1
|
Liew H, Pienkowska A, Ang CS, Mahadzir MDA, Goh KFI, Lodh N, Bojic I, Lawate A, Ong QC, Venkataraman K, Car J, Ho AHY. Empowering Foot Care Literacy Among People Living With Diabetes and Their Carers With an mHealth App: Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e52036. [PMID: 37988150 DOI: 10.2196/52036] [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: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wound occurs. Modern technologies, including mobile health (mHealth) interventions such as health apps, bring the potential for more cost-effective and scalable interventions. OBJECTIVE This study aims to examine the feasibility and usability of a newly developed mHealth app called Well Feet, which is a diabetes and foot care education app for individuals at risk of developing DFU. METHODS Well Feet was developed using an evidence-based and expert panel cocreation approach to deliver educational content available in 3 languages (ie, English, Chinese, and Malay) via animation videos and a range of additional features, including adaptive learning. A nonrandomized, single-arm feasibility study using a mixed methods approach with a series of validated questionnaires and focus group discussions will be conducted. In total, 40 patients and carers will be recruited from a tertiary hospital diabetes clinic to receive a 1-month mHealth intervention. The primary outcomes are the usability of the app and a qualitative perspective on user experience. Secondary outcomes include changes in foot care knowledge, self-management behaviors, and quality of life. RESULTS Patient recruitment began in July 2023, and the intervention and data collection will be completed by the end of September 2023. This study has been approved by National Healthcare Group Domain Specific Review Board (2022/00614) on February 10, 2023. The expected results will be published in spring 2024. CONCLUSIONS Through this feasibility study, the Well Feet DFU education app will undergo a comprehensive quantitative and qualitative evaluation of its usability and acceptance for future improvement in its design. With local contextualization, cultural adaptation, and its multilingual functionality, the app addresses a critical aspect of DFU health education and self-management in a multiethnic population. Findings from this study will refine and enhance the features of the app based on user feedback and shape the procedural framework for a subsequent randomized controlled trial to assess the effectiveness of Well Feet. TRIAL REGISTRATION ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52036.
Collapse
Affiliation(s)
- Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anita Pienkowska
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chin-Siang Ang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Kelley Fann Ing Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nandika Lodh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Iva Bojic
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ashwini Lawate
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Qi Chwen Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
2
|
Drovandi A, Crowley B, Alahakoon C, Seng L, Fernando ME, Ross D, Evans R, Golledge J. Perceptions of Australians with diabetes-related foot disease on requirements for effective secondary prevention. Aust J Rural Health 2023; 31:690-703. [PMID: 37092611 PMCID: PMC10947538 DOI: 10.1111/ajr.12989] [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: 01/13/2023] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Secondary prevention is essential in reducing recurrence of diabetes-related foot disease (DFD) but is frequently poorly implemented in clinical practice. OBJECTIVE To explore the perceptions of people with diabetes-related foot disease (DFD) on their self-perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. DESIGN Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi-structured interviews. Interviews were audio-recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. FINDINGS AND DISCUSSION Participants had high self-perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. CONCLUSION People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support.
Collapse
Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Faculty of Biological Sciences, School of Biomedical SciencesUniversity of LeedsLeedsUK
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Malindu E. Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Faculty of Health and Medicine, School of Health SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
- Department of Vascular and Endovascular Surgery, John Hunter HospitalHunter New England Local Health District, New South Wales HealthNewcastleNew South WalesAustralia
| | - Diane Ross
- Townsville Aboriginal and Islander Health ServicesTownsvilleQueenslandAustralia
| | - Rebecca Evans
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
| |
Collapse
|
3
|
Crowley B, Drovandi A, Seng L, Fernando ME, Ross D, Golledge J. Patient Perspectives on the Burden and Prevention of Diabetes-Related Foot Disease. Sci Diabetes Self Manag Care 2023; 49:217-228. [PMID: 37114642 DOI: 10.1177/26350106231170531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE The purpose of the study was to understand patient perspectives about the impact and prevention of diabetes-related foot disease (DFD). METHODS An online survey was distributed to patients with a history of DFD during 2020. The survey was designed alongside clinical specialists and DFD patients and utilized the health belief model. It asked about the impact of DFD on health, perceptions on preventive strategies, perceived need for additional support, and patient preferences for telehealth in DFD management. Quantitative data were summarized descriptively and compared between groups. Open-text responses were analyzed using conceptual content analysis. RESULTS Of 80 participants with a history of DFD, foot ulcers were the complication most often experienced, with over two-thirds having been admitted to hospital for a DFD-related issue and over one-third having a DFD-related amputation. Participants had ranging perceptions on the effect of DFD on health, from minimal to crippling. Those with previous severe DFD complications leading to hospital admission found a lack of mobility and independence the consequences of most concern. Using offloading footwear was perceived as very important for preventing DFD complications, although the use of offloading footwear was low, with participants citing issues relating to cost, comfort, appearance, and access to footwear as barriers to better adherence. Perceptions on telehealth were mixed, with many participants not having access to or being comfortable with the use of digital technologies. CONCLUSIONS Patients with DFD require additional supports for effective prevention, including offloading footwear.
Collapse
Affiliation(s)
- Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, England
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Malindu E Fernando
- Ulcer and Wound Healing Consortium, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Diane Ross
- Townsville Aboriginal and Islander Health Services, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Ulcer and Wound Healing Consortium, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| |
Collapse
|
4
|
Ploderer B, Clark D, Brown R, Harman J, Lazzarini PA, Van Netten JJ. Self-Monitoring Diabetes-Related Foot Ulcers with the MyFootCare App: A Mixed Methods Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:2547. [PMID: 36904750 PMCID: PMC10006972 DOI: 10.3390/s23052547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
People with diabetes-related foot ulcers (DFUs) need to perform self-care consistently over many months to promote healing and to mitigate risks of hospitalisation and amputation. However, during that time, improvement in their DFU can be hard to detect. Hence, there is a need for an accessible method to self-monitor DFUs at home. We developed a new mobile phone app, "MyFootCare", to self-monitor DFU healing progression from photos of the foot. The aim of this study is to evaluate the engagement and perceived value of MyFootCare for people with a plantar DFU over 3 months' duration. Data are collected through app log data and semi-structured interviews (weeks 0, 3, and 12) and analysed through descriptive statistics and thematic analysis. Ten out of 12 participants perceive MyFootCare as valuable to monitor progress and to reflect on events that affected self-care, and seven participants see it as potentially valuable to enhance consultations. Three app engagement patterns emerge: continuous, temporary, and failed engagement. These patterns highlight enablers for self-monitoring (such as having MyFootCare installed on the participant's phone) and barriers (such as usability issues and lack of healing progress). We conclude that while many people with DFUs perceive app-based self-monitoring as valuable, actual engagement can be achieved for some but not for all people because of various facilitators and barriers. Further research should target improving usability, accuracy and sharing with healthcare professionals and test clinical outcomes when using the app.
Collapse
Affiliation(s)
- Bernd Ploderer
- School of Computer Science, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Damien Clark
- School of Computer Science, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Metro North Hospital and Health Service, Herston, QLD 4029, Australia
| | - Ross Brown
- School of Computer Science, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Joel Harman
- School of Computer Science, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Peter A. Lazzarini
- Metro North Hospital and Health Service, Herston, QLD 4029, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Jaap J. Van Netten
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation and Development, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
5
|
Lo ZJ, Chong B, Tan E, Ooi D, Liew H, Hoi WH, Cho YT, Wu K, Surendra NK, Mammadova M, Nah A, Goh V, Car J. Patients, carers and healthcare providers' perspectives on a patient-owned surveillance system for diabetic foot ulcer care: A qualitative study. Digit Health 2023; 9:20552076231183544. [PMID: 37377563 PMCID: PMC10291864 DOI: 10.1177/20552076231183544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Objective Digital health has recently gained a foothold in monitoring and improving diabetes care. We aim to explore the views of patients, carers and healthcare providers (HCPs) regarding the use of a novel patient-owned wound surveillance application as part of outpatient management of patients with diabetic foot ulcers (DFUs). Methods Semi-structured online interviews were conducted with patients, carers and HCPs in wound care for DFUs. The participants were recruited from a primary care polyclinic network and two tertiary hospitals in Singapore, within the same healthcare cluster. Purposive maximum variation sampling was used to select participants with differing attributes to ensure heterogeneity. Common themes relating to the wound imaging app were captured. Results A total of 20 patients, 5 carers and 20 HCPs participated in the qualitative study. None of the participants have used a wound imaging app before. Regarding a patient-owned wound surveillance app, all were open and receptive to the system and workflow for use in DFU care. Four major themes emerged from patients and carers: (1) technology, (2) application features and usability, (3) feasibility of using the wound imaging application and (4) logistics of care. Four major themes were identified from HCPs: (1) attitudes towards wound imaging app, (2) preferences regarding functionality, (3) perceived challenges for patients/carers and (4) perceived barriers for HCPs. Conclusion Our study highlighted several barriers and facilitators from patients, carers and HCPs regarding the use of a patient-owned wound surveillance app. These findings demonstrate the potential of digital health and areas to improve and tailor a DFU wound app suitable for implementation in the local population.
Collapse
Affiliation(s)
- Zhiwen Joseph Lo
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elaine Tan
- National Healthcare Group Polyclinics, Singapore
| | - Desmond Ooi
- Vascular Surgery Service, Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Wai Han Hoi
- Department of Endocrinology, Woodlands Health, Singapore
| | - Yuan Teng Cho
- Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
| | | | - Naren Kumar Surendra
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Maleyka Mammadova
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Audrey Nah
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Victor Goh
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| |
Collapse
|
6
|
Søndergaard SF, Vestergaard EG, Andersen AB, Kolbæk R, Dahl M, Høgh A. How patients with diabetic foot ulcers experience telemedicine solutions: A scoping review. Int Wound J 2022; 20:1796-1810. [PMID: 36453130 PMCID: PMC10088844 DOI: 10.1111/iwj.14026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Diabetic foot ulcer (DFU) is a common, complex and severe complication of diabetes that is associated with severely decreased health-related quality of life. Treatment of DFUs calls for a multi-sectoral approach, incorporating interdisciplinary care pathways. Telemedicine (TM) may be used as a communication tool between caregivers across healthcare sectors to obligate the need for close follow-up, including early intervention in preventing the recurrence of DFU. The objective of this review was to identify, examine and conceptually map the available literature on patients' experiences and views regarding the use of TM solutions among patients with DFUs. We identified the Population, Concept and Context to pinpoint the focus of this review, word the research question and title as well as facilitate the literature search strategy. The literature examined stems from 13 sources. We imposed no restrictions on the methodological approach of the included studies, neither on the format. During the review process, four main maps emerged: "A whole human not merely a hole in a human," "Less of a burden on the family, the community and the environment," "Competences and continuity of care are essential for high-quality care" and "The quality and modality of the technology." Further investigation from both the patients' and the multi-sectoral caregivers' perspective is needed, focusing on whatever modifications of the TM intervention may fit the DFU care pathway better.
Collapse
Affiliation(s)
- Susanne Friis Søndergaard
- Centre for Research in Clinical Nursing Regional Hospital Viborg Viborg Denmark
- VIA University College and Aarhus University, Health Aarhus Denmark
| | - Else Godsk Vestergaard
- Wound Nurse, Vascular Research Unit, Department of Surgery Viborg Regional Hospital Viborg Denmark
| | - Anne Bendix Andersen
- Centre for Research in Clinical Nursing Regional Hospital Viborg Viborg Denmark
- VIA University College and Aarhus University, Health Aarhus Denmark
| | | | - Marie Dahl
- Vascular Research Unit, Department of Surgery Viborg Regional Hospital Viborg Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Clinical Research University of Southern Denmark and Odense University Hospital Odense Denmark
| | - Annette Høgh
- Vascular Research Unit and Wound Centre. Department of Surgery Regional Hospital Viborg, Region Central Jutland Viborg Denmark
- Institute for Clinical Medicine Aarhus University Aarhus Denmark
| |
Collapse
|
7
|
Tekale S, Varma A, Tekale S, Kumbhare U. A Review on Newer Interventions for the Prevention of Diabetic Foot Disease. Cureus 2022; 14:e30591. [PMID: 36426316 PMCID: PMC9682366 DOI: 10.7759/cureus.30591] [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: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
Abstract
Diabetic foot disease (DFD), which includes ulcers on the foot, infections, and gangrene of the foot, is one of the leading causes of disability worldwide. About half of diabetic foot disease (DFD) patients have a recurrence in less than a year. To alleviate the burden of DFD globally, it is essential to give long-term medication to reduce the likelihood of recurrence. The effectiveness of telemedicine, wearable technologies, and sensors in DFD prevention is discussed in this review. Offloading footwear helps to cure and prevent ulcerated diabetic foot by distributing physical stress away from bony prominences. Sensors and wearables can record the temperatures of the foot, blood pressure (BP), and blood sugar levels and estimate lipid profile. These technologies have offered a practical means of reaching individuals in rural areas with a heightened risk of developing DFD. There is less need for in-person consultations with this strategy. This methodology is simple to operate and lessens reliance on patients. The benefits of adopting these remote monitoring approaches have been demonstrated in some studies with DFD-at-risk individuals. It is required to do more analysis to ascertain the effectiveness and value of incorporating different remote monitoring systems as part of an all-encompassing strategy to prevent DFD.
Collapse
Affiliation(s)
- Sanket Tekale
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Anuj Varma
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| | - Shubhangi Tekale
- Department of Pathology, Dr. Ulhas Patil Medical College and Hospital, Jalgaon, IND
| | - Unnati Kumbhare
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND
| |
Collapse
|
8
|
Cross K, Harding K. Risk profiling in the prevention and treatment of chronic wounds using artificial intelligence. Int Wound J 2022; 19:1283-1285. [PMID: 36131590 PMCID: PMC9493230 DOI: 10.1111/iwj.13952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 12/13/2022] Open
|
9
|
Crocker RM, Tan T, Palmer KNB, Marrero DG. The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and
care seeking. J Adv Nurs 2022; 78:2482-2494. [PMID: 35285035 PMCID: PMC9283226 DOI: 10.1111/jan.15192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/29/2021] [Accepted: 02/09/2022] [Indexed: 01/13/2023]
Abstract
AIMS Diabetic foot ulceration can contribute to lowered life expectancy and quality of life for people with diabetes, and yet, scant attention has been given to improving preventive and educational measures. This article uses a phenomenological approach to explore individuals' lived experiences of diabetic foot ulcerations to explore factors that can be harnessed to achieve improved outcomes. DESIGN This was a qualitative study using semi-structured interviews grounded in a phenomenological framework to explore how patients perceive and understand their foot problems. METHODS Study participants were recruited from February 2020 to February 2021 from a tertiary referral centre that treats foot problems in persons with diabetes. A total of 15 Hispanic, Native American and White patients participated in the study. We conducted in-depth semi-structured interviews which were audio recorded with the participant's consent. Interview data were transcribed and analysed with Dedoose data management software. RESULTS Analysis revealed findings in two primary domains: (1) how patients perceive foot ulceration, with themes around limited understandings of foot ulceration, close sensory observation of foot problems and barriers to ulcer perception and (2) how patients experience the timing of foot ulceration, with themes on how time perceptions shifted as foot problems became more serious, which correlated closely to how patients responded to their foot problems. CONCLUSION Despite the close sensory observation of their feet, people with diabetes face an array of barriers to recognizing and understanding the implications of diabetic foot ulceration, which can lead to delayed care seeking. Nurses can play a critical role in promoting patient education and improving patient self-management of foot ulcers. IMPACT This phenomenological study offers important lessons to guide nurses and other providers in enhancing patient self-management of DFUs and improving care outcomes by expanding an understanding of DFU early warning signs, the imperative to seek medical care quickly, and addressing possible barriers.
Collapse
Affiliation(s)
- Rebecca M. Crocker
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| | - Tze‐Woei Tan
- Division of Vascular and Endovascular Surgery University of Arizona College of Medicine‐ Tucson, Southern Arizona Limb Salvage Alliances (SALSA) Tucson Arizona USA
| | - Kelly N. B. Palmer
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| | - David G. Marrero
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| |
Collapse
|
10
|
Ayatollahi H. PATIENTS' AND PHYSICIANS' PERSPECTIVES ABOUT USING HEALTH INFORMATION TECHNOLOGY IN DIABETES MANAGEMENT IN IRAN: A QUALITATIVE STUDY. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2022; 18:1i. [PMID: 34975358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Introduction Diabetes mellitus is known as a major chronic disease that has a number of consequences affecting individuals' health conditions and socioeconomic aspects of life. These challenges require innovative interventions, such as self-management to improve patients' health condition and reduce the economic burden of healthcare systems. The current research aimed to identify patients' and physicians' perspectives about the use of health information technology in diabetes management in Iran. Methods This was a qualitative study conducted in 2019. In order to collect data, semi-structured interviews were conducted with eight patients and 10 specialists in an endocrine and metabolism research center and in a teaching hospital. The interviews were digitally recorded and transcribed verbatim. Finally, data were analyzed by using framework analysis method and MAXQDA version 10. Results According to the results, both patients and physicians believed that while using health information technology can improve access to healthcare services, the high cost of technology may hinder its usage. Factors such as government and health system support can motivate users to use the technology, and factors such as lack of user training and technical problems may have a negative impact on technology usage. Conclusion As a number of motivational and inhibitory factors may influence the use of health information technology in diabetes management, it is imperative to take each of these factors into account before designing and implementing new technologies, especially for diabetes management.
Collapse
|
11
|
Cassidy B, Reeves ND, Pappachan JM, Ahmad N, Haycocks S, Gillespie D, Yap MH. A Cloud-Based Deep Learning Framework for Remote Detection of Diabetic Foot Ulcers. IEEE PERVASIVE COMPUTING 2022. [DOI: 10.1109/mprv.2021.3135686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
12
|
Umaefulam V, Premkumar K, Koole M. Perceptions on mobile health use for health education in an Indigenous population. Digit Health 2022; 8:20552076221092537. [PMID: 35449712 PMCID: PMC9016580 DOI: 10.1177/20552076221092537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Indigenous peoples in Canada face numerous health needs and challenges and
often have poor health status due to inequitable access to care. Providing
culturally appropriate support for health conditions, particularly chronic
conditions that require self-management, can assist in averting
complications and morbidity. Mobile health is a useful medium for delivering
health education across different populations. However, meaningful user
involvement is necessary because mobile health interventions suitable for
one population may not be appropriate for another. Indigenous people’s views
will inform the use of mobile health interventions in Indigenous
communities. Objective The study explored the perception of Indigenous women on using mobile health
as a tool for receiving health information. Methods This was a qualitative study, and participants comprised of 22 Indigenous
women (First Nations and Métis) with or at risk of diabetes, aged 18–69
years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye
care information via text messaging, data were collected via sharing circle
discussions and analyzed using thematic analysis. Results Participants indicated that the nature of messages such as the use of
Indigenous languages, the message content, frequency of messages, group
activities, and delivery formats such as voice messages, mobile
applications, Internet, two-way messaging, and text messages were essential
considerations in using mobile health as a tool for receiving health
information. Conclusion Different factors need to be considered in using mobile health as a tool for
health education among Indigenous peoples. These factors could be applicable
in implementing mobile health solutions in other populations for the
management of health conditions.
Collapse
Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marguerite Koole
- Educational Technology and Design, Department of Curriculum Studies, College of Education, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
13
|
Lee JK, Hung CS, Huang CC, Chen YH, Wu HW, Chuang PY, Yu JY, Ho YL. The Costs and Cardiovascular Benefits in Patients With Peripheral Artery Disease From a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study. J Med Internet Res 2021; 23:e24346. [PMID: 34003132 PMCID: PMC8170551 DOI: 10.2196/24346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/22/2020] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events, including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a fourth-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. OBJECTIVE The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the fourth-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with a diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization, acute coronary syndrome, stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. RESULTS The mean follow-up duration was 3.1 (SD 1.8) years for the patients who participated in the telehealth program and 3.2 (SD 1.8) for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than did the control group in the first year after IPTW (0.9% vs 3.5%; hazard ratio [HR] 0.24; 95% CI 0.07-0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs 5.2%; HR 0.46; 95% CI 0.21-0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than did the control group after IPTW (0.9% vs 3.5%; HR 0.52, 95% CI 0.28-0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. CONCLUSIONS The PAD patients who participated in the fourth-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger-scale and prospective randomized clinical trials are needed to confirm our findings.
Collapse
Affiliation(s)
- Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Hsien Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Wen Wu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yu Chuang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Yu Yu
- Department of Business Administration, College of Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Lwun Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
14
|
Lin DSH, Lee JK. Mobile Health-Based Thermometer for Monitoring Wound Healing After Endovascular Therapy in Patients With Chronic Foot Ulcer: Prospective Cohort Study. JMIR Mhealth Uhealth 2021; 9:e26468. [PMID: 33960955 PMCID: PMC8140381 DOI: 10.2196/26468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/14/2021] [Accepted: 04/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Foot temperature may increase after endovascular therapy, but the relationship between foot temperature and wound healing is unclear. OBJECTIVE This study was performed to evaluate the feasibility of a mobile health (mHealth)-based thermometer for foot temperature monitoring in patients with chronic foot ulcer before and after endovascular therapy and to determine the association between temperature change and wound healing time. METHODS This was a prospective cohort study. Patients who had a chronic foot ulcer (>3 months) and underwent endovascular therapy between June 2019 and December 2019 were included. The participants received standard medical care and endovascular therapy for revascularization. The mHealth-based thermometer, composed of 4 temperature-sensing chips, was put on the foot before and after endovascular therapy. Data from the chips were transferred to an associated mobile phone app via Bluetooth. Wound healing time was estimated using the Kaplan-Meier method, and the associations between baseline characteristics and clinical outcomes were evaluated using a Cox proportional hazard model. RESULTS A total of 163 patients with chronic foot ulcer who underwent endovascular therapy were enrolled and followed up until wound healing was complete or for 180 days. The mean foot temperature before endovascular therapy was 30.6 (SD 2.8 °C). Foot temperature increased significantly (mean 32.1 °C, SD 2.8 °C; P=.01) after the procedure. Wound healing time was significantly different in the Kaplan-Meier curves of the patient group with temperature changes ≥2 °C and the group with temperature changes ≤2 °C (log-rank P<.001). A foot temperature increase ≥2 °C after endovascular therapy was associated with increased wound healing in univariate analysis (hazard ratio [HR] 1.78, 95% CI 1.24-2.76, P=.02), and the association remained significant in multivariate analysis (HR 1.69, 95% CI 1.21-2.67, P=.03). CONCLUSIONS The mHealth-based thermometer was feasible and useful for foot temperature monitoring, which may provide health care professionals with a new endpoint for endovascular therapy. Foot temperature increases ≥2 °C after endovascular therapy were associated with faster wound healing in patients with chronic foot ulcer. Further studies are needed, however, to confirm these findings.
Collapse
Affiliation(s)
- Donna Shu-Han Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
15
|
Dehnavi Z, Ayatollahi H, Hemmat M, Abbasi R. Health Information Technology and Diabetes Management: A Review of Motivational and Inhibitory Factors. Curr Diabetes Rev 2021; 17:268-279. [PMID: 32682380 DOI: 10.2174/1573399816666200719012849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Health information technology helps patients to take better care of themselves and improves health status of patients with chronic diseases, such as diabetes. OBJECTIVE This study aimed to identify factors influencing the use of health information technology in diabetes management. METHODS This was a review study conducted in 2019. To obtain the related articles, databases, including Scopus, Web of Science, Proquest, and PubMed, were searched and the time frame was between 2010 and 2018. Initially, 1159 articles were retrieved and after screening, 28 articles were selected to be included in the study. RESULTS Factors influencing the use of health information technology in diabetes management could be divided into the motivational and inhibitory factors, and each of them could be categorized into five groups of organizational, technical, economic, individual, and ethical/legal factors. The motivational factors included training, system ease of use, economic support, having computer literacy, and maintaining privacy and confidentiality. The inhibitory factors included a lack of long-term planning, technical problems, inadequate financial resources, old age, and concerns over confidentiality issues. CONCLUSION Identifying motivational and inhibitory factors can help to make better use of technology for diabetes management. This approach, in turn, can improve the acceptability of the technology and save cost, reduce long-term complications of diabetes, and improve the quality of life in diabetic patients.
Collapse
Affiliation(s)
- Zari Dehnavi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hemmat
- Department of Health Information Technology, Saveh University of Medical Sciences, Saveh, Iran
| | - Rowshanak Abbasi
- Endocrinology and Metabolism Research Institute, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Lazo-Porras M, Bernabe-Ortiz A, Taype-Rondan A, Gilman RH, Malaga G, Manrique H, Neyra L, Calderon J, Pinto M, Armstrong DG, Montori VM, Miranda JJ. Foot thermometry with mHeath-based supplementation to prevent diabetic foot ulcers: A randomized controlled trial. Wellcome Open Res 2020; 5:23. [PMID: 32923686 PMCID: PMC7463300 DOI: 10.12688/wellcomeopenres.15531.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Novel approaches to reduce diabetic foot ulcers (DFU) in low- and middle-income countries are needed. Our objective was to compare incidence of DFUs in the thermometry plus mobile health (mHealth) reminders (intervention) vs. thermometry-only (control). Methods: We conducted a randomized trial enrolling adults with type 2 diabetes mellitus at risk of foot ulcers (risk groups 2 or 3) but without foot ulcers at the time of recruitment, and allocating them to control (instruction to use a liquid crystal-based foot thermometer daily) or intervention (same instruction supplemented with text and voice messages with reminders to use the device and messages to promote foot care) groups, and followed for 18 months. The primary outcome was time to occurrence of DFU. A process evaluation was also conducted. Results: A total of 172 patients (63% women, mean age 61 years) were enrolled; 86 to each study group. More patients enrolled in the intervention arm had a history of previous DFU (66% vs. 48%). Follow-up for the primary endpoint was complete for 158 of 172 participants (92%). Adherence to ≥80% of daily temperature measurements was 87% (103 of 118) among the study participants who returned the logbook. DFU cumulative incidence was 24% (19 of 79) in the intervention arm and 11% (9 of 79) in the control arm. After adjusting for history of foot ulceration and study site, the hazard ratio (HR) for DFU was 1.44 (95% CI 0.65, 3.22). Conclusions: In our study, conducted in a low-income setting, the addition of mHealth to foot thermometry was not effective in reducing foot ulceration. Importantly, there was a higher rate of previous DFU in the intervention group, the adherence to thermometry was high, and the expected rates of DFU used in our sample size calculations were not met. Trial registration: ClinicalTrials.gov NCT02373592 (27/02/2015).
Collapse
Affiliation(s)
- Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alvaro Taype-Rondan
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - German Malaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Helard Manrique
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Luis Neyra
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Jorge Calderon
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Miguel Pinto
- Endocrinology Service, Hospital Cayetano Heredia, Lima, Peru
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
17
|
Golledge J, Fernando M, Lazzarini P, Najafi B, G. Armstrong D. The Potential Role of Sensors, Wearables and Telehealth in the Remote Management of Diabetes-Related Foot Disease. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4527. [PMID: 32823514 PMCID: PMC7491197 DOI: 10.3390/s20164527] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022]
Abstract
Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene, is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed.
Collapse
Affiliation(s)
- Jonathan Golledge
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland 4814, Australia
| | - Malindu Fernando
- Ulcer and wound Healing consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia;
| | - Peter Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland 4000, Australia;
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Queensland 4006, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90089, USA;
| |
Collapse
|
18
|
Foong HF, Kyaw BM, Upton Z, Tudor Car L. Facilitators and barriers of using digital technology for the management of diabetic foot ulcers: A qualitative systematic review. Int Wound J 2020; 17:1266-1281. [PMID: 32390305 PMCID: PMC7948580 DOI: 10.1111/iwj.13396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023] Open
Abstract
The use of digital technology has been shown to be effective in managing chronic conditions. Telemedicine and mobile application are two common applications of digital technology in managing diabetic foot ulcers (DFU). The facilitators and barriers of using it for DFU management are yet to be explored. This is a qualitative systematic review. Five bibliography databases and grey literature sources were searched (2000‐2019). Two reviewers independently screened the citations, extracted the data, assessed the quality of the included studies, and performed thematic synthesis. Three studies on patients and five studies on healthcare practitioners (HCPs) were included. Two studies focused on the use of mobile applications and six on telemedicine. In studies on patients, four analytical themes were generated: the relationships with HCPs; the attitude towards the usage of digital technology; the role of wound image taking; and impact of digital technology on DFU care, encompassing 15 facilitators (eg, enabling community support, improving wound care knowledge) and 12 barriers (eg, lack of technological savviness, difficulty reading on smartphones). Three analytical themes were generated from studies on HCPs: the impact of digital technology on HCPs; the role of digital technology in DFU care; and organisation of DFU care delivery, encompassing 17 facilitators (eg, adequate wound care training, digital technology enables holistic care) and 16 barriers (eg, lack of multidisciplinary approach in caring for DFU, lack of direct contact in care provision). Patients and HCPs reported various barriers and facilitators relating to different aspects of using digital technology in DFU management. Our findings can help inform future research as well as the adoption of digital technology in DFU management.
Collapse
Affiliation(s)
- Hui Foh Foong
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Zee Upton
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
19
|
Lazo-Porras M, Bernabe-Ortiz A, Taype-Rondan A, Gilman RH, Malaga G, Manrique H, Neyra L, Calderon J, Pinto M, Armstrong DG, Montori VM, Miranda JJ. Foot thermometry with mHeath-based supplementation to prevent diabetic foot ulcers: A randomized controlled trial. Wellcome Open Res 2020; 5:23. [PMID: 32923686 PMCID: PMC7463300 DOI: 10.12688/wellcomeopenres.15531.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Three previous clinical trials have found that thermometry use reduced diabetic foot ulcers (DFUs) incidence four- to ten-fold among individuals with diabetes at high-risk of developing a DFU. However, these benefits depend on patient adherence to self-assessment. Therefore, novel approaches to improve self-management thermometry adherence are needed. Our objective was to compare incidence of DFUs in the thermometry plus mobile health (mHealth) reminders intervention arm vs. thermometry-only control arm. Methods: We conducted a randomized trial, enrolling adults with type 2 diabetes mellitus at risk of foot ulcers (risk groups 2 or 3) but without foot ulcers at the time of recruitment and allocating them to control (instruction to use a liquid crystal-based foot thermometer daily) or intervention (same instruction supplemented with text and voice messages with reminders to use the device and messages to promote foot care) groups and followed for 18 months. The primary outcome was time to occurrence of DFU. A process evaluation was also conducted. Results: A total of 172 patients (63% women, mean age 61 years) were enrolled; 86 to each study group. More patients enrolled in the intervention arm had a history of DFU (66% vs. 48%). Follow-up for the primary endpoint was complete for 158 of 172 participants (92%). DFU cumulative incidence was 24% (19 of 79) in the intervention arm and 11% (9 of 79) in the control arm. After adjusting for history of foot ulceration and study site, the Hazard Ratio (HR) for DFU was 1.44 (95% CI 0.65, 3.22). Adherence to ≥80% of daily temperature measurements was 87% (103 of 118) among the study participants who returned the logbook, with no difference between the intervention and control arms. Conclusions: This trial contributes to the evidence about the value of mHealth in preventing diabetes foot ulcers. Trial registration: ClinicalTrials.gov NCT02373592 (27/02/2015).
Collapse
Affiliation(s)
- Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alvaro Taype-Rondan
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - German Malaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Helard Manrique
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Luis Neyra
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Jorge Calderon
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Miguel Pinto
- Endocrinology Service, Hospital Cayetano Heredia, Lima, Peru
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
20
|
McLean A. mHealth Apps as Effective Persuasive Health Technology: Contextualizing the "Necessary" Functionalities. JMIR Nurs 2020; 3:e19302. [PMID: 34345788 PMCID: PMC8279448 DOI: 10.2196/19302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/26/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
Persuasive health technology (PHT) is any technology purposely designed to influence, reinforce, change, or shape health-related attitudes or behaviors. Behavioral interventions can be developed for the purpose of maintaining or improving a person's health status. Delivering behavioral interventions via PHTs is a promising approach for encouraging healthy behaviors among individuals and populations. Important attributes of all PHTs include their functionalities. A functionality refers to any useful features, functions, capabilities, or technologies associated with computer hardware or software. Creating effective PHTs requires a deliberate selection of appropriate functionalities for supporting specific behavioral interventions. The number and types of functionalities necessary to create an effective PHT will be specific to the context of each project, influenced by project objectives, stakeholder goals, behavioral interventions, and a variety of real-world constraints. Selecting appropriate functionalities can be challenging. Fortunately, there are frameworks and models developed specifically for guiding the design of PHTs. The Persuasive Systems Design model describes 4 categories, and 28 design principles for creating effective persuasive interventions. These same design principles could also be useful for guiding the selection of appropriate functionalities.
Collapse
|
21
|
Cabeceira HDS, de Souza DMST, Juliano Y, Veiga DF. Work ability and productivity in patients with diabetic foot. Clinics (Sao Paulo) 2019; 74:e421. [PMID: 30916210 PMCID: PMC6424068 DOI: 10.6061/clinics/2019/e421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/19/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess work ability and productivity in patients with diabetic foot. METHODS This investigation was a cross-sectional controlled study. A total of 117 individuals were selected from March to June 2014 and allocated to group A (patients without diabetes, n=43), group B (diabetes patients without foot ulcers, n=43), or group C (patients with diabetic foot, n=31). Two validated instruments, the Work Limitations Questionnaire (WLQ) and the Work Productivity and Activity Impairment Questionnaire General Health v2.0 (WPAI-GH), were used to assess work ability and productivity. RESULTS The groups were homogeneous regarding age and sex; however, patients in group C had a lower education level than the other participants (p=0.006). The median WLQ scores for groups A, B, and C were 0.0121, 0.0146, and 0.0852, respectively (p<0.0001). The WPAI-GH scores revealed a mean productivity loss of 20% for groups A and B and 100% for group C (p<0.0001). CONCLUSIONS Patients with diabetic foot showed decreased work ability and productivity.
Collapse
Affiliation(s)
- Helga dos Santos Cabeceira
- Mestrado Profissional em Ciencias Aplicadas a Saude, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
| | - Diba Maria Sebba Tosta de Souza
- Departamento de Enfermagem, Mestrado Profissional em Ciencias Aplicadas a Saude, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
- *Corresponding author. E-mail:
| | - Yara Juliano
- Departamento de Bioestatistica, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
| | - Daniela Francescato Veiga
- Divisao de Cirurgia Plastica, Mestrado Profissional em Ciencias Aplicadas a Saude, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
| |
Collapse
|
22
|
Ploderer B, Brown R, Seng LSD, Lazzarini PA, van Netten JJ. Promoting Self-Care of Diabetic Foot Ulcers Through a Mobile Phone App: User-Centered Design and Evaluation. JMIR Diabetes 2018; 3:e10105. [PMID: 30305266 PMCID: PMC6238831 DOI: 10.2196/10105] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/21/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Without effective self-care, people with diabetic foot ulcers (DFUs) are at risk of prolonged healing times, hospitalization, amputation, and reduced quality of life. Despite these consequences, adherence to DFU self-care remains low. New strategies are needed to engage people in the self-care of their DFUs. Objective This study aimed to evaluate the usability and potential usefulness of a new mobile phone app to engage people with DFUs in self-care. Methods We developed a new mobile phone app, MyFootCare, to engage people with DFUs through goals, progress monitoring, and reminders in self-care. Key features included novel visual analytics that automatically extract and monitor DFU size information from mobile phone photos of the foot. A functional prototype of MyFootCare was created and evaluated through a user-centered design process with 11 participants with DFUs. Data were collected through semistructured interviews discussing existing self-care practices and observations of MyFootCare with participants. Data were analyzed qualitatively through thematic analysis. Results Key themes were as follows: (1) participants already used mobile phone photos to monitor their DFU progress; (2) participants had limited experience with using mobile phone apps; (3) participants desired the objective DFU size data provided by the tracking feature of MyFootCare to monitor their DFU progress; (4) participants were ambivalent about the MyFootCare goal image and diary features, commenting that these features were useful but also that it was unlikely that they would use them; and (5) participants desired to share their MyFootCare data with their clinicians to demonstrate engagement in self-care and to reflect on their progress. Conclusions MyFootCare shows promising features to engage people in DFU self-care. Most notably, ulcer size data are useful to monitor progress and engage people. However, more work is needed to improve the usability and accuracy of MyFootCare, that is, by refining the process of taking and analyzing photos of DFUs and removing unnecessary features. These findings open the door for further work to develop a system that is easy to use and functions in everyday life conditions and to test it with people with DFUs and their carers.
Collapse
Affiliation(s)
- Bernd Ploderer
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ross Brown
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Leonard Si Da Seng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Jaap J van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
| |
Collapse
|