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Grant V, Litchfield I. Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1306199. [PMID: 38836261 PMCID: PMC11148349 DOI: 10.3389/fcdhc.2024.1306199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/26/2024] [Indexed: 06/06/2024]
Abstract
Objective Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities. Materials and methods The major databases were searched for existing qualitative evidence of participants' experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon's Theoretical Framework of Acceptability. Results The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants' satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs. Conclusion Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.
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Affiliation(s)
- Vivene Grant
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Abdelhameed F, Pearson E, Parsons N, Barber TM, Panesar A, Summers C, de la Fosse M, Hanson P. Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study. JMIR Diabetes 2023; 8:e47224. [PMID: 38016426 PMCID: PMC10784975 DOI: 10.2196/47224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X-certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health. OBJECTIVE This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool. METHODS This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool. RESULTS A total of 84% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people's preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3% improvement (61.7, SD 18.1 at baseline; 73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001). CONCLUSIONS This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service-certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes.
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Affiliation(s)
- Farah Abdelhameed
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Eilish Pearson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Arjun Panesar
- Diabetes Digital Media Health, Coventry, United Kingdom
| | | | | | - Petra Hanson
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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Hawkes RE, Miles LM, Ainsworth B, Ross J, Meacock R, French DP. Engagement with a nationally-implemented digital behaviour change intervention: Usage patterns over the 9-month duration of the National Health Service Digital Diabetes Prevention Programme. Internet Interv 2023; 33:100647. [PMID: 37502122 PMCID: PMC10368926 DOI: 10.1016/j.invent.2023.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Background Digital behaviour change interventions may offer a scalable way to promote weight loss by increasing physical activity and improving diet. However, user engagement is necessary for such benefits to be achieved. There is a dearth of research that assesses engagement with nationally implemented digital programmes offered in routine practice. The National Health Service Digital Diabetes Prevention Programme (NHS-DDPP) is a nine-month digital behaviour change intervention delivered by independent providers for adults in England who are at high risk of developing type 2 diabetes. This study reports engagement with the NHS-DDPP for users enrolled onto the programme over the nine-month duration. Methods Anonymous usage data was obtained for a cohort of service users (n = 1826) enrolled on the NHS-DDPP with three independent providers, between December 2020 and June 2021. Usage data were obtained for time spent in app, and frequency of use of NHS-DDPP intervention features in the apps including self-monitoring, goal setting, receiving educational content (via articles) and social support (via health coaches and group forums), to allow patterns of usage of these key features to be quantified across the nine-month intervention. Median usage was calculated within nine 30-day engagement periods to allow a longitudinal analysis of the dose of usage for each feature. Results App usage declined from a median of 32 min (IQR 191) in month one to 0 min (IQR 14) in month nine. Users self-monitored their behaviours (e.g., physical activity and diet) a median of 117 times (IQR 451) in the apps over the nine-month programme. The open group discussion forums were utilised less regularly (accessed a median of 0 times at all time-points). There was higher engagement with some intervention features (e.g., goal setting) when support from a health coach was linked to those features. Conclusions App usage decreased over the nine-month programme, although the rate at which the decrease occurred varied substantially between individuals and providers. Health coach support may promote engagement with specific intervention features. Future research should assess whether engagement with particular features of digital diabetes prevention programmes is associated with outcomes such as reduced bodyweight and HbA1c levels.
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Affiliation(s)
- Rhiannon E. Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, UK
| | - Lisa M. Miles
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, UK
| | - Ben Ainsworth
- Department of Psychology, University of Bath, UK
- School of Psychology, University of Southampton, UK
| | - Jamie Ross
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Rachel Meacock
- Health Organisation, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - David P. French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, UK
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Murray E, Goodfellow H, Bindman J, Blandford A, Bradbury K, Chaudhry T, Fernandez-Reyes D, Gomes M, Hamilton FL, Heightman M, Henley W, Hurst JR, Hylton H, Linke S, Pfeffer P, Ricketts W, Robson C, Singh R, Stevenson FA, Walker S, Waywell J. Development, deployment and evaluation of digitally enabled, remote, supported rehabilitation for people with long COVID-19 (Living With COVID-19 Recovery): protocol for a mixed-methods study. BMJ Open 2022; 12:e057408. [PMID: 35131836 PMCID: PMC8822541 DOI: 10.1136/bmjopen-2021-057408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Long COVID-19 is a distressing, disabling and heterogeneous syndrome often causing severe functional impairment. Predominant symptoms include fatigue, cognitive impairment ('brain fog'), breathlessness and anxiety or depression. These symptoms are amenable to rehabilitation delivered by skilled healthcare professionals, but COVID-19 has put severe strain on healthcare systems. This study aims to explore whether digitally enabled, remotely supported rehabilitation for people with long COVID-19 can enable healthcare systems to provide high quality care to large numbers of patients within the available resources. Specific objectives are to (1) develop and refine a digital health intervention (DHI) that supports patient assessment, monitoring and remote rehabilitation; (2) develop implementation models that support sustainable deployment at scale; (3) evaluate the impact of the DHI on recovery trajectories and (4) identify and mitigate health inequalities due to the digital divide. METHODS AND ANALYSIS Mixed-methods, theoretically informed, single-arm prospective study, combining methods drawn from engineering/computer science with those from biomedicine. There are four work packages (WP), one for each objective. WP1 focuses on identifying user requirements and iteratively developing the intervention to meet them; WP2 combines qualitative data from users with learning from implementation science and normalisation process theory, to promote adoption, scale-up, spread and sustainability of the intervention; WP3 uses quantitative demographic, clinical and resource use data collected by the DHI to determine illness trajectories and how these are affected by use of the DHI; while WP4 focuses on identifying and mitigating health inequalities and overarches the other three WPs. ETHICS AND DISSEMINATION Ethical approval obtained from East Midlands - Derby Research Ethics Committee (reference 288199). Our dissemination strategy targets three audiences: (1) Policy makers, Health service managers and clinicians responsible for delivering long COVID-19 services; (2) patients and the public; (3) academics. TRIAL REGISTRATION NUMBER Research Registry number: researchregistry6173.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Henry Goodfellow
- Department of Primary Care and Population Health, University College London, London, UK
| | - Julia Bindman
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | - Tahreem Chaudhry
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Manuel Gomes
- Department for Applied Health Research, University College London, London, UK
| | - Fiona L Hamilton
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Melissa Heightman
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - William Henley
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - John R Hurst
- Academic Unit of Respiratory Medicine, University College London, London, UK
| | - Hannah Hylton
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Stuart Linke
- Camden and Islington NHS Foundation Trust, London, UK
| | - Paul Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - William Ricketts
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Richa Singh
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Fiona A Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sarah Walker
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Poduval S, Ross J, Pal K, Newhouse N, Hamilton F, Murray E. Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach. JMIR Hum Factors 2022; 9:e31567. [PMID: 35029531 PMCID: PMC8800092 DOI: 10.2196/31567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Digital health research encompasses methods from human-computer interaction and health research. OBJECTIVE This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. METHODS The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. RESULTS The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. CONCLUSIONS The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs.
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Affiliation(s)
- Shoba Poduval
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Jamie Ross
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Kingshuk Pal
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fiona Hamilton
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
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8
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Emerson MR, Buckland S, Lawlor MA, Dinkel D, Johnson DJ, Mickles MS, Fok L, Watanabe-Galloway S. Addressing and evaluating health literacy in mHealth: a scoping review. Mhealth 2022; 8:33. [PMID: 36338314 PMCID: PMC9634204 DOI: 10.21037/mhealth-22-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development. METHODS A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework. RESULTS Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was end-user focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. CONCLUSIONS The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.
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Affiliation(s)
| | - Sydney Buckland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Maxwell A. Lawlor
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Danae Dinkel
- College of Education Health and Human Sciences, University of Nebraska, Omaha, NE, USA
| | - David J. Johnson
- Department of Psychiatry & Behavioral Science, Mercer University School of Medicine, Atlanta, GA, USA
| | - Maria S. Mickles
- College of Public Health University of Nebraska Medical Center, Omaha, NE, USA
| | - Louis Fok
- College of Public Health University of Nebraska Medical Center, Omaha, NE, USA
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9
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Azelton KR, Crowley AP, Vence N, Underwood K, Morris G, Kelly J, Landry MJ. Digital Health Coaching for Type 2 Diabetes: Randomized Controlled Trial of Healthy at Home. Front Digit Health 2021; 3:764735. [PMID: 34901926 PMCID: PMC8655126 DOI: 10.3389/fdgth.2021.764735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022] Open
Abstract
Digital health coaching is an intervention for type 2 diabetes mellitus (T2DM) that has potential to improve the quality of care for patients. Previous research has established the efficacy of digital interventions for behavior change. This pilot study addresses a research gap in finding effective and accessible behavioral interventions for under-resourced individuals with T2DM. We examined the impact of Healthy at Home, a 12-week phone and SMS-based (short message service) digital health coaching program, on insulin resistance which is an upstream marker for T2DM progression. We compared this intervention to usual diabetic care in a family medicine residency clinic in a randomized controlled trial. Digital health coaching significantly improved participants' calculated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) by −0.9 ± 0.4 compared with the control group (p = 0.029). This significance remained after controlling for years diagnosed with T2DM, enrollment in Medicaid, access to food, baseline stage of change, and race (p = 0.027). Increasing access to digital health coaching may lead to more effective control of diabetes for under-resourced patients. This study demonstrates the potential to implement a personalized, scalable, and effective digital health intervention to treat and manage T2DM through a lifestyle and behavioral approach to improve clinical outcomes (http://clinicaltrials.gov, NCT04872647).
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Affiliation(s)
- Kimberly R Azelton
- Beacon Health System, E. Blair Warner Family Medicine Residency, South Bend, IN, United States
| | - Aidan P Crowley
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Gerald Morris
- Beacon Health System, E. Blair Warner Family Medicine Residency, South Bend, IN, United States
| | - John Kelly
- Preventive Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, United States
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10
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Solar C, Halat AM, MacLean RR, Rajeevan H, Williams DA, Krein SL, Heapy AA, Bair MJ, Kerns RD, Higgins DM. Predictors of engagement in an internet-based cognitive behavioral therapy program for veterans with chronic low back pain. Transl Behav Med 2021; 11:1274-1282. [PMID: 33098304 DOI: 10.1093/tbm/ibaa098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Internet-based interventions for chronic pain have demonstrated efficacy and may address access barriers to care. Participant characteristics have been shown to affect engagement with these programs; however, limited information is available about the relationship between participant characteristics and engagement with internet-based programs for self-management of chronic pain. The current study examined relationships between demographic and clinical characteristics and engagement with the Pain EASE program, a self-directed, internet-based cognitive behavioral therapy intervention for veterans with chronic low back pain (cLBP). Veterans with cLBP were enrolled in a 10 week trial of the Pain EASE program. Engagement measures included the number of logins, access to coping skill modules, and completed study staff-initiated weekly check-in calls. Regression analyses were conducted to identify significant predictors of engagement from hypothesized predictors (e.g., race/ethnicity, age, depressive symptom severity, and pain interference). Participants (N = 58) were 93% male, 60.3% identified as White, and had a mean age of 54.5 years. Participants logged into the program a median of 3.5 times, accessed a median of 2 skill modules, and attended a median of 6 check-in calls. Quantile regression revealed that, at the 50th percentile, non-White-identified participants accessed fewer modules than White-identified participants (p = .019). Increased age was associated with increased module use (p = .001). No clinical characteristics were significantly associated with engagement measures. White-identified race/ethnicity and increased age were associated with greater engagement with the Pain EASE program. Results highlight the importance of defining and increasing engagement in internet-delivered pain care.
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Affiliation(s)
- Chelsey Solar
- Department of Emergency Medicine, VA Boston Healthcare System, Boston, MA USA
| | - Allison M Halat
- Research Service, VA Boston Healthcare System, Boston, MA, USA
| | - R Ross MacLean
- Department of Psychology, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Haseena Rajeevan
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah L Krein
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alicia A Heapy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Pain, Research, Informatics, Medical comorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew J Bair
- Center for Health Information and Communication (CHIC), VA Health Services Research and Development, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, USA
| | - Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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11
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Handley MA, Landeros J, Wu C, Najmabadi A, Vargas D, Athavale P. What matters when exploring fidelity when using health IT to reduce disparities? BMC Med Inform Decis Mak 2021; 21:119. [PMID: 33827562 PMCID: PMC8028253 DOI: 10.1186/s12911-021-01476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Implementation of evidence-based interventions often involves strategies to engage diverse populations while also attempting to maintain external validity. When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with 'on-the ground' tailoring approaches for patient-centered care or ensuring equity among linguistically diverse populations. METHODS We conducted a fidelity and acceptability-focused evaluation of the STAR MAMA Program, a 5-month bilingual (English and Spanish) intervention for reducing diabetes risk factors among 181 post-partum women with recent gestational diabetes. The study's purpose was to explore fidelity to pre-determined 'core' (e.g. systems integration) and 'modifiable' equity components (e.g. health coaching responsiveness, and variation by language) using an adapted implementation fidelity framework. Participant-level surveys, systems-level databases of message delivery, call completion, and coaching notes were included. RESULTS 96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA intervention; 55 received the calls in Spanish (61%) and 35 English (39%). 90% (n = 81) completed ≥ one week. Initially, systems errors were common, and increased triggers for health coach call-backs. Although Spanish speakers had more triggers over the intervention period, the difference was not statistically significant. Of the calls triggering a health coach follow-up, attempts were made for 85.4% (n = 152) of the English call triggers and for 80.0% (n = 279) of the Spanish call triggers (NS). Of attempted calls, health coaching calls were complete for 55.6% (n = 85) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (p = < 0.01) and English-speakers reporting health coaches were less considerate of their time (p = 0.03). CONCLUSIONS By exploring fidelity by language-specific factors, we identified important differences in some but not all equity indicators, with early systems errors quicky remedied and high overall engagement and acceptability. Practice implications include: (1) establishing criteria for languge-equity in interventions, (2) planning for systems level errors so as to reduce their impact between language groups and over time; and (3) examining the impact of engagement with language-concordant interventions on outcomes, including acceptability. Trial Registration National Clinical Trials registration number: CT02240420 Registered September 15, 2014. ClinicalTrials.gov.
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Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA.
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA.
| | - Jerad Landeros
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Cindie Wu
- University of California, Berkeley School of Public Health, Berkeley, USA
| | - Adriana Najmabadi
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Daniela Vargas
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Priyanka Athavale
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
- University of California, Berkeley School of Public Health, Berkeley, USA
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12
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Tighe SA, Ball K, Kensing F, Kayser L, Rawstorn JC, Maddison R. Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions. J Med Internet Res 2020; 22:e16774. [PMID: 33112239 PMCID: PMC7657720 DOI: 10.2196/16774] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. OBJECTIVE This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. METHODS A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. CONCLUSIONS Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
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Affiliation(s)
- Sarah A Tighe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Finn Kensing
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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13
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Muscat DM, Lambert K, Shepherd H, McCaffery KJ, Zwi S, Liu N, Sud K, Saunders J, O'Lone E, Kim J, Robbins A, Webster AC. Supporting patients to be involved in decisions about their health and care: Development of a best practice health literacy App for Australian adults living with Chronic Kidney Disease. Health Promot J Austr 2020; 32 Suppl 1:115-127. [PMID: 32888215 DOI: 10.1002/hpja.416] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/21/2020] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Inadequate health literacy is common in those with chronic kidney disease (CKD), especially among culturally and linguistically diverse groups. Patient information for people with CKD, including those with kidney failure requiring dialysis, is often written beyond their literacy level, and many CKD-related apps are not accurate or evidence based. These represent important barriers to health care decision-making and equity in access to health care. METHODS We developed a cross-platform application (the "SUCCESS app") to support Australian adults with kidney failure requiring dialysis to actively participate in self-management and decision-making. App content was informed by health literacy theory which recognises the importance of reducing the complexity of health information as well as equipping consumers with the skills necessary to access, understand and act on this information. The development team comprised members of diverse backgrounds and expertise, including nursing, allied health, psychology, epidemiology, nephrology and IT, as well as consumer representatives. RESULTS Content areas included diet, fluids, medicine, physical activity, emotional well-being and supportive care, chosen as they represent important decision points in the CKD trajectory. To support functional health literacy, a four-step process to simplify written content was used including calculating readability statistics, applying the Patient Education Materials Assessment Tool, supplementing written information with video and audio content, and incorporating micro-learning and interactive quizzes. To develop communicative and critical health literacy skills, question prompt lists and evidence-based volitional help sheets were included in each module to support question-asking and behaviour change. We also developed animated skills training related to communication, shared decision-making and critical appraisal of health information. CONCLUSIONS This is the first health literacy informed app developed to promote active patient participation in CKD management and decision-making. Ongoing evaluation of the SUCCESS app through analysis of quantitative and qualitative data will provide valuable insights into the feasibility of implementing the app with dialysis patients, and the impact of the intervention of psychosocial and clinical outcomes. SO WHAT?: Digital health solutions have been found to improve self-management for chronic conditions, and could optimise the use of health care services and patient outcomes.
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Affiliation(s)
- Danielle Marie Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kelly Lambert
- Discipline of Nutrition and Dietetics, Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, Australia
| | - Heather Shepherd
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Kirsten J McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Stephanie Zwi
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Na Liu
- School of Computer Science, Faculty of Engineering and IT, The University of Sydney, Sydney, Australia
| | - Kamal Sud
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, Australia
| | - John Saunders
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, Australia
| | - Emma O'Lone
- Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, Australia
| | - Jinman Kim
- School of Computer Science, Faculty of Engineering and IT, The University of Sydney, Sydney, Australia.,Telehealth and Technology Center, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | - Angela C Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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14
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Hardman R, Begg S, Spelten E. What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review. BMC Health Serv Res 2020; 20:150. [PMID: 32106889 PMCID: PMC7045733 DOI: 10.1186/s12913-020-5010-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background The social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes. Methods Six databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results. Results Nineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura’s concept of self-efficacy. Conclusions The limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity. Trial registration PROSPERO registration CRD42019124760. Registration date 17/4/19.
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Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, Victoria, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia
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15
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Poduval S, Marston L, Hamilton F, Stevenson F, Murray E. Feasibility, Acceptability, and Impact of a Web-Based Structured Education Program for Type 2 Diabetes: Real-World Study. JMIR Diabetes 2020; 5:e15744. [PMID: 31904580 PMCID: PMC6971513 DOI: 10.2196/15744] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/04/2019] [Accepted: 10/22/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Structured education for people with type 2 diabetes improves outcomes, but uptake is low globally. In the United Kingdom in 2016, only 8.3% of people who were referred to education programs attended the program. We have developed a Web-based structured education program named Healthy Living for People with type 2 Diabetes (HeLP-Diabetes): Starting Out (HDSO), as an alternative to face-to-face courses. A Web-based program gives people more options for accessing structured education and may help improve overall uptake. OBJECTIVE The aim was to explore the feasibility and acceptability of delivering a Web-based structured education program (named HeLP-Diabetes: Starting Out) in routine primary health care and its potential impact on self-efficacy and diabetes-related distress. METHODS HDSO was delivered as part of routine diabetes services in primary health care in the United Kingdom, having been commissioned by local Clinical Commissioning Groups. Quantitative data were collected on uptake, use of the program, demographic characteristics, self-reported self-efficacy, and diabetes-related distress. A subsample of people with type 2 diabetes and health care professionals were interviewed about acceptability of the program. RESULTS It was feasible to deliver the program, but completion rates were low: of 791 people with type 2 diabetes registered, only 74 (9.0%) completed it. Completers improved their self-efficacy (change in median score 2.5, P=.001) and diabetes-related distress (change in median score 6.0, P=.001). Interview data suggested that the course was acceptable, and that uptake and completion may be related to nonprioritization of structured education. CONCLUSIONS The study provides evidence of the feasibility and acceptability of a Web-based structured education. However, uptake and completion rates were low, limiting potential population impact. Further research is needed to improve completion rates, and to determine the relative effectiveness of Web-based versus face-to-face education.
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Affiliation(s)
- Shoba Poduval
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | | | - Fiona Hamilton
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
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16
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Davies N, Hopwood J, Walker N, Ross J, Iliffe S, Walters K, Rait G. Designing and developing a co-produced theoretical and evidence-based online support for family caregivers of people with dementia at the end of life. BMC Palliat Care 2019; 18:71. [PMID: 31409329 PMCID: PMC6693100 DOI: 10.1186/s12904-019-0455-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Caring for someone with dementia can be physically and emotionally difficult. Acting as a caregiver can make it difficult to access sources of support, particularly in the later stages of dementia. This paper reports the development and presents the targets (subject areas) and components of a prototype website to support family caregivers of a person with dementia towards the end of life. METHODS Adopting an iterative approach and co-production methods the development process consisted of four stages: Stage1-Synthesis of data: three sources of data (interviews, systematic review and theory) were synthesised using tabulation, to identify the targets of the prototype; Stage2-Identifying intervention targets and components: a research development group (health practitioners, a family caregiver and academic experts) met to discuss the development, using a modified nominal group process, refining the synthesis from stage 1; Stage3-Developing the intervention prototype: an outline of the prototype was developed based on stage 1 and 2; and Stage4-User testing: interviews with caregivers testing the prototype website. RESULTS Qualitative interviews with caregivers identified four targets for the intervention: 1) feeling prepared and equipped; 2) feeling connected and supported; 3) valuing themselves as a caregiver and as an individual; 4) maintaining control of the caring situation and being the coordinator of care. The systematic review provided evidence on how and what components could address these targets, including providing information, peer support, contact with professionals, and psychological support. Theory helped to narrow the focus within each of these targets. Active discussion with the research development group and end users provided an outline of the prototype website. The prototype website presented addresses these targets with written information, videos from other caregivers, and peer and professional support sections. The subject areas covered included expectations at the end of life, support with day-to-day caring, care planning, and communication. CONCLUSIONS This paper provides a detailed account of the development process of a prototype website for caregiver support. The transparent methodology and key lessons learnt from developing the prototype should help those who are developing similar interventions, across complex, progressive conditions and not just limited to dementia.
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Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Jenny Hopwood
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Nina Walker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Jamie Ross
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Steve Iliffe
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Greta Rait
- Priment Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
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17
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A digital self-management intervention for adults with type 2 diabetes: Combining theory, data and participatory design to develop HeLP-Diabetes. Internet Interv 2019; 17:100241. [PMID: 31372349 PMCID: PMC6660456 DOI: 10.1016/j.invent.2019.100241] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Digital health interventions have potential to contribute to better health outcomes, better healthcare and lower costs. However, evidence for their effectiveness is variable. The development and content of digital health interventions are often not described in enough detail to enable others to replicate the research or improve on previous interventions. This has led to a call for transparent reporting of intervention content and development. PURPOSE To describe the development process and content of a digital self-management intervention for people with type 2 diabetes (HeLP-Diabetes) that has been found to achieve its target clinical outcome, the reduction of HbA1c, a measure of glycaemic control. METHOD We synthesised theory, data from existing research evidence and international guidelines, and new qualitative data from target users to identify the determinants of self-management and the content to be included in HeLP-Diabetes. Using an ongoing iterative participatory design approach the content of the intervention was written, produced, reviewed and changed. CONCLUSION It is possible to develop and transparently report self-management programmes for long-term conditions, which reflect current best evidence, theoretical underpinning and user involvement. We intend that reporting the development process and content will inform future digital intervention development.
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Key Words
- CBT, Cognitive Behaviour Therapy
- Diabetes mellitus, type 2
- Digital intervention development
- HCPs, Health Care Professionals
- HeLP Diabetes, Healthy Living for People with Type 2 Diabetes
- HealthTalk Online, HTO
- Internet
- LLTTF, Living Life to the Full
- MRC, Medical Research Council
- NICE, National Institute for Health Care Excellence
- NPT, Normalisation Process Theory
- Participatory design
- Patient education as topic
- RNIB, Royal National Institute of Blind People
- Self-management
- T2DM, Type 2 diabetes mellitus
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