESRS as a subject recruitment digital technology which significantly enhanced the recruitment effort while reducing the study staff burden of recruitment while maintaining the consistency of characteristics of recruited subjects. The strategy and support for implementing and testing TESRS in other study settings should be considered.
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Affiliation(s)
- Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
| | - Katherine S. King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
- Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Traci L. Natoli
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
| | - Ryan P. Miller
- Department of Information Technology, Mayo Clinic, Phoenix, AZ, USA
| | - Matthew J. Spiten
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
| | - Bijan J. Borah
- Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
| | - Paul Y. Takahashi
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Robert J. Pignolo
- Department of Medicine, Divisions of Hospital Internal Medicine, Endocrinology, and Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Precision Population Science Lab, Mayo Clinic, Rochester, MN, USA
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11
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Proctor SL. Rewarding recovery: the time is now for contingency management for opioid use disorder. Ann Med 2022; 54:1178-1187. [PMID: 35471190 PMCID: PMC9045772 DOI: 10.1080/07853890.2022.2068805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/03/2022] [Accepted: 04/16/2022] [Indexed: 01/30/2023] Open
Abstract
Contingency management (i.e. rewarding people, often with money, for achieving their recovery goals) is backed by decades of empirical support yet remains highly underutilized. Rewards are rarely used in real-world clinical practice due to a number of concerns, including most notably, the apparent lack of innovation, as well as moral, philosophical, ethical, and economic concerns, and even federal rules meant to prevent illegal inducements in health care. Still, other opponents argue that some patients will try to "game" the system by simply doing whatever it takes to earn monetary rewards. This paper provides a succinct, up-to-date overview of the current evidence base for contingency management for opioid use disorder. Common barriers and solutions to implementation, as well as implications for future research and clinical practice are discussed. Although important, greater uptake of contingency management interventions is about more than legislation and regulations; it's about recognizing stigma, shaping attitudes, and increasing awareness. Provider involvement in advocacy efforts at all levels and collaboration involving academic-industry partnerships is necessary to advance the burgeoning digital health care space and improve outcomes for people with opioid use disorder. Key MessagesContingency management is highly effective but highly underutilized.Low uptake is largely attributed to a lack of innovation and moral, ethical, and economic concerns, among other barriers.Technology-enabled solutions and academic-industry partnerships are critical to advance opioid use disorder care.
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Affiliation(s)
- Steven L. Proctor
- Thriving Mind South Florida, Miami, FL, USA
- PRO Health Group, Miami Beach, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
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12
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Nelson LA, Alfonsi SP, Lestourgeon LM, Mayberry LS. Disparities in mobile phone use among adults with type 2 diabetes participating in clinical trials 2017-2021. JAMIA Open 2022; 5:ooac095. [PMID: 36380850 PMCID: PMC9648685 DOI: 10.1093/jamiaopen/ooac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/27/2022] [Accepted: 10/25/2022] [Indexed: 11/20/2023] Open
Abstract
Despite smartphone ownership becoming ubiquitous, it is unclear whether and where disparities persist in experience using health apps. In 2 diverse samples of adults with type 2 diabetes collected 2017-2018 and 2020-2021, we examined adjusted disparities in smartphone ownership and health app use by age, gender, race, education, annual household income, health insurance status, health literacy, and hemoglobin A1c. In the earlier sample (N = 422), 87% owned a smartphone and 49% of those had ever used a health app. Participants with lower income or limited health literacy had ≥50% lower odds of owning a smartphone. Comparatively, in the later sample (N = 330), almost all participants (98%) owned a smartphone and 70% of those had ever used a health app; however, disparities in health app use closely mirrored disparities in smartphone ownership from 2017 to 2018. Our findings suggest device ownership is necessary but insufficient for assuming people will use apps to support their health.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel P Alfonsi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lauren M Lestourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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DeWitt A, Kientz J, Liljenquist K. Quality of Mobile Apps for Child Development Support: Search in App Stores and Content Analysis. JMIR Pediatr Parent 2022; 5:e38793. [PMID: 36346656 PMCID: PMC9682452 DOI: 10.2196/38793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/01/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Following increases in smartphone access, more parents seek parenting advice through internet sources, including blogs, web-based forums, or mobile apps. However, identifying quality apps (ones that respond to the diverse experiences of families) for guidance on child development can be challenging. OBJECTIVE This review of mobile health apps aimed to document the landscape, design, and content of apps in the United States available to parents as they promote their child's developmental health. METHODS To understand the availability and quality of apps for early childhood health promotion, we completed a content analysis of apps in 2 major app stores (Google Play and Apple App stores). RESULTS We found that most apps do not provide tailored experiences to parents, including cultural considerations, and instead promote generic guidance that may be useful to parents in some contexts. We discuss the need for an evaluative framework to assess apps aimed to support parents on child development topics. CONCLUSIONS Future work is needed on how to support designers in this area, specifically related to avoiding potential burdens on users and providing culturally informed and equity-driven experiences.
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Affiliation(s)
- Akeiylah DeWitt
- Department of Human-Centered Design and Engineering, Seattle, WA, United States
| | - Julie Kientz
- Department of Human-Centered Design and Engineering, Seattle, WA, United States
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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14
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Patel RJS, Ding J, Marvel FA, Shan R, Plante TB, Blaha MJ, Post WS, Martin SS. Associations of Demographic, Socioeconomic, and Cognitive Characteristics With Mobile Health Access: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Heart Assoc 2022; 11:e024885. [PMID: 36056720 PMCID: PMC9496404 DOI: 10.1161/jaha.121.024885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Mobile health (mHealth) has an emerging role in the prevention of cardiovascular disease. This study evaluated possible inequities in mHealth access in older adults. Methods and Results mHealth access was assessed from 2019 to 2020 in MESA (Multi‐Ethnic Study of Atherosclerosis) telephone surveys of 2796 participants aged 62 to 102 years. A multivariable logistic regression model adjusted for general health status assessed associations of mHealth access measures with relevant demographic, socioeconomic, and cognitive characteristics. There were lower odds of all access measures with older age (odds ratios [ORs], 0.37–0.59 per 10 years) and annual income <$50 000 (versus ≥$50 000 ORs, 0.55–0.62), and higher odds with higher Cognitive Abilities Screening Instrument Score (ORs, 1.22–1.29 per 5 points). Men (versus women) had higher odds of internet access (OR, 1.32 [95% CI,1.05–1.66]) and computing device ownership (OR, 1.31 [95% CI, 1.05–1.63]) but lower fitness tracker ownership odds (OR, 0.70 [95% CI, 0.49–0.89]). For internet access and computing device ownership, we saw lower odds for Hispanic participants (versus White participants OR, 0.61 [95% CI, 0.44–0.85]; OR, 0.69 [95% CI, 0.50–0.95]) and less than a high school education (versus bachelor's degree or higher OR, 0.27 [95% CI, 0.18–0.40]; OR, 0.32 [95% CI, 0.28–0.62]). For internet access, lower odds were seen for Black participants (versus White participants OR, 0.64 [95% CI, 0.47–0.86]) and other health insurance (versus health maintenance organization/private OR, 0.59 [95% CI, 0.47–0.74]). Chinese participants (versus White participants) had lower internet access odds (OR, 0.63 [95% CI, 0.44–0.91]) but higher computing device ownership odds (OR, 1.87 [95% CI, 1.28–2.77]). Conclusions Among older‐age adults, mHealth access varied by major demographic, socioeconomic, and cognitive characteristics, suggesting a digital divide. Novel mHealth interventions should consider individual access barriers. Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT00005487.
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Affiliation(s)
- Reshmi J S Patel
- Krieger School of Arts and Sciences Johns Hopkins University Baltimore MD
| | - Jie Ding
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Francoise A Marvel
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Rongzi Shan
- David Geffen School of Medicine at UCLA Los Angeles CA
| | - Timothy B Plante
- Department of Medicine Larner College of Medicine at the University of Vermont Burlington VT
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Seth S Martin
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
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15
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Sun EY, Alvarez C, Callahan LF, Sheikh SZ. The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study. J Med Internet Res 2022; 24:e38802. [PMID: 36001872 PMCID: PMC9439379 DOI: 10.2196/38802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs. OBJECTIVE Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center. METHODS In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic's patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated. RESULTS We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US $50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or "other" race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of <US $25,000 (P=.01) were associated with lower odds of MyChart activation. Following COVID-19, younger age (P<.001), commercial insurance (P=.03), state insurance (P=.02), and median income of US $50,000-75,000 (P=.01) were associated with significantly higher odds of MyChart use. However, being of Black or African American (P<.001) or "other" race (P=.01), Spanish as a primary language (P=.002), male sex (P=.004), rural residence (P=.005), and having no insurance (P<.001) or Medicaid (P=.008) were associated with lower odds of MyChart use. CONCLUSIONS Residence in a rural area, being of minority race/ethnicity, older age, male sex, lower median income, Medicaid, being uninsured, and non-English primary language are associated with lower odds of patient portal activation and use. Future health policy and clinical practice measures should focus on reducing barriers to health technology adoption among these groups.
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Affiliation(s)
- Enid Y Sun
- Section of Rheumatology, Department of Medicine, Temple Lewis Katz School of Medicine, Philadelphia, PA, United States
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Saira Z Sheikh
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, United States.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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16
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Krebs F, Lorenz L, Nawabi F, Alayli A, Stock S. Effectiveness of a Brief Lifestyle Intervention in the Prenatal Care Setting to Prevent Excessive Gestational Weight Gain and Improve Maternal and Infant Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105863. [PMID: 35627403 PMCID: PMC9141141 DOI: 10.3390/ijerph19105863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023]
Abstract
Research on perinatal programming shows that excessive gestational weight gain (GWG) increases the risk of overweight and obesity later in a child’s life and contributes to maternal weight retention and elevated risks of obstetrical complications. This study examined the effectiveness of a brief lifestyle intervention in the prenatal care setting, compared to routine prenatal care, in preventing excessive GWG as well as adverse maternal and infant health outcomes. The GeMuKi study was designed as a cluster RCT using a hybrid effectiveness implementation design and was conducted in the prenatal care setting in Germany. A total of 1466 pregnant women were recruited. Pregnant women in intervention regions received up to six brief counseling sessions on lifestyle topics (e.g., physical activity, nutrition, drug use). Data on GWG and maternal and infant outcomes were entered into a digital data platform by the respective healthcare providers. The intervention resulted in a significant reduction in the proportion of women with excessive GWG (OR = 0.76, 95% CI (0.60 to 0.96), p = 0.024). Gestational weight gain in the intervention group was reduced by 1 kg (95% CI (−1.56 to −0.38), p < 0.001). No evidence of intervention effects on pregnancy, birth, or neonatal outcomes was found.
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17
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Are Mobile Apps in Geriatric Mental Health Worth the Effort? Am J Geriatr Psychiatry 2022; 30:585-587. [PMID: 35065873 PMCID: PMC8785416 DOI: 10.1016/j.jagp.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022]
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18
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Idris MY, Korin M, Araya F, Chowdhury S, Medina P, Cruz L, Hawkins TR, Brown H, Claudio L. Including the Public in Public eHealth: The Need for Community Participation in the Development of State-Sponsored COVID-19-Related Mobile Apps. JMIR Mhealth Uhealth 2022; 10:e30872. [PMID: 35113793 PMCID: PMC8916100 DOI: 10.2196/30872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/28/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has overwhelmed health care systems worldwide, particularly in underresourced communities of color with a high prevalence of pre-existing health conditions. Many state governments and health care entities responded by increasing their capacity for telemedicine and disease tracking and creating mobile apps for dissemination of medical information. Our experiences with state-sponsored apps suggest that because many of these eHealth tools did not include community participation, they inadvertently contributed to widening digital health disparities. We propose that, as eHealth tools continue to expand as a form of health care, more attention needs to be given to their equitable distribution, accessibility, and usage. In this viewpoint collaboratively written by a minority-serving community-based organization and an eHealth academic research team, we present our experience participating in a community advisory board working on the dissemination of the COVID Alert NY mobile app to illustrate the importance of public participation in app development. We also provide practical recommendations on how to involve community representatives in the app development process. We propose that transparency and community involvement in the process of app development ultimately increases buy-in, trust, and usage of digital technology in communities where they are needed most.
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Affiliation(s)
- Muhammed Yassin Idris
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Maya Korin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Faven Araya
- Arthur Ashe Institute for Urban Health, New York, NY, United States
| | - Sayeeda Chowdhury
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Patty Medina
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Larissa Cruz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Trey-Rashad Hawkins
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Humberto Brown
- Arthur Ashe Institute for Urban Health, New York, NY, United States
| | - Luz Claudio
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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19
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Khedraki R, Srivastava AV, Bhavnani SP. Framework for Digital Health Phenotypes in Heart Failure. Heart Fail Clin 2022; 18:223-244. [DOI: 10.1016/j.hfc.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Sharma S, Gergen Barnett K, Maypole JJ, Grochow Mishuris R. Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study. JMIR Form Res 2022; 6:e29922. [PMID: 35147502 PMCID: PMC8881782 DOI: 10.2196/29922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/19/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background The use of mobile technology or smartphones has grown exponentially in the United States, allowing more individuals than ever internet access. This access has been especially critical to households earning less than US $30,000, the majority of whom indicate that smartphones are their main source of internet access. The increasing ubiquity of smartphones and virtual care promises to offset some of the health disparities that cut through the United States. However, disparities cannot be addressed if the medical information offered though smartphones is not accessible or reliable. Objective This study seeks to create a framework to review the strengths and weaknesses of mobile Health (mHealth) apps for diverse, low-income populations. Methods Focusing on smoking cessation, diabetes management, and medication adherence as models of disease management, we describe the process for selecting, evaluating, and obtaining patient feedback on mHealth apps. Results The top 2 scoring apps in each category were QuitNow! and Smoke Free-Quit Smoking Now for smoking cessation, Glucosio and MyNetDiary for diabetes management, and Medisafe and MyMeds for medication adherence. Conclusions We believe that this framework will prove useful for future mHealth app development, and clinicians and patient advisory groups in connecting culturally, educationally, and socioeconomically appropriate mHealth apps with low-income, diverse communities and thus work to bridge health disparities.
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Affiliation(s)
- Shreya Sharma
- Boston University School of Medicine, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Katherine Gergen Barnett
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States.,Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | - John Jack Maypole
- Department of Pediatrics, Boston Medical Center, Boston, CA, United States.,Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Rebecca Grochow Mishuris
- Department of Medicine, Boston Medical Center, Boston, MA, United States.,Department of Medicine, Boston University School of Medicine, Boston, MA, United States
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21
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Yoo W. Addressing the Social Determinants of Health in South Korea: Moderating Role of mHealth Technologies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031871. [PMID: 35162893 PMCID: PMC8834917 DOI: 10.3390/ijerph19031871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
Mobile health (mHealth) technologies may reduce or widen health inequalities. Despite the extensive literature in support of both of these contrasting views, little attention has been paid to the role of mHealth technologies with regard to social strata and health in the context of South Korea, a country with one of the highest usages of smartphones worldwide. This study examined the effects of social determinants on health self-efficacy and health status and explored how mHealth technologies moderate the impacts of social determinants on health outcomes. Data were collected via online surveys from 29 July to 3 August 2021. Survey data from 1187 Korean adults showed that men had higher levels of health self-efficacy than women. The higher an individual’s education level, the greater their subjective health status. Individuals with higher levels of monthly household income, social capital, and healthcare quality reported higher levels of health self-efficacy and superior health status. The use of mHealth technologies moderated the associations between social determinants and health outcomes. Specifically, monthly household income and social capital had smaller effects on health self-efficacy and health status among those who used higher levels of mHealth technologies. Among higher users of mHealth technologies, females reported better health status than males, while men showed better health status than women in the low-user group. These findings highlight the effectiveness of mHealth technologies in addressing health disparities.
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Affiliation(s)
- Woohyun Yoo
- Department of Mass Communication & Institute of Social Sciences, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon 22012, Korea
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22
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Foster C, Schinasi D, Kan K, Macy M, Wheeler D, Curfman A. Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics. Pediatrics 2022; 149:e2021054137. [PMID: 35102417 PMCID: PMC9215346 DOI: 10.1542/peds.2021-054137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 01/25/2023] Open
Abstract
In this article, we provide an overview of remote monitoring of pediatric PGHD and family-generated health data, including its current uses, future opportunities, and implementation resources.
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Affiliation(s)
- Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care,
Department of Pediatrics, Feinberg School of Medicine, Northwestern University,
Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center
- Digital Health Programs
| | - Dana Schinasi
- Digital Health Programs
- Divisions of Pediatric Emergency Medicine
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care,
Department of Pediatrics, Feinberg School of Medicine, Northwestern University,
Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center
| | - Michelle Macy
- Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center
- Digital Health Programs
- Divisions of Pediatric Emergency Medicine
| | - Derek Wheeler
- Critical Care and Hospital-Based Medicine, Ann &
Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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23
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Guzman A, Brown T, Liss DT. "It closes the gap when the ball is dropped": patient perspectives of a novel smartphone app for regional care coordination after hospital encounters. Mhealth 2022; 8:13. [PMID: 35449511 PMCID: PMC9014227 DOI: 10.21037/mhealth-21-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the broad adoption of electronic health records (EHRs) for inpatient and outpatient care, and wide availability of EHR-linked portals, these tools are not always effective in informing primary care teams about patients' emergency department (ED) visits or inpatient admissions, leading to persistent gaps in care coordination. The objective of this study was to understand how patients with limited patient portal use in a safety net setting engaged with a smartphone app that used location tracking to detect and notify care teams about patients' hospital use in order to stimulate care coordination and follow-up care. METHODS We recruited English- and Spanish-speaking adults at high risk of hospital use from a Federally Qualified Health Center (FQHC). The app detected when patients visited the hospital and asked them to confirm a hospital visit. When confirmed, the app notified the primary care team about the visit, and the care team followed up with patients according to the FQHC protocols for care coordination. We collected qualitative data on app experience from participants who used the app for four months and used a general inductive approach to identify recurring themes. RESULTS Participants generally reported a positive app experience, as it helped solve the problem of poor follow-up care. "I liked the goal of the app…Ultimate goal of it was comforting", recounted one participant when describing her app experience. Participants thought the app push notifications could be refined and the app itself could be modernized. Participants also suggested improvements to the push notifications they received from the app and the visit information they entered into the app for care teams to receive. Some participants also suggested improvements to the FQHC's care coordination workflows facilitated by the app, like an immediate connection to the patient's primary care team. CONCLUSIONS The app was well received by low-income patients at high risk of ED/inpatient visits. Future research is needed to determine feasibility of implementation in other settings.
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Affiliation(s)
- Adriana Guzman
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David T Liss
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ender PT, Markson RH, Suri A, Ruppert K, Padron N, Stoltzfus JC, Berges V, Reed R. Rapid Implementation of a Telemedicine Program in a Ryan White-Funded HIV Clinic During a Global Pandemic. J Acquir Immune Defic Syndr 2022; 89:e2-e4. [PMID: 34878440 DOI: 10.1097/qai.0000000000002815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Peter T Ender
- Section of Infectious Diseases, Department of Medicine, St. Luke's University Health Network, Bethlehem, PA
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
- Temple/St. Luke's School of Medicine, Bethlehem, PA
| | - Rebecca H Markson
- Department of Family Medicine, St. Luke's University Health Network, Easton, PA
| | - Ambuj Suri
- Temple/St. Luke's School of Medicine, Bethlehem, PA
| | - Katey Ruppert
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Nichole Padron
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Jill C Stoltzfus
- Temple/St. Luke's School of Medicine, Bethlehem, PA
- Graduate Medical Education, Data Management and Outcomes Assessment, St. Luke's University Health Network, Bethlehem, PA
| | - Victoria Berges
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Rajika Reed
- Department of Community Health and Preventive Medicine, St. Luke's University Health Network, Bethlehem, PA
- Temple/St. Luke's School of Medicine, Bethlehem, PA
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Ender PT, Markson RH, Suri A, Ruppert K, Padron N, Stoltzfus JC, Berges V, Reed R. Rapid Implementation of a Telemedicine Program in a Ryan White–Funded HIV Clinic During a Global Pandemic. J Acquir Immune Defic Syndr 2022. [DOI: http://doi.org.10.1097/qai.0000000000002815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Kiekens G, Robinson K, Tatnell R, Kirtley OJ. Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility. JMIR Ment Health 2021; 8:e30915. [PMID: 34807835 PMCID: PMC8663644 DOI: 10.2196/30915] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023] Open
Abstract
Although nonsuicidal self-injury (NSSI)-deliberate damaging of body tissue without suicidal intent-is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Kealagh Robinson
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Ruth Tatnell
- Faculty of Health, School of Psychology, Deakin University, Melbourne, Australia
| | - Olivia J Kirtley
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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Xiao J, Luo J, Ly-Mapes O, Wu TT, Dye T, Al Jallad N, Hao P, Ruan J, Bullock S, Fiscella K. Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study. JMIR Res Protoc 2021; 10:e32921. [PMID: 34529582 PMCID: PMC8571694 DOI: 10.2196/32921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. OBJECTIVE This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence-powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. METHODS Our previous work has led to the prototype of AICaries, which offers artificial intelligence-powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. RESULTS The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. CONCLUSIONS Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/32921.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Jiebo Luo
- Computer Science, University of Rochester, Rochester, NY, United States
| | - Oriana Ly-Mapes
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Timothy Dye
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Peirong Hao
- Computer Science, University of Rochester, Rochester, NY, United States
| | - Jinlong Ruan
- Computer Science, University of Rochester, Rochester, NY, United States
| | | | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
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Leziak K, Birch E, Jackson J, Strohbach A, Niznik C, Yee LM. Identifying Mobile Health Technology Experiences and Preferences of Low-Income Pregnant Women with Diabetes. J Diabetes Sci Technol 2021; 15:1018-1026. [PMID: 33605158 PMCID: PMC8442194 DOI: 10.1177/1932296821993175] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapid expansion of mobile technology has resulted in the development of many mobile health ("mHealth") platforms for health monitoring and support. However, applicability, desirability, and extent of tailoring of these platforms for pregnant women, particularly in populations who experience the greatest health inequities-such as women with diabetes mellitus (DM) and/or those with greater socioeconomic barriers-remains unknown. The objective is to understand low-income pregnant women's experiences and preferences for mHealth tools to support DM health and improve DM self-management during pregnancy. METHODS Low-income pregnant and postpartum women were included in individual interviews or focus groups; women with type 2 DM, gestational DM, or no DM were included. Analysis was performed with the constant comparison method. RESULTS In this population of 45 (N=37 with DM) low-income, largely minority, pregnant and postpartum women, 100% reported access to smartphones and prior experience with apps. Interest in mHealth to support health and engagement during pregnancy was high. Preferences for general mHealth features included education that reduces uncertainty, support communities, visualizing progress, convenient access to information, and support for better management of pregnancy-related tasks. Preferred design elements included personalization, interactive features, and integrated graphics. Women with DM expressed multiple additional DM-specific needs, including support tools for DM self-management and self-regulation tasks. CONCLUSION Pregnant and postpartum women, especially those with DM, desire mHealth technology to support engagement and to adapt lifestyle guidelines and treatment requirements for a healthy pregnancy. Further work to develop mHealth interventions tailored for target populations remains a key step in reducing health inequities and promoting access to evidence-based perinatal health interventions.
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Affiliation(s)
- Karolina Leziak
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Eleanor Birch
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Jenise Jackson
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Angelina Strohbach
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Charlotte Niznik
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
- Lynn M. Yee, MD, MPH, Department of
Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine,
250 E. Superior Street, #5-2145, Chicago, IL 60611, USA.
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29
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Kirkland E, Schumann SO, Schreiner A, Heincelman M, Zhang J, Marsden J, Mauldin P, Moran WP. Patient Demographics and Clinic Type Are Associated With Patient Engagement Within a Remote Monitoring Program. Telemed J E Health 2021; 27:843-850. [PMID: 34115942 DOI: 10.1089/tmj.2020.0535] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Remote physiological monitoring (RPM) is accessible, convenient, relatively inexpensive, and can improve clinical outcomes. Yet, it is unclear in which clinical setting or target population RPM is maximally effective. Objective: To determine whether patients' demographic characteristics or clinical settings are associated with data transmission and engagement. Methods: This is a prospective cohort study of adults enrolled in a diabetes RPM program for a minimum of 12 months as of April 2020. We developed a multivariable logistic regression model for engagement with age, gender, race, income, and primary care clinic type as variables and a second model to include first-order interactions for all demographic variables by time. The participants included 549 adults (mean age 53 years, 63% female, 54% Black, and 75% very low income) with baseline hemoglobin A1c ≥8.0% and enrolled in a statewide diabetes RPM program. The main measure was the transmission engagement over time, where engagement is defined as a minimum of three distinct days per week in which remote data are transmitted. Results: Significant predictors of transmission engagement included increasing age, academic clinic type, higher annual household income, and shorter time-in-program (p < 0.001 for each). Self-identified race and gender were not significantly associated with transmission engagement (p = 0.729 and 0.237, respectively). Conclusions: RPM appears to be an accessible tool for minority racial groups and for the aging population, yet engagement is impacted by primary care location setting and socioeconomic status. These results should inform implementation of future RPM studies, guide advocacy efforts, and highlight the need to focus efforts on maintaining engagement over time.
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Affiliation(s)
- Elizabeth Kirkland
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina, USA.,Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samuel O Schumann
- Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Schreiner
- Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marc Heincelman
- Division of Hospital Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jingwen Zhang
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Justin Marsden
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrick Mauldin
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William P Moran
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina, USA.,Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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30
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Kirkland EB, Marsden J, Zhang J, Schumann SO, Bian J, Mauldin P, Moran WP. Remote patient monitoring sustains reductions of hemoglobin A1c in underserved patients to 12 months. Prim Care Diabetes 2021; 15:459-463. [PMID: 33509728 PMCID: PMC8131229 DOI: 10.1016/j.pcd.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
AIMS We sought to determine whether underserved patients enrolled in a statewide remote patient monitoring (RPM) program for diabetes achieve sustained improvements in hemoglobin A1c at 6 and 12 months and whether those improvements are affected by demographic and clinical variables. METHODS Demographic and clinical variables were obtained at baseline, 6 months and 12 months. Baseline HbA1c values were compared with those obtained at 6 and 12 months via paired t-tests. A multivariable regression model was developed to identify patient-level variables associated with HbA1c change at 12 months. RESULTS HbA1c values were obtained for 302 participants at 6 months and 125 participants at 12 months. Compared to baseline, HbA1c values were 1.8% (19 mmol/mol) lower at 6 months (p < 0.01) and 1.3% (14 mmol/mol) lower at 12 months (p < 0.01). Reductions at 12 months were consistent across clinical settings. A regression model for change in HbA1c showed no statistically significant difference for patient age, sex, race, household income, insurance, or clinic type. CONCLUSIONS Patients enrolled in RPM had improved diabetes control at 6 and 12 months. Neither clinic type nor sociodemographic variables significantly altered the likelihood that patients would benefit from this type of technology. These results suggest the promise of RPM for delivering care to underserved populations.
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Affiliation(s)
- Elizabeth B Kirkland
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA.
| | - Justin Marsden
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Jingwen Zhang
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Samuel O Schumann
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - John Bian
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Patrick Mauldin
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - William P Moran
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
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Dahl M, Morocco E, Rodriguez L, Dancz CE. Acceptability of Text Messaging and Disparities in Mobile Health Access in Women's Health Care: A Survey Study. Telemed J E Health 2021; 27:866-873. [PMID: 33999723 DOI: 10.1089/tmj.2020.0516] [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: 01/21/2023] Open
Abstract
Objective: Few studies in women's health care have utilized text messaging as a data collection tool. Our aims were to (1) determine the willingness of Obstetrics and Gynecology (Ob/Gyn) patients to participate in text message surveys, (2) determine the patient-preferred mode of survey distribution, (3) compare preferences between a low-resource and university population, and (4) review the practical aspects of implementing text message surveys. Methods: Paper surveys were distributed to Ob/Gyn clinic patients at two academic centers. English and Spanish speakers were included. Questions assessed sociodemographic data, survey preferences, and text messaging preferences. Appropriate tests were used to look for associations between demographics and survey preferences. Results: One hundred eighty-two participants completed the survey. Respondents were seen at either a university (42%) or a safety net (58%) clinic. Most owned a mobile phone (94%), used text messaging everyday (88%), and had an unlimited data plan (83%). Of the respondents willing to participate in a survey, text messaging was the preferred survey method (70%), followed by phone (14%) and mobile applications (8%). Fifty-six percent of respondents were willing to participate in a daily text message survey. There were no associations between socioeconomic status and survey preferences or willingness to participate in text message surveys. Survey preference was associated with age (p < 0.01). Respondents of all age groups preferred text message surveys; however, those aged 31-60 years were most likely to prefer text messaging (odds ratio: 8.3, confidence interval: 2.6-29.8). Conclusions: Most Ob/Gyn patients are willing and able to participate in text message surveys, and text messaging is the most preferred survey method across sociodemographic categories.
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Affiliation(s)
- Molly Dahl
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Elise Morocco
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Larissa Rodriguez
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Christina E Dancz
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of Southern California, Los Angeles, California, USA
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Liu M, Luo Z, Zhou D, Ji L, Zhang H, Ghose B, Tang S, Wang R, Feng D. Determinants of health insurance ownership in Jordan: a cross-sectional study of population and family health survey 2017-2018. BMJ Open 2021; 11:e038945. [PMID: 33664063 PMCID: PMC7934725 DOI: 10.1136/bmjopen-2020-038945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES With about one-third of the population living below the poverty line, Jordan faces major healthcare, social and national development issues. Low insurance coverage among the poor and high out-of-pocket expenditure worsens the financial insecurity especially for the marginalised population. The Government of Jordan aims to achieve universal coverage of health insurance-a bold plan that requires research evidence for successful implementation. In this study, we aimed to assess the proportion of the population covered by any health insurance, and the determinants owing a health insurance. DESIGN A population-based prospective cohort study. SETTING Jordan. METHODS Data for this study were derived from the Jordan Population and Family Health Survey, which was implemented by the Department of Statistics from early October 2017 to January 2018. Sample characteristics were described as percentages with 95% CIs. Binary logistic regression models were used to estimate OR of health insurance ownership. Parsimonious model was employed to assess the sex and geographical differences. RESULTS Data revealed that in 2017-2018, 73.13% of the 12 992 men and women had health insurance. There was no indication of age of sex difference in health insurance ownership; however, marital status and socioeconomic factors such as wealth and education as well as internet access and geographical location appeared to be the important predictors of non-use of health insurance. The associations differed by sex and urbanicity for certain variables. Addressing these inequities may help achieve universal coverage in health insurance ownership in the population. CONCLUSIONS More than one-quarter of the population in Jordan were not insured. Efforts to decrease disparities in insurance coverage should focus on minimising socioeconomic and geographical disparities to promote equity in terms of healthcare services.
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Affiliation(s)
- Meilian Liu
- School of Business, Guilin University of Electronic Technology, Guilin, China
| | - Zhaoxin Luo
- School of Business, Guilin University of Electronic Technology, Guilin, China
| | - Donghua Zhou
- School of Physical Education, Research Center of Sports and Health, Wuhan Business University, Wuhan, China
| | - Lu Ji
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huilin Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bishwajit Ghose
- Social Sciences and Humanities Research Council of Canada, University of Ottawa, Ottawa, Ontario, Canada
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Da Feng
- School of Pharmacy, Huazhong University of Science and Technology, Wuhan, China
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Jones DJ, Loiselle R, Zachary C, Georgeson AR, Highlander A, Turner P, Youngstrom JK, Khavjou O, Anton MT, Gonzalez M, Bresland NL, Forehand R. Optimizing Engagement in Behavioral Parent Training: Progress Toward a Technology-Enhanced Treatment Model. Behav Ther 2021; 52:508-521. [PMID: 33622517 PMCID: PMC7362816 DOI: 10.1016/j.beth.2020.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Abstract
Low-income families are more likely to have a child with an early-onset Behavior Disorder (BD); yet, socioeconomic strain challenges engagement in Behavioral Parent Training (BPT). This study follows a promising pilot to further examine the potential to cost-effectively improve low-income families' engagement in and the efficiency of BPT. Low-income families were randomized to (a) Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), a weekly, mastery-based BPT program that includes both the parent and child or (b) Technology-Enhanced HNC (TE-HNC), which includes all of the standard HNC components plus a parent mobile application and therapist web portal that provide between-session monitoring, modeling, and coaching of parent skill use with the goal of improved engagement in the context of financial strain. Relative to HNC, TE-HNC families had greater homework compliance and mid-week call participation. TE-HNC completers also required fewer weeks to achieve skill mastery and, in turn, to complete treatment than those in HNC without compromising parent satisfaction with treatment; yet, session attendance and completion were not different between groups. Future directions and clinical implications are discussed.
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Barber-Gumbs T, Trolle Lagerros Y, Sena LM, Gittelsohn J, Chang LW, Zachary WW, Surkan PJ. Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study. JMIR Form Res 2021; 5:e18224. [PMID: 33635279 PMCID: PMC7954654 DOI: 10.2196/18224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/18/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care–related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users’ logs.
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Affiliation(s)
- Tai Barber-Gumbs
- Program in Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Ylva Trolle Lagerros
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Laura M Sena
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Larry W Chang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wayne W Zachary
- Starship Health Technologies, LLC, Fort Washington, PA, United States
| | - Pamela J Surkan
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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COVID-19 Reducing the Risks: Telemedicine is the New Norm for Surgical Consultations and Communications. Aesthetic Plast Surg 2021; 45:343-348. [PMID: 32885319 PMCID: PMC7471549 DOI: 10.1007/s00266-020-01907-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION COVID-19, a worldwide pandemic, has enforced a national lockdown in the UK which produced a paradigm shift about the way medical practitioners would perform consultations and communication with their patients. Senior authors realised that in lockdown there was only one option to see a patient: virtual consultation via telecommunication technologies. This paper will discuss the current benefits and considerations of Telemedicine, particularly in plastic surgery, to decipher the next route of action to further validate its use for future implementation. METHOD A detailed literature review was carried out comparing papers from 1992 to 2020. A survey of 122 consultant plastic surgeons found an encouraging result as 70% positively embraced the suggestion of Telemedicine in their current practice. DISCUSSION Telemedicine produced equal or improved patient satisfaction. Its utilisation reduced cost for patient, clinic and consultant. With accessibility to a large percentage of the population, Telemedicine enables infection control and adherence to social distancing during COVID-19. Considerations include dependability on internet access, legal aspects, cyber security and General Data Protection Regulation (GDPR), the inability to perform palpation or physical inspection and psychological impacts on the patient. CONCLUSION In modern times, Telemedicine has become more accessible and COVID-19 has made it more applicable than ever before. More in-depth research is needed for validation of this technique within plastic surgery. While maintaining quality of care and a vital role in social distancing, there is a strong need for standardisation of Telemedicine processes, platforms, encryption and data storage. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Ke JXC, George RB, Wozney L, Munro A. Perioperative mobile application for mothers undergoing Cesarean delivery: a prospective cohort study on patient engagement. Can J Anaesth 2021; 68:505-513. [PMID: 33420678 PMCID: PMC7794079 DOI: 10.1007/s12630-020-01907-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Giving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric anesthesiologists, we previously developed a mobile application, C-Care, for patients undergoing Cesarean delivery. The focus of C-Care is perioperative education and self-monitoring of potential anesthetic complications. This study aimed to obtain feedback on patient engagement with C-Care. Method We conducted a prospective cohort study of patients ≥ 18 yr (n = 36) undergoing elective Cesarean delivery. Anonymous usage data were recorded for 30 days. On postoperative days 1–5, participants received daily self-monitoring questionnaires within C-Care. Fourteen days after surgery, participants received an online survey regarding satisfaction and use of C-Care. Results Thirty-five out of 36 participants visited the application after orientation, with a median [interquartile range (IQR)] age of 32 [31–36] yr. Each participant visited the application a median of 15 [9–31] times over 30 days and completed a median of 3 [2–4] out of five self-monitoring questionnaires. Each participant viewed a median of 4 [2–7] out of eight education topics, with the most viewed patient education topics being “Controlling Pain” and “The First Few Days”. Visits to the application were highest in the first week postpartum. Of the 18 respondents who completed the day 14 survey, 83% (n = 15) participants would recommend C-Care to other women, and the median participant satisfaction score was 7.5 out of 10 (range, 2–10). Conclusion Most participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs. Trial registration www.ClinicalTrials.gov (NCT03746678); registered 5 November 2018. Supplementary Information The online version of this article (10.1007/s12630-020-01907-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janny Xue Chen Ke
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Ronald B George
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Lori Wozney
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Allana Munro
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Hein AE, Vrijens B, Hiligsmann M. A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats. FRONTIERS IN MEDICAL TECHNOLOGY 2020; 2:604183. [PMID: 35047888 PMCID: PMC8757755 DOI: 10.3389/fmedt.2020.604183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective. Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis. Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations. Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.
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Affiliation(s)
- Anna-Elisa Hein
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Bernard Vrijens
- AARDEX Group, Research and Development, Liège, Belgium.,Department of Public Health, University of Liège, Liège, Belgium
| | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Alon N, Stern AD, Torous J. Assessing the Food and Drug Administration's Risk-Based Framework for Software Precertification With Top Health Apps in the United States: Quality Improvement Study. JMIR Mhealth Uhealth 2020; 8:e20482. [PMID: 32927429 PMCID: PMC7652687 DOI: 10.2196/20482] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background As the development of mobile health apps continues to accelerate, the need to implement a framework that can standardize the categorization of these apps to allow for efficient yet robust regulation is growing. However, regulators and researchers are faced with numerous challenges, as apps have a wide variety of features, constant updates, and fluid use cases for consumers. As past regulatory efforts have failed to match the rapid innovation of these apps, the US Food and Drug Administration (FDA) has proposed that the Software Precertification (Pre-Cert) Program and a new risk-based framework could be the solution. Objective This study aims to determine whether the risk-based framework proposed by the FDA’s Pre-Cert Program could standardize categorization of top health apps in the United States. Methods In this quality improvement study during summer 2019, the top 10 apps for 6 disease conditions (addiction, anxiety, depression, diabetes, high blood pressure, and schizophrenia) in Apple iTunes and Android Google Play Store in the United States were classified using the FDA’s risk-based framework. Data on the presence of well-defined app features, user engagement methods, popularity metrics, medical claims, and scientific backing were collected. Results The FDA’s risk-based framework classifies an app’s risk by the disease condition it targets and what information that app provides. Of the 120 apps tested, 95 apps were categorized as targeting a nonserious health condition, whereas only 7 were categorized as targeting a serious condition and 18 were categorized as targeting a critical condition. As the majority of apps targeted a nonserious condition, their risk categorization was largely determined by the information they provided. The apps that were assessed as not requiring FDA review were more likely to be associated with the integration of external devices than those assessed as requiring FDA review (15/58, 26% vs 5/62, 8%; P=.03) and health information collection (24/58, 41% vs 9/62, 15%; P=.008). Apps exempt from the review were less likely to offer health information (25/58, 43% vs 45/62, 72%; P<.001), to connect users with professional care (7/58, 12% vs 14/62, 23%; P=.04), and to include an intervention (8/58, 14% vs 35/62, 55%; P<.001). Conclusions The FDA’s risk-based framework has the potential to improve the efficiency of the regulatory review process for health apps. However, we were unable to identify a standard measure that differentiated apps requiring regulatory review from those that would not. Apps exempt from the review also carried concerns regarding privacy and data security. Before the framework is used to assess the need for a formal review of digital health tools, further research and regulatory guidance are needed to ensure that the Pre-Cert Program operates in the greatest interest of public health.
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Affiliation(s)
- Noy Alon
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA, United States
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Yamada J, Kouri A, Simard SN, Segovia SA, Gupta S. Barriers and Enablers to Using a Patient-Facing Electronic Questionnaire: A Qualitative Theoretical Domains Framework Analysis. J Med Internet Res 2020; 22:e19474. [PMID: 33030437 PMCID: PMC7582145 DOI: 10.2196/19474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic patient questionnaires are becoming ubiquitous in health care. To address care gaps that contribute to poor asthma management, we developed the Electronic Asthma Management System, which includes a previsit electronic patient questionnaire linked to a computerized clinical decision support system. OBJECTIVE This study aims to identify the determinants (barriers and enablers) of patient uptake and completion of a previsit mobile health questionnaire. METHODS We conducted semistructured interviews with adult patients with asthma in Toronto, Canada. After demonstrating the questionnaire, participants completed the questionnaire using their smartphones and were then interviewed regarding perceived barriers and enablers to using and completing the questionnaire. Interview questions were based on the Theoretical Domains Framework to identify the determinants of health-related behavior. We generated themes that addressed the enablers and barriers to the uptake and completion of the questionnaire. RESULTS In total, 12 participants were interviewed for saturation. Key enablers were as follows: the questionnaire was easy to complete without additional knowledge or skills and was perceived as a priority and responsibility for patients, use could lead to more efficient and personalized care, completion on one's own time would be convenient, and uptake and completion could be optimized through patient reminders. Concerns about data security, the usefulness of questionnaire data, the stress of completing it accurately and on time, competing priorities, and preferences to complete the questionnaire on other devices were the main barriers. CONCLUSIONS The barriers and enablers identified by patients should be addressed by developing implementation strategies to enhance e-questionnaire use and completion by patients. As the use of e-questionnaires grows, our findings will contribute to implementation efforts across settings and diseases.
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Affiliation(s)
- Janet Yamada
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Andrew Kouri
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah-Nicole Simard
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Stephanie A Segovia
- Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Samir Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Impact of a self-monitoring application on pediatric asthma disparities. Int J Med Inform 2020; 144:104294. [PMID: 33080504 DOI: 10.1016/j.ijmedinf.2020.104294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We previously reported improved outcomes after implementing the electronic-AsthmaTracker (e-AT), a self-monitoring tool for children with asthma, at 11 ambulatory pediatric clinics. This study assesses e-AT adherence and impact across race/ethnicity subgroups. STUDY DESIGN Secondary data analysis of a prospective cohort study of children ages 2-17 years with persistent asthma, enrolled from January 2014 to December 2015 to use the e-AT for 1 year. Survival analysis was used to compare e-AT use adherence and generalized estimating equation models to compare outcomes pre- and post e-AT initiation, between race/ethnicity subgroups. RESULTS Data from 318 children with baseline measurements were analyzed: 76.4 % white, 11.3 % Hispanic, 7.8 % "other", and 4.4 % unknown race/ethnicity subgroups. Mean e-AT adherence was 82 % (95 %CI: 79-84 %, reference) for whites, 73 % (64-81 %, p = 0.025) for Hispanics, and 78 % (69-86 %, p = 0.373) for other minorities. Compared to whites, Cox proportional hazard ratio for study dropout risk was 2.14 (1.31-3.77, p = 0.001) for Hispanics and 0.95 (0.60-1.50, p = 0.834) for other minorities. Disparities existed at baseline, with lower QOL (74.9 vs 80.6; p = 0.025) and asthma control (18.4 vs 19.7; p = 0.027) among Hispanics, compared to whites. After e-AT initiation, disparities disappeared at 3 months for QOL (87.2 vs 90.5; p = 0.159) and asthma control (23.1 vs 22.4; p = 0.063), persisting until study end. Disparities also existed at baseline, with lower QOL (74.6 vs. 80.6; p = 0.042) and asthma control (18.2 vs. 19.7, p = 0.024) among "other" minorities, compared to whites, and disappeared at 3 months for QOL (92.7 vs. 90.5, p = 0.432) and asthma control (22.7 vs 22.4; p = 0.518), persisting until study end. Subgroup analysis was underpowered to detect a difference in oral steroid use or ED/hospital admissions. CONCLUSIONS Our study shows improved asthma control and QOL among minorities and disparity elimination after e-AT implementation. Future adequately powered studies will explore the impact on oral steroid and ED/hospital use disparities.
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Bond DM, Hammond J, Shand AW, Nassar N. Comparing a Mobile Phone Automated System With a Paper and Email Data Collection System: Substudy Within a Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e15284. [PMID: 32763873 PMCID: PMC7479579 DOI: 10.2196/15284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/06/2019] [Accepted: 06/13/2020] [Indexed: 12/16/2022] Open
Abstract
Background Traditional data collection methods using paper and email are increasingly being replaced by data collection using mobile phones, although there is limited evidence evaluating the impact of mobile phone technology as part of an automated research management system on data collection and health outcomes. Objective The aim of this study is to compare a web-based mobile phone automated system (MPAS) with a more traditional delivery and data collection system combining paper and email data collection (PEDC) in a cohort of breastfeeding women. Methods We conducted a substudy of a randomized controlled trial in Sydney, Australia, which included women with uncomplicated term births who intended to breastfeed. Women were recruited within 72 hours of giving birth. A quasi-randomized number of women were recruited using the PEDC system, and the remainder were recruited using the MPAS. The outcomes assessed included the effectiveness of data collection, impact on study outcomes, response rate, acceptability, and cost analysis between the MPAS and PEDC methods. Results Women were recruited between April 2015 and December 2016. The analysis included 555 women: 471 using the MPAS and 84 using the PEDC. There were no differences in clinical outcomes between the 2 groups. At the end of the 8-week treatment phase, the MPAS group showed an increased response rate compared with the PEDC group (56% vs 37%; P<.001), which was also seen at the 2-, 6-, and 12-month follow-ups. At the 2-month follow-up, the MPAS participants also showed an increased rate of self-reported treatment compliance (70% vs 56%; P<.001) and a higher recommendation rate for future use (95% vs 64%; P<.001) as compared with the PEDC group. The cost analysis between the 2 groups was comparable. Conclusions MPAS is an effective and acceptable method for improving the overall management, treatment compliance, and methodological quality of clinical research to ensure the validity and reliability of findings.
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Affiliation(s)
- Diana M Bond
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jeremy Hammond
- Strategic Ventures, University of Sydney, Sydney, Australia
| | - Antonia W Shand
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department for Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Natasha Nassar
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Patel D, Sarlati S, Martin-Tuite P, Feler J, Chehab L, Texada M, Marquez R, Orellana FJ, Henderson TL, Nwabuo A, Plevin R, Dicker RA, Juillard C, Sammann A. Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study. JMIR Mhealth Uhealth 2020; 8:e15866. [PMID: 32831179 PMCID: PMC7477672 DOI: 10.2196/15866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/31/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Background Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community.
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Affiliation(s)
- Devika Patel
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Siavash Sarlati
- Department of Emergency Medicine, University of California, San Francisco, CA, United States
| | - Patrick Martin-Tuite
- University of California, San Francisco School of Medicine, San Francisco, CA, United States
| | - Joshua Feler
- Yale University School of Medicine, New Haven, CT, United States
| | - Lara Chehab
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Michael Texada
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Ruben Marquez
- Department of Surgery, University of California, San Francisco, CA, United States
| | - F Julia Orellana
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Terrell L Henderson
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Adaobi Nwabuo
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Rebecca Plevin
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Rochelle Ami Dicker
- Division of Surgical Critical Care, Department of Surgery, University of California, Los Angeles, CA, United States
| | - Catherine Juillard
- Division of Surgical Critical Care, Department of Surgery, University of California, Los Angeles, CA, United States
| | - Amanda Sammann
- Department of Surgery, University of California, San Francisco, CA, United States
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Yin Z, Errisuriz VL, Evans M, Inupakutika D, Kaghyan S, Li S, Esparza L, Akopian D, Parra-Medina D. A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development. JMIR Form Res 2020; 4:e20679. [PMID: 32726748 PMCID: PMC7471894 DOI: 10.2196/20679] [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: 05/25/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 11/13/2022] Open
Abstract
Rural residents face numerous challenges in accessing quality health care for management of chronic diseases (eg, obesity, diabetes), including scarcity of health care services and insufficient public transport. Digital health interventions, which include modalities such as internet, smartphones, and monitoring sensors, may help increase rural residents’ access to health care. While digital health interventions have become an increasingly popular intervention strategy to address obesity, research examining the use of technological tools for obesity management among rural Latino populations is limited. In this paper, we share our experience developing a culturally tailored, interactive health intervention using digital technologies for a family-oriented, weight management program in a rural, primarily Latino community. We describe the formative research that guided the development of the intervention, discuss the process of developing the intervention technologies including issues of privacy and data security, examine the results of a pilot study, and share lessons learned. Our experience can help others design user-centered digital health interventions to engage underserved populations in the uptake of healthy lifestyle and disease management skills.
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Affiliation(s)
- Zenong Yin
- Department of Kinesiology, Health, and Nutrition, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Vanessa L Errisuriz
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
| | - Martin Evans
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
| | - Devasena Inupakutika
- Department of Electrical and Computer Engineering, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Sahak Kaghyan
- Department of Electrical and Computer Engineering, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Shiyu Li
- Department of Kinesiology, Health, and Nutrition, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Laura Esparza
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
| | - David Akopian
- Department of Electrical and Computer Engineering, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Deborah Parra-Medina
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
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Henderson BR, Flaherty CM, Floyd GC, You J, Xiao R, Bryant-Stephens TC, Miller VA, Feudtner C, Kenyon CC. Tailored Medication Adherence Incentives Using mHealth for Children With High-Risk Asthma (TAICAM): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e16711. [PMID: 32459653 PMCID: PMC7459431 DOI: 10.2196/16711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Background Poor adherence to inhaled corticosteroid medications for children with high-risk asthma is both well documented and poorly understood. It has a disproportionate prevalence and impact on children of minority demographics in urban settings. Financial incentives have been shown to be a compelling method to engage those in a high-risk asthma population, but whether adherence can be maintained by offering financial incentives and how these incentives can be used to sustain high adherence are unknown. Objective The aim of this study is to determine the marginal effects of a financial incentive–based intervention on inhaled corticosteroid adherence, health care system use, and costs. Methods Participants include children aged 5 to 12 years who have had either at least two hospitalizations or one hospitalization and one emergency department visit for asthma in the year prior to their enrollment (and their caregivers). Participants are given an electronic inhaler sensor in order to track their medication use over a period of 7 months. After a 1-month period of observation, participants are randomized to 1 of 3 arms for a 3-month period. Participants in arm 1 receive daily text message reminders, feedback, and gain–framed, nominal financial incentives; participants in arm 2 receive daily text message reminders and feedback only, and participants in arm 3 receive no reminders, feedback, or incentives. All participants are subsequently observed for an additional 3-month period with no reminders, feedback, or incentives to assess whether any sustained effects are apparent. Results Study enrollment began in September 2019 with a target sample size of N=125 children. As of June 2020, 61 children have been enrolled. Data collection is estimated to be completed in June 2022, and analyses will be completed by June 2023. Conclusions This study will provide data that will help to determine whether a financial incentive–based mobile health intervention for promoting inhaled corticosteroid use can be effective in patients with high-risk asthma over longer periods. Trial Registration Clinicaltrial.gov NCT03907410; https://clinicaltrials.gov/ct2/show/NCT03907410 International Registered Report Identifier (IRRID) DERR1-10.2196/16711
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Affiliation(s)
- Brittney R Henderson
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Carina M Flaherty
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - G Chandler Floyd
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jack You
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rui Xiao
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Tyra C Bryant-Stephens
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Chén Collin Kenyon
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Acuna N, Vento I, Alzate-Duque L, Valera P. Harnessing Digital Videos to Promote Cancer Prevention and Education: a Systematic Review of the Literature from 2013-2018. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:635-642. [PMID: 31707640 DOI: 10.1007/s13187-019-01624-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Social media has transformed the way cancer patients search for information about their chronic health problems. The purpose of this systematic review is to identify the use of online digital videos to increase cancer knowledge and to understand information preference, behavioral changes, and attitudes towards online cancer education videos. The databases used for this review included MedLine, PsychINFO, and PubMed. These medical databases were used to locate peer-reviewed academic journals from 2013-2018 using the following MeSH terms: "cancer education videos," "cancer prevention videos," and "cancer education digital videos." A total of 4996 articles were retrieved from the initial search, and 33 articles were reviewed. Articles were excluded if videos did not (1) focus on cancer education and prevention; (2) posted on an online platform; and (3) assessed participants' knowledge, attitude, or beliefs about cancer. Eleven articles were found to meet inclusion criteria for final review. All of the studies focused on increasing education on preventive health behaviors (i.e., sunscreen use, smoking, and diet) and/or early detection strategies (i.e., screening testing and/or self-skin exams). While online digital health videos have the potential to improve health outcomes, issues related to technology access and health literacy must be considered when developing online health education videos.
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Affiliation(s)
- Nicholas Acuna
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, NJ, 08854, USA
| | - Ismary Vento
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, 07102, USA
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, NJ, 08854, USA
| | - Luis Alzate-Duque
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, 07102, USA
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ, 07102, USA
- Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Pamela Valera
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, 07102, USA.
- Department of Urban-Global Public Health, Rutgers University School of Public Health, Newark, NJ, 07102, USA.
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Solomon DH, Rudin RS. Digital health technologies: opportunities and challenges in rheumatology. Nat Rev Rheumatol 2020; 16:525-535. [PMID: 32709998 DOI: 10.1038/s41584-020-0461-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 12/22/2022]
Abstract
The past decade in rheumatology has seen tremendous innovation in digital health technologies, including the electronic health record, virtual visits, mobile health, wearable technology, digital therapeutics, artificial intelligence and machine learning. The increased availability of these technologies offers opportunities for improving important aspects of rheumatology, including access, outcomes, adherence and research. However, despite its growth in some areas, particularly with non-health-care consumers, digital health technology has not substantially changed the delivery of rheumatology care. This Review discusses key barriers and opportunities to improve application of digital health technologies in rheumatology. Key topics include smart design, voice enablement and the integration of electronic patient-reported outcomes. Smart design involves active engagement with the end users of the technologies, including patients and clinicians through focus groups, user testing sessions and prototype review. Voice enablement using voice assistants could be critical for enabling patients with hand arthritis to effectively use smartphone apps and might facilitate patient engagement with many technologies. Tracking many rheumatic diseases requires frequent monitoring of patient-reported outcomes. Current practice only collects this information sporadically, and rarely between visits. Digital health technology could enable patient-reported outcomes to inform appropriate timing of face-to-face visits and enable improved application of treat-to-target strategies. However, best practice standards for digital health technologies do not yet exist. To achieve the potential of digital health technology in rheumatology, rheumatology professionals will need to be more engaged upstream in the technology design process and provide leadership to effectively incorporate the new tools into clinical care.
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Affiliation(s)
- Daniel H Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Nguyen N, Leveille E, Guadagno E, Kalisya LM, Poenaru D. Use of mobile health technologies for postoperative care in paediatric surgery: A systematic review. J Telemed Telecare 2020; 28:331-341. [PMID: 32605411 DOI: 10.1177/1357633x20934682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Mobile health (mHealth) is the use of mobile communication devices such as smartphones, wireless patient monitoring devices and tablet computers to deliver health services. Paediatric surgery patient care could potentially benefit from these technologies. This systematic review summarises the current literature on the use of mHealth for postoperative care after children's surgery. METHODS Seven databases were searched by a senior medical librarian. Studies were included if they reported the use of mHealth systems for postoperative care for children <18 years old. Data extraction and risk of bias assessment were performed in duplicate. RESULTS A total of 18 studies were included after screening. mHealth use was varied and included appointment or medication reminders, postoperative monitoring and postoperative instruction delivery. mHealth systems included texting systems and mobile applications, and were implemented for a wide range of surgical conditions and countries. DISCUSSION Studies showed that mHealth systems can increase the postoperative follow-up appointment attendance rate (p < 0.001), decrease the rate of postoperative complications and returns to the emergency department and reliably monitor postoperative pain. mHealth systems were generally appreciated by patients. Most non-randomised and randomised studies had many methodological problems, including lack of appropriate control groups, lack of blinding and a tendency to devote more time to the care of the intervention group. mHealth systems have the potential to improve postoperative care, but the lack of high-quality research evaluating their impact calls for further studies exploring evidence-based mHealth implementation.
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Affiliation(s)
- Nam Nguyen
- Faculty of Medicine, McGill University, Canada
| | | | - Elena Guadagno
- Department of Paediatric Surgery, McGill University Health Centre, Canada
| | | | - Dan Poenaru
- Department of Paediatric Surgery, McGill University Health Centre, Canada
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Abstract
Technological advancements in the capabilities of modern smartphones offer tremendous potential to generate big data from small devices that could influence oncologists' decision-making. Here we describe the value of patient-generated health data (PGHD) that can be captured using mobile devices. We comment on the current use of smartphones in oncology clinical research and describe how smartphones will bring big data into the oncology clinic by enabling continuous patient monitoring, information sharing, and personalized clinical decision making in cancer care. Lastly, we describe practical considerations about how we can access and store PGHD in the future, describing how to harness the clinical value of PGHD and comment on the emerging applications for digital biomarkers captured by smartphones.
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Katz DL, Rhee LQ, Katz CS, Aronson DL, Frank GC, Gardner CD, Willett WC, Dansinger ML. Dietary assessment can be based on pattern recognition rather than recall. Med Hypotheses 2020; 140:109644. [PMID: 32131036 DOI: 10.1016/j.mehy.2020.109644] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/26/2022]
Abstract
Diet is the leading predictor of health status, including all-cause mortality, in the modern world, yet is rarely measured; whereas virtually every adult in a developed country knows their approximate blood pressure, hardly any knows their objective diet quality. Leading authorities have called for the inclusion of nutrition in every electronic health record as one of the many remedial steps required to give dietary quality the routine attention it warrants. Existing tools to capture dietary intake are based on either real-time journaling or recall. Journaling, or logging, is time and labor intensive. Recall is notoriously unreliable, as humans are notably bad at remembering detail. Even allowing for the challenge of recall, these dietary intake methods are labor and time intensive, and require analysis at the n-of-1 level. We hypothesize that dietary intake assessment can be "reverse engineered"-predicating assessment on the recognition of fully formed dietary patterns-rather than endeavoring to assemble such a representation one food, meal, dish, or day at a time. This pattern recognition-based method offers potential advantages over existing methods, including speed, efficiency, cost, and applicability. We have developed and provisionally tested such a system, and the results thus far support our hypothesis. We are convinced that leveraging pattern recognition to make dietary assessment quick, user-friendly, economical, and scalable can allow for the conversion of dietary quality into a universally measured and routinely managed vital sign. In this paper, we present the supporting case.
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Affiliation(s)
- D L Katz
- Diet ID, Inc, Detroit, MI, United States.
| | - L Q Rhee
- Diet ID, Inc, Detroit, MI, United States
| | - C S Katz
- Diet ID, Inc, Detroit, MI, United States
| | | | - G C Frank
- Department of Family and Consumer Sciences, California State University, Long Beach, United States
| | - C D Gardner
- Stanford Prevention Research Center, Department of Medicine, Stanford University Medical School, Stanford, CA, United States
| | - W C Willett
- Harvard T.H. Chan School of Public Health, Harvard Medical School, Boston, MA, United States
| | - M L Dansinger
- Boston Heart Diagnostics, Framingham, MA, United States
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Gordon WJ, Landman A, Zhang H, Bates DW. Beyond validation: getting health apps into clinical practice. NPJ Digit Med 2020; 3:14. [PMID: 32047860 PMCID: PMC6997363 DOI: 10.1038/s41746-019-0212-z] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/05/2019] [Indexed: 12/16/2022] Open
Abstract
Fueled by advances in technology, increased access to smartphones, and capital investment, the number of available health "apps" has exploded in recent years. Patients use their smartphones for many things, but not as much as they might for health, especially for managing their chronic conditions. Moreover, while significant work is ongoing to develop, validate, and evaluate these apps, it is less clear how to effectively disseminate apps into routine clinical practice. We propose a framework for prescribing apps and outline the key issues that need to be addressed to enable app dissemination in clinical care. This includes: education and awareness, creating digital formularies, workflow and EHR integration, payment models, and patient/provider support. As work in digital health continues to expand, integrating health apps into clinical care delivery will be critical if digital health is to achieve its potential.
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Affiliation(s)
- William J. Gordon
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA USA
- Partners HealthCare, Somerville, MA USA
- Harvard Medical School, Boston, MA USA
| | - Adam Landman
- Partners HealthCare, Somerville, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Haipeng Zhang
- Harvard Medical School, Boston, MA USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA USA
- Brigham and Women’s Hospital, Boston, MA USA
| | - David W. Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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