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Van Stee SK, Yang Q, Falcone M. Health Behavior Change Interventions Using Mobile Phones: A Meta-Analysis. HEALTH COMMUNICATION 2024:1-23. [PMID: 39206617 DOI: 10.1080/10410236.2024.2393005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The technological capabilities of mobile phones have made them a useful tool for delivering interventions, but additional research is needed to determine the mechanisms underlying the comparative effectiveness of mobile health interventions. This meta-analysis analyzes the relative effectiveness of mobile phone-based health interventions relative to comparison/control groups (e.g., eHealth interventions, standard of care, etc.), the utility of the theory of planned behavior in mobile phone-based health interventions, and the roles of various moderators. One hundred eighteen studies met inclusion criteria and contributed to an overall effect size of d = 0.27 (95% CI [.22, .32]). Findings indicate that mobile phone-based health interventions are significantly more effective than comparison/control conditions at improving health behaviors. Additionally, perceived behavioral control was a significant moderator providing some support for the usefulness of theory of planned behavior in mobile phone-based health interventions.
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Affiliation(s)
| | - Qinghua Yang
- Department of Communication Studies, Texas Christian University
| | - Maureen Falcone
- Department of Patient Care Services, Veterans Administration St. Louis Health Care System
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Huang H, Zhang L, Yang Y, Huang L, Lu X, Li J, Yu H, Cheng S, Xiao J. Construction and application of medication reminder system: intelligent generation of universal medication schedule. BioData Min 2024; 17:23. [PMID: 39010132 PMCID: PMC11247871 DOI: 10.1186/s13040-024-00376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/09/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Patients with chronic conditions need multiple medications daily to manage their condition. However, most patients have poor compliance, which affects the effectiveness of treatment. To address these challenges, we establish a medication reminder system for the intelligent generation of universal medication schedule (UMS) to remind patients with chronic diseases to take medication accurately and to improve safety of home medication. METHODS To design medication time constraint with one drug (MTCOD) for each drug and medication time constraint with multi-drug (MTCMD) for each two drugs in order to better regulate the interval and time of patients' medication. Establishment of a medication reminder system consisting of a cloud database of drug information, an operator terminal for medical staff and a patient terminal. RESULTS The cloud database has a total of 153,916 pharmaceutical products, 496,708 drug interaction data, and 153,390 pharmaceutical product-ingredient pairs. The MTCOD data was 153,916, and the MTCMD data was 8,552,712. An intelligent UMS medication reminder system was constructed. The system can read the prescription information of patients and provide personalized medication guidance with medication timeline for chronic patients. At the same time, patients can query medication information and get remote pharmacy guidance in real time. CONCLUSIONS Overall, the medication reminder system provides intelligent medication reminders, automatic drug interaction identification, and monitoring system, which is helpful to monitor the entire process of treatment in patients with chronic diseases.
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Affiliation(s)
- Hangxing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- College of Medicine, Wuhan University of Science and Technology, Wuhan, 430000, Hubei, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yongyu Yang
- Department of Pharmacy, The Second People's Hospital of Beihai, Beihai, 536000, Guangxi, China
| | - Ling Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xikui Lu
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Jingyang Li
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Huimin Yu
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Shuqiao Cheng
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, NO.87, Xiangya Road, Changsha, 410008, Hunan Province, China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Lemos M, Henriques AR, Lopes DG, Mendonça N, Victorino A, Costa A, Arriaga M, Gregório MJ, de Sousa R, Canhão H, Rodrigues AM. Usability and Utility of a Mobile App to Deliver Health-Related Content to an Older Adult Population: Pilot Noncontrolled Quasi-Experimental Study. JMIR Form Res 2024; 8:e46151. [PMID: 38758585 PMCID: PMC11160343 DOI: 10.2196/46151] [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: 02/01/2023] [Revised: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Digital patient-centered interventions may be important tools for improving and promoting social interaction, health, and well-being among older adults. In this regard, we developed a mobile app called DigiAdherence for an older adult population, which consisted of easy-to-access short videos and messages, to improve health-related knowledge among them and prevent common health conditions, such as falls, polypharmacy, treatment adherence, nutritional problems, and physical inactivity. OBJECTIVE This study aimed to assess the usability and utility of the DigiAdherence app among Portuguese older adults 65 years or older. METHODS In this pilot noncontrolled quasi-experimental study, older adults who were patients at the primary health care center in Portimão, Portugal, and owned a smartphone or tablet were recruited. Participants were assessed at baseline, given access to the DigiAdherence app for 1 month, and assessed again immediately after 30 days (first assessment) and 60 days after stopping the use of the app (second assessment). App usability and utility (primary outcomes) were analyzed in the first follow-up assessment using a structured questionnaire with 8 items. In the second follow-up assessment, our focus was on knowledge acquired through the app. Secondary outcomes such as treatment adherence and health-related quality of life were also assessed. RESULTS The study included 26 older adults. Most participants rated the different functionalities of the app positively and perceived the app as useful, attractive, and user-friendly (median score of 6 on a 7-point Likert scale). In addition, after follow-up, participants reported having a sense of security and greater knowledge in preventing falls (16/24, 67%) and managing therapies and polypharmacy (16/26, 62%). CONCLUSIONS The DigiAdherence mobile app was useful and highly accepted by older adults, who developed more confidence regarding health-related knowledge. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/29675.
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Affiliation(s)
- Marta Lemos
- Unidade de Saúde Pública do ACES Algarve II - Barlavento, Centro de Saúde de Portimão, Portimão, Portugal
| | - Ana Rita Henriques
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - David Gil Lopes
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Nuno Mendonça
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - André Victorino
- Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Costa da Caparica, Almada, Portugal
| | - Andreia Costa
- Direção-Geral de Saúde, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisboa, Portugal
- Catolica Research Centre for Psychological, Family and Social Wellbeing, Lisboa, Portugal
| | - Miguel Arriaga
- Direção-Geral de Saúde, Lisboa, Portugal
- Catolica Research Centre for Psychological, Family and Social Wellbeing, Lisboa, Portugal
| | - Maria João Gregório
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisboa, Portugal
| | - Rute de Sousa
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ana M Rodrigues
- CHRC, NOVA Medical School, NMS, Universidade NOVA de Lisboa, Lisboa, Portugal
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Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Toïgo M, Marc J, Hayot M, Moulis L, Carbonnel F. Quality Assessment of Smartphone Medication Management Apps in France: Systematic Search. JMIR Mhealth Uhealth 2024; 12:e54866. [PMID: 38498042 PMCID: PMC10985613 DOI: 10.2196/54866] [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: 12/09/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Adherence to medication is estimated to be around 50% for chronically ill patients in high-income countries. Improving the effectiveness of adherence interventions could have a far greater impact on population health than any improvement in specific medical treatments. Mobile health (mHealth) is one of the most effective solutions for helping patients improve their medication intake, notably through the use of mobile apps with reminder systems. With more than 327,000 apps available in the mHealth field, it is difficult for health care professionals and patients alike to choose which apps to recommend and use. OBJECTIVE We aim to carry out a systematic search of medication management smartphone apps available in France that send reminders to patients and assess their quality using a validated scale. METHODS Mobile apps were identified in October and November 2022 after a systematic keyword search on the 2 main app download platforms: App Store (Apple Inc) and Google Play Store. Inclusion criteria were free availability, date of last update, and availability in French. Next, 2 health care professionals independently evaluated the included apps using the French version of the Mobile App Rating Scale (MARS-F), an objective scoring system validated for assessing the overall quality of apps in the mHealth field. An intraclass correlation coefficient was calculated to determine interrater reliability. RESULTS In total, 960 apps were identified and 49 were selected (25 from the App Store and 24 from the Google Play Store). Interrater reliability was excellent (intraclass correlation coefficient 0.92; 95% CI 0.87-0.95; P<.001). The average MARS-F score was 3.56 (SD 0.49) for apps on the App Store and 3.51 (SD 0.46) for those on the Google Play Store, with 10 apps scoring above 4 out of 5. Further, 2 apps were tested in at least one randomized controlled trial and showed positive results. The 2 apps with the highest ratings were Mediteo rappel de médicaments (Mediteo GmbH) and TOM rappel medicaments, pilule (Innovation6 GmbH), available on both platforms. Each app's MARS-F score was weakly correlated with user ratings on the App Store and moderately correlated on the Google Play Store. CONCLUSIONS To our knowledge, this is the first study that used a validated scoring system to evaluate medication management apps that send medication reminders. The quality of the apps was heterogeneous, with only 2 having been studied in a randomized controlled trial with positive results. The evaluation of apps in real-life conditions by patients is necessary to determine their acceptability and effectiveness. Certification of apps is also essential to help health care professionals and patients identify validated apps.
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Affiliation(s)
- Mickael Toïgo
- Department of General Practice, Univ Montpellier, Montpellier, France
| | - Julie Marc
- Department of General Practice, Univ Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, Department of Public Health, Univ Montpellier, CHU Montpellier, Montpellier, France
- Pathogenesis and Control of Chronic and Emerging Infections, Univ Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Francois Carbonnel
- Department of General Practice, Univ Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
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Mac Eochagain C, Senac NMG, Cavanagh M, Roy M, Ciccone AS, Contreras B, Testa GD, Velasco R, Marinho J, Serrano AG, Schiaffino MK, Gomes F. Digital health in geriatric oncology: A Young International Society of Geriatric Oncology review. J Geriatr Oncol 2023; 14:101649. [PMID: 38682324 DOI: 10.1016/j.jgo.2023.101649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 05/01/2024]
Abstract
The integration of digital health technologies in geriatric oncology has the potential to enhance patient care and self-management. This review article discusses the applications of these technologies, including teleassessment, telemonitoring, and teleintervention, within geriatric oncology, and evaluates their potential to improve cancer care and patient outcomes. We also review challenges to the implementation of digital health technologies among populations of older patients with cancer. The article provides a perspective for clinicians, researchers, policymakers, and patients on the integration and utilisation of digital health technologies in current geriatric oncology practice.
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Affiliation(s)
- Colm Mac Eochagain
- Trinity St James Cancer Institute, Dublin, Ireland; Royal Marsden Hospital, London, UK.
| | - Nicolas Maria Gonzalez Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Cavanagh
- Medical Oncology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Mukul Roy
- Department of Radiation Oncology, Jaslok Hospital, Mumbai, India
| | - Andrea Sebastiano Ciccone
- Université Côte d'Azur, Sophia-Antipolis INSERM U1081, CNRS UMR 7284, Centre Hospitalier, Universitaire de Nice, Hôpital de Cimiez, Nice, France
| | | | - Giuseppe Dario Testa
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Rogelio Velasco
- Clinical Trial and Research Divison, Philippine Heart Center, Quezon City, Philippines; Lung Center of the Philippines, Quezon City, Philippines
| | - Joana Marinho
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Adolfo Gonzalez Serrano
- Urology Department, Hospital Universitari Son Espases, Palma, Spain; Inserm, IMRB, Université Paris-Est-Créteil, Créteil, France
| | - Melody K Schiaffino
- School of Public Health, Division of Health Management and Policy, San Diego State University, San Diego, CA, United States of America; Center for Health Equity, Education and Research (CHEER), University of California San Diego, La Jolla, CA, United States of America; UC San Diego School of Medicine, CA, United States of America
| | - Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK
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Espinosa García J, Aliaga Gutiérrez L, López Simarro F, Alonso Moreno FJ, Ricote Belinchón M, Montero Peña C, Manzano Vilches A. [Therapeutic adherence of patients with cardiovascular risk in primary care. REAAP project]. Semergen 2023; 49:102016. [PMID: 37327740 DOI: 10.1016/j.semerg.2023.102016] [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: 02/14/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. MATERIAL AND METHODS A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. RESULTS Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients' therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. CONCLUSIONS There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves.
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Affiliation(s)
- J Espinosa García
- Medicina Familiar y Comunitaria, Centro de Salud Villanueva de la Serena Norte, Badajoz. Excoordinador del Grupo de Trabajo de Adherencia Terapéutica e Inercia Clínica y miembro del Grupo de Trabajo de Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente de SEMERGEN. Jefe de estudios UDMAFYC , Don Benito-Villanueva de la Serena, Badajoz, España.
| | - L Aliaga Gutiérrez
- Medicina Familiar y Comunitaria, Centro de Salud Sevilla la Nueva, Madrid. Coordinadora del Grupo de Trabajo de Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente de SEMERGEN, España
| | - F López Simarro
- Medicina Familiar y Comunitaria, Barcelona. Miembro de los Grupos de Trabajo de Diabetes Mellitus y Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente de SEMERGEN, España
| | - F J Alonso Moreno
- Medicina Familiar y Comunitaria, Centro de Salud de Sillería, Toledo. Miembro de los Grupos de Trabajo de Hipertensión Arterial y Enfermedad Cardiovascular, Grupo de Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente, y Grupo de Enfermedades Infecciosas, Migrantes, Vacunas y Actividades Preventivas (IMVAP) de SEMERGEN, España
| | - M Ricote Belinchón
- Medicina Familiar y Comunitaria, Centro de Salud Mar Báltico, Madrid. Miembro del Grupo de Trabajo de Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente de SEMERGEN y responsable de SEMERGEN para la Cartera de Servicios de Atención Primaria en el Ministerio de Sanidad, España
| | - C Montero Peña
- Residente de Medicina Familiar y Comunitaria, Unidad docente multiprofesional Don Benito-Villanueva de la Serena, Badajoz. Miembro de los Grupos de Trabajo de Diabetes Mellitus y de Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente de SEMERGEN, España
| | - A Manzano Vilches
- Residente de Medicina Familiar y Comunitaria, Centro de Salud María de Guzmán, Alcalá de Henares, Madrid. Miembro del Grupo de Trabajo de Gestión del Medicamento, Inercia Clínica y Seguridad del Paciente de SEMERGEN, España
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Mikkelsen TH, Søndergaard J, Kjaer NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Handling polypharmacy -a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr 2023; 23:477. [PMID: 37553585 PMCID: PMC10410867 DOI: 10.1186/s12877-023-04131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs. METHODS We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients' management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists. RESULTS The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers. CONCLUSION Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication's timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjaer
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, 6 The, Odense, Denmark
| | - Lene Juel Kjeldsen
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Jimenez J, del Rio A, Berman AN, Grande M. Personalizing Digital Health: Adapting Health Technology Systems to Meet the Needs of Different Older Populations. Healthcare (Basel) 2023; 11:2140. [PMID: 37570380 PMCID: PMC10419052 DOI: 10.3390/healthcare11152140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The ageing of the population is growing significantly and will challenge healthcare systems. Chronic diseases in the older population require a change in service delivery, and new technologies can be a key element in ensuring the viability and sustainability of these systems. However, the generation gap and the physical and cognitive decline commonly associated with the older generation are barriers to the transition to these models of care. Despite this, there has been a trend towards digital healthcare, which has many potential benefits for the older population. Numerous studies have assessed the acceptability of new technologies for older people in healthcare. These studies highlight the importance of perceived usefulness, compatibility, ease of use and personalisation of the technology. Personalisation is necessary to ensure that the system is useful for users, and different characteristics such as country of origin, gender, age, or comfort with the technology should be taken into account. A person-centred approach in the development of new health technology systems is essential to ensure that applications can be better tailored to the needs of different ageing populations. Many organisations have dedicated time and resources to ensure a person-centred approach in the development of new health technology systems, and putting the individual first is the best way forward in digital health. This article presents the work carried out in this regard in the framework of the European TeNDER project together with an analysis of the results obtained in terms of satisfaction, usefulness, and usability from end-users. The dynamic and continuous process carried out throughout the TeNDER project translates the needs reported by users, as far as personalisation of interactions is concerned. All end-users held a positive opinion about the usability and usefulness of the system.
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Affiliation(s)
- Jennifer Jimenez
- Asociación Parkinson Madrid, 28014 Madrid, Spain; (A.N.B.); (M.G.)
| | - Alberto del Rio
- GATV Research Group, Signals, Systems and Radiocommunications Department, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | | | - Miriam Grande
- Asociación Parkinson Madrid, 28014 Madrid, Spain; (A.N.B.); (M.G.)
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10
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Cafaro T, LaRiccia PJ, Bandomer B, Goldstein H, Brobyn TL, Hunter K, Roy S, Ng KQ, Mitrev LV, Tsai A, Thwing D, Maag MA, Chung MK, van Helmond N. Remote and semi-automated methods to conduct a decentralized randomized clinical trial. J Clin Transl Sci 2023; 7:e153. [PMID: 37528946 PMCID: PMC10388435 DOI: 10.1017/cts.2023.574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Designing and conducting clinical trials is challenging for some institutions and researchers due to associated time and personnel requirements. We conducted recruitment, screening, informed consent, study product distribution, and data collection remotely. Our objective is to describe how to conduct a randomized clinical trial using remote and automated methods. Methods A randomized clinical trial in healthcare workers is used as a model. A random group of workers were invited to participate in the study through email. Following an automated process, interested individuals scheduled consent/screening interviews. Enrollees received study product by mail and surveys via email. Adherence to study product and safety were monitored with survey data review and via real-time safety alerts to study staff. Results A staff of 10 remotely screened 406 subjects and enrolled 299 over a 3-month period. Adherence to study product was 87%, and survey data completeness was 98.5% over 9 months. Participants and study staff scored the System Usability Scale 93.8% and 90%, respectively. The automated and remote methods allowed the study maintenance period to be managed by a small study team of two members, while safety monitoring was conducted by three to four team members. Conception of the trial to study completion was 21 months. Conclusions The remote and automated methods produced efficient subject recruitment with excellent study product adherence and data completeness. These methods can improve efficiency without sacrificing safety or quality. We share our XML file for researchers to use as a template for learning purposes or designing their own clinical trials.
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Affiliation(s)
- Teresa Cafaro
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ, USA
- Cooper Research Institute, Cooper University Health Care, Camden, NJ, USA
- Won Sook Chung Foundation, Moorestown, NJ, USA
| | - Patrick J. LaRiccia
- Won Sook Chung Foundation, Moorestown, NJ, USA
- Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Tracy L. Brobyn
- Won Sook Chung Foundation, Moorestown, NJ, USA
- The Chung Institute of Integrative Medicine, Moorestown, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Krystal Hunter
- Cooper Research Institute, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Division of General Internal Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Kevin Q. Ng
- Won Sook Chung Foundation, Moorestown, NJ, USA
- The Chung Institute of Integrative Medicine, Moorestown, NJ, USA
- Division of Infectious Disease, Cooper University Health Care, Camden, NJ, USA
| | - Ludmil V. Mitrev
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Alan Tsai
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | - Myung K. Chung
- Won Sook Chung Foundation, Moorestown, NJ, USA
- The Chung Institute of Integrative Medicine, Moorestown, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Department of Family Medicine, Cooper University Health Care, Camden, NJ, USA
| | - Noud van Helmond
- Department of Anesthesiology, Cooper University Health Care, Camden, NJ, USA
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Rostam Niakan Kalhori S, Rahmani Katigari M, Talebi Azadboni T, Pahlevanynejad S, Hosseini Eshpala R. The effect of m-health applications on self-care improvement in older adults: A systematic review. Inform Health Soc Care 2023. [PMID: 36867051 DOI: 10.1080/17538157.2023.2171878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PARTICIPANTS Four electronic databases were searched on March 6, 2020 including Scopus, PubMed, ISI, and Embase. METHODS Our search consisted of concepts of "self-care," "elderly" and "Mobile device." English journal papers and, RCTs conducted for individuals older than 60 in the last 10 years were included. A narrative approach was used to synthesize the data due to the heterogeneous nature of the data. RESULTS Initially, 3047 studies were obtained and finally 19 studies were identified for deep analysis. 13 outcomes were identified in m-health interventions to help older adults' self-care. Each outcome has at least one or more positive results. The psychological status and clinical outcome measures were all significantly improved. CONCLUSION According to the findings, it is not possible to draw a definite positive decision about the effectiveness of interventions on older adults because the measures are very diverse and have been measured with different tools. However, it might be declared that m-health interventions have one or more positive results and can be used along with other interventions to improve the health of older adults.
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Affiliation(s)
- Sharareh Rostam Niakan Kalhori
- Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Braunschweig, Germany.,Ph.D of Medical Informatics, Health Information Technology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Rahmani Katigari
- PhD in Health Information Management, Health Information Technology Department, Saveh University of Medical Sciences, Saveh, Iran.,Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Tahere Talebi Azadboni
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,Ph.D Candidate, Health Information Management Department, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Pahlevanynejad
- Ph.D in Health Information Management, Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Rahil Hosseini Eshpala
- Ph.D Candidate, Health Information Management Department, Tehran University of Medical Sciences, Tehran, Iran
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12
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Gomes MLF, Da Silva Fernandes C, Sousa MGAD, Silva RLBD, Silva IDJMDC, Barros LM. Aplicaciones móviles dirigidas a personas mayores para la autogestión del cuidado: revisión del alcances. REVISTA CUIDARTE 2023. [DOI: 10.15649/cuidarte.2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Introducción: el uso de aplicaciones móviles puede facilitar la autogestión en salud y brindar oportunidades para la autonomía de las personas mayores en su autocuidado. Objetivo: mapear la producción científica en aplicaciones móviles para la autogestión del cuidado dirigido a las personas mayores. Materiales y Métodos: revisión de alcance realizada desde septiembre de 2020 a enero de 2021, con base en las siguientes bases de datos: MEDLINE, SciELO, Scopus, Web of Science y Science Direct, utilizando la estrategia de búsqueda: (“Self-management” OR “Self-care”) AND (Elderly OR “Old man”) AND (“Mobile Applications” OR Smartphone OR “Cell phone”), con la inclusión de artículos que tratan sobre el uso de aplicaciones móviles por parte de los ancianos para la autogestión de cuidado, sin limitaciones de tiempo e idioma. Resultados: la muestra final constó de 14 artículos, categorizados en tres aspectos del manejo, a saber: medicamentos, comorbilidades y prácticas saludables. En la mayoría de los estudios, las aplicaciones estuvieron dirigidas al autocontrol de los medicamentos, seguido de la atención de las condiciones crónicas y finalmente la autoevaluación del riesgo de caídas y los tratamientos no farmacológicos del dolor. Discusión: esta revisión contribuye a la práctica clínica y la investigación en enfermería, ya que sus resultados apuntan a lo publicado sobre el desarrollo y uso de aplicaciones móviles por parte de los ancianos para la autogestión del cuidado. Conclusiones: el uso de aplicaciones móviles facilita el autocuidado de la población anciana, especialmente en el manejo de la medicación para enfermedades crónicas.
Como citar este artículo: Gomes, Manoelise Linhares Ferreira; Fernandes, Cristina da Silva; Sousa, Maria Gabrieli Aguiar de; Silva, Raimunda Leandra Bráz da; Silva, Illeanne de Jesus Manhiça da Costa; Barros, Lívia Moreira. Aplicativos móveis direcionados aos idosos para autogerenciamento do cuidado: revisão de escopo. Revista Cuidarte. 2023;14(1):e2594. http://dx.doi.org/10.15649/cuidarte.2594
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13
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Fernández C, Vicente MA, Guilabert M, Carrillo I, Mira JJ. Developing a mobile health app for chronic illness management: Insights from focus groups. Digit Health 2023; 9:20552076231210662. [PMID: 37928329 PMCID: PMC10621305 DOI: 10.1177/20552076231210662] [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] [Accepted: 10/12/2023] [Indexed: 11/07/2023] Open
Abstract
Background Mobile applications have the potential to assist patients and caregivers in managing chronic diseases, but current offerings are typically limited to a single disease or only focused on patients. A multifaceted app could expand the user base and provide more comprehensive support for patients who usually suffer from diverse chronic conditions at the same time and their caregivers. Objectives This study aimed to design, develop, and evaluate a mobile application that could aid chronic patients and their caregivers in managing the range of chronic conditions. Methods Focus group meetings were conducted with patients and caregivers to identify their needs, which were translated into app functionalities. The final version of the app was evaluated through a survey and analysis of the most used features. Results Five focus group (FG) meetings were held, involving 39 patients and 22 caregivers. The app included medication aids, self-monitoring aids, activation reminders, messages for caregiver shifts, remote monitoring, medicine management, and informative videos. Testing by 65 patients revealed that medication reminders (96.8% positive responses), medicine information (96.8%), messages for caregiver shifts (90.3%), and ease of use (80.6%) were the most valued aspects. The most frequently used feature was the health data record check. Conclusions A multifaceted mobile application can address the needs of a variety of chronic patients and their caregivers, while still being easy to use. The app's most used functionalities were aligned with the needs expressed in the FG, which reflects the success of this study and suggests that future research could benefit from incorporating similar user-centered design methodologies.
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Affiliation(s)
- César Fernández
- Telematics Engineering, Miguel Hernandez University, Elche, Spain
| | | | | | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - José Joaquín Mira
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
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14
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Pratiwi H, Kristina SA, Widayanti AW, Prabandari YS, Kusuma IY. A Systematic Review of Compensation and Technology-Mediated Strategies to Maintain Older Adults' Medication Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:803. [PMID: 36613130 PMCID: PMC9819645 DOI: 10.3390/ijerph20010803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/16/2023]
Abstract
Elderly medication adherence is a challenge in health care. The elderly are often at higher risk for non-adherence, and more likely to be on multiple prescription medications for many comorbidities. This systematic review aimed to explore the current strategies for maintaining older adults' medication adherence with compensation and technology-mediated strategies. We conducted a systematic review to examine related articles published in the PubMed, Web of Science, and Scopus databases, as well as Google Scholar for additional reference sources by cross-reference review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this review. A total of 217 articles were screened, and 27 studies fulfilled the inclusion criteria. Older adults applied a variety of methods to maintain or enhance their medication adherence. Three studies indicated compensation strategies, 19 studies reported technological assistance, two studies used other strategies (community-offered help or caregivers help), and three studies used a combination of compensation with another strategy or technology. Studies identified various compensation- and technology-based strategies carried out by older adults to help remind them to take medication. This review identified potential benefits of technology and compensation strategy implementation in older adults to increase medication adherence. Although we are conscious of the heterogeneity of the included studies, it remains challenging to determine which elements underpin the most effective approaches.
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Affiliation(s)
- Hening Pratiwi
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pharmacy, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto 53122, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Anna Wahyuni Widayanti
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Yayi Suryo Prabandari
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Ikhwan Yuda Kusuma
- Pharmacy Study Program, Faculty of Health, Universitas Harapan Bangsa, Purwokerto 53182, Indonesia
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15
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Leung T, Victorino A, Lemos M, Porojan L, Costa A, Arriaga M, Gregório MJ, de Sousa RD, Rodrigues AM, Canhão H. A Video-Based Mobile App as a Health Literacy Tool for Older Adults Living at Home: Protocol for a Utility Study. JMIR Res Protoc 2022; 11:e29675. [PMID: 36476754 PMCID: PMC9773022 DOI: 10.2196/29675] [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: 04/16/2021] [Revised: 11/25/2021] [Accepted: 05/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People aged ≥65 years are more likely to have health problems related to aging, polypharmacy, and low treatment adherence. Moreover, health literacy levels decrease with increasing age. OBJECTIVE The aim of this study is to assess an app's utility in promoting health-related knowledge in people aged ≥65 years. METHODS We developed a simple, intuitive, and video-based app (DigiAdherence) that presents a recipe, nutritional counseling, and content on physical activity, cognitive exercise, motivation to adhere to treatment, fall prevention, and health literacy. A convenience sample of 25 older adults attending the Personalized Health Care Unit of Portimão or the Family Health Unit of Portas do Arade (ACeS Algarve II - Barlavento, ARS Algarve, Portugal) will be recruited. Subjects must be aged ≥65 years, own a smartphone or tablet, be willing to participate, and consent to participate. Those who do not know how to use or do not have a smartphone/tablet will be excluded. Likewise, people with major cognitive or physical impairment as well as those living in a long-term care center will not be included in this study. Participants will have access to the app for 4 weeks and will be evaluated at 3 different timepoints (V0, before they start using the app; V1, after using it for 30 days; and V2, 60 days after stopping using it). After using the app for 30 days, using a 7-point Likert scale, participants will be asked to score the mobile tool's utility in encouraging them to take their medications correctly, improving quality of life, increasing their health-related knowledge, and preventing falls. They will also be asked to assess the app's ease of use and visual esthetics, their motivation to use the app, and their satisfaction with the app. Subjects will be assessed in a clinical interview with a semistructured questionnaire, including questions regarding user experience, satisfaction, the utility of the app, quality of life (EQ-5D-3L instrument), and treatment adherence (Morisky scale). The proportion of participants who considered the app useful for their health at V1 and V2 will be analyzed. Regarding quality of life and treatment adherence perceptions, comparisons will be made between V0 and V1, using the t test for dependent samples. The same comparisons will be made between V0 and V2. RESULTS This study was funded in December 2019 and authorized by the Executive Board of ACeS Algarve II - Barlavento and by the Ethics Committee of NOVA Medical School (99/2019/CEFCM, June 2020). This protocol was also approved by the Ethics Committee for Health (16/2020, September 2020) and the Executive Board (December 2020) of the Regional Health Administration of the Algarve, IP (Instituto Público). Recruitment was completed in June 2021. CONCLUSIONS Since the next generation of older adults may have higher digital literacy, information and communication technologies could potentially be used to deliver health-related content to improve lifestyles among older adults. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/29675.
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Affiliation(s)
| | - André Victorino
- Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Costa da Caparica, Portugal
| | - Marta Lemos
- Unidade de Saúde Pública Algarve II - Barlavento, Centro de Saúde de Portimão, Portimão, Portugal
| | - Ludmila Porojan
- Unidade de Saúde Pública Algarve II - Barlavento, Centro de Saúde de Portimão, Portimão, Portugal
| | - Andreia Costa
- Direção-Geral da Saúde, Lisbon, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal.,Catolica Research Centre for Psychological, Family and Social Wellbeing, Lisbon, Portugal
| | - Miguel Arriaga
- Direção-Geral da Saúde, Lisbon, Portugal.,Catolica Research Centre for Psychological, Family and Social Wellbeing, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal.,Programa Nacional para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisbon, Portugal
| | - Rute Dinis de Sousa
- Comprehensive Health Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Helena Canhão
- Comprehensive Health Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Episaúde - Associação Científica, Évora, Portugal
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Zhou TT, Wang R, Gu SJ, Xie LL, Zhao QH, Xiao MZ, Chen YL. Effectiveness of Mobile Medical Apps in Ensuring Medication Safety Among Patients With Chronic Diseases: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e39819. [PMID: 36413386 PMCID: PMC9727690 DOI: 10.2196/39819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Along with the rapid growth of the global aging society, the mobile and health digital market has expanded greatly. Countless mobile medical apps (mmApps) have sprung up in the internet market, aiming to help patients with chronic diseases achieve medication safety. OBJECTIVE Based on the medication safety action plans proposed by the World Health Organization, we aimed to explore the effectiveness of mmApps in ensuring the medication safety of patients with chronic diseases, including whether mmApps can improve the willingness to report adverse drug events (ADEs), improve patients' medication adherence, and reduce medication errors. We hoped to verify our hypothesis through a systematic review and meta-analysis. METHODS The meta-analysis was performed in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included literature searched from 7 databases-PubMed, Web Of Science, Embase, CINAHL, China National Knowledge Infrastructure, Wanfang, and SinoMed. The publication time was limited to the time of database establishment to April 30, 2022. Studies were screened based on inclusion and exclusion criteria. The data extracted included authors, years of publication, countries or regions, participants' characteristics, intervention groups, and control groups, among others. Our quality assessment followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, Version 6.3. RevMan 5.2 software (Cochrane Collaboration) was used to analyze the statistical data, and a sensitivity analysis was performed to assess data stability. The degree of stability was calculated by using a different statistical method and excluding large-sample studies from the analysis. RESULTS We included 8 studies from 5 countries (China, the United States, France, Canada, and Spain) that were published from January 1, 2014, to December 31, 2021. The total number of participants was 1355, and we analyzed the characteristics of included studies, each app's features, the risk of bias, and quality. The results showed that mmApps could increase ADE reporting willingness (relative risk [RR] 2.59, 95% CI 1.26-5.30; P=.009) and significantly improve medication adherence (RR 1.17, 95% CI 1.04-1.31; P=.007), but they had little effect on reducing medication errors (RR 1.54, 95% CI 0.33-7.29; P=.58). CONCLUSIONS We analyzed the following three merits of mmApps, with regard to facilitating the willingness to report ADEs: mmApps facilitate more communication between patients and physicians, patients attach more importance to ADE reporting, and the processing of results is transparent. The use of mmApps improved medication adherence among patients with chronic diseases by conveying medical solutions, providing educational support, tracking medications, and allowing for remote consultations. Finally, we found 3 potential reasons for why our medication error results differed from those of other studies. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022322072; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322072.
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Affiliation(s)
- Ting Ting Zhou
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Wang
- Hepatobiliary Surgery, The Second Affliated Hospital of Chongqing Medical University, Chongqing, China
| | - Si Jia Gu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Ling Xie
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Hua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming Zhao Xiao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Lu Chen
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Vicente MA, Fernández C, Guilabert M, Carrillo I, Martín-Delgado J, Mira JJ. Patient Engagement Using Telemedicine in Primary Care during COVID-19 Pandemic: A Trial Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14682. [PMID: 36429402 PMCID: PMC9690471 DOI: 10.3390/ijerph192214682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
The correct treatment of most non-transmissible diseases requires, in addition to adequate medication, adherence to physical activity and diet guidelines, as well as health data monitoring and patient motivation. The restrictions caused by the COVID-19 pandemic made telemedicine tools and mobile apps the best choice for monitoring patient compliance. The objective of this study was to analyze the benefits of an m-Health solution designed specifically for chronic patients during the COVID-19 pandemic. A pragmatic clinical trial with pre-post measurements of a single group was carried out with 70 patients (aged 40+) with one or more chronic conditions. Patients were provided with an ad hoc mobile app and health data measuring devices according to their diseases. The health status of the patients was monitored remotely by health professionals who could also modify the patient's objectives according to their evolution. The results obtained show an average fulfillment of objectives of 77%. Higher fulfillment values: medication adherence (98%) and oxygen saturation (82%); lower fulfillment values: weight (48%), glucose (57%), and distance walked (57%). Globally, the ad hoc app was rated 8.72 points out of 10 (standard deviation 1.10). Concerning the pre-post analysis, there were significant improvements vs. prior apps used by the participants in the following items: improved physical activation and better control of blood pressure, diet, weight, glucose, and oxygen saturation. In conclusion, the telemedicine tool developed was useful in increasing patient engagement and adherence to treatment.
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Affiliation(s)
| | - César Fernández
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
| | - Jimmy Martín-Delgado
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 0313 Alicante, Spain
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil 090603, Ecuador
| | - José Joaquín Mira
- Health Psychology Department, Miguel Hernandez University, 03202 Elche, Spain
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 0313 Alicante, Spain
- Alicante-Sant Joan d’Alacant Health Department, 03013 Alicante, Spain
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18
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Chaudhry BM, Dasgupta D, Chawla NV. Successful Aging for Community-Dwelling Older Adults: An Experimental Study with a Tablet App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13148. [PMID: 36293730 PMCID: PMC9603432 DOI: 10.3390/ijerph192013148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 05/08/2023]
Abstract
Mobile health (mHealth) technologies offer an opportunity to enable the care and support of community-dwelling older adults, however, research examining the use of mHealth in delivering quality of life (QoL) improvements in the older population is limited. We developed a tablet application (eSeniorCare) based on the Successful Aging framework and investigated its feasibility among older adults with low socioeconomic status. Twenty five participants (females = 14, mean age = 65 years) used the app to set and track medication intake reminders and health goals, and to play selected casual mobile games for 24 weeks. The Older person QoL and Short Health (SF12v2) surveys were administered before and after the study. The Wilcoxon rank tests were used to determine differences from baseline, and thematic analysis was used to analyze post-study interview data. The improvements in health-related QoL (HRQoL) scores were statistically significant (V=41.5, p=0.005856) across all participants. The frequent eSeniorCare users experienced statistically significant improvements in their physical health (V=13, p=0.04546) and HRQoL (V=7.5, p=0.0050307) scores. Participants reported that the eSeniorCare app motivated timely medication intake and health goals achievement, whereas tablet games promoted mental stimulation. Participants were willing to use mobile apps to self-manage their medications (70%) and adopt healthy activities (72%), while 92% wanted to recommend eSeniorCare to a friend. This study shows the feasibility and possible impact of an mHealth tool on the health-related QoL in older adults with a low socioeconomic status. mHealth support tools and future research to determine their effects are warranted for this population.
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Affiliation(s)
- Beenish Moalla Chaudhry
- School of Computing and Informatics, University of Louisiana at Lafayette, 104 E. University Circle, Lafayette, LA 70501, USA
| | - Dipanwita Dasgupta
- Department of Computer Science and Engineering, University of Notre Dame, Indiana, IN 46656, USA
| | - Nitesh V. Chawla
- Department of Computer Science and Engineering, University of Notre Dame, Indiana, IN 46656, USA
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19
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Spetz K, Hult M, Olbers T, Bonn S, Svedjeholm S, Lagerros YT, Andersson E. A smartphone application to improve adherence to vitamin and mineral supplementation after bariatric surgery. Obesity (Silver Spring) 2022; 30:1973-1982. [PMID: 36050801 PMCID: PMC9805084 DOI: 10.1002/oby.23536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This trial evaluated a smartphone application's effectiveness in improving adherence to vitamin and mineral supplementation postoperatively. METHODS This study was a randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 to the 12-week intervention, using the smartphone application PromMera, or to standard care. The primary end point was adherence to vitamin and mineral supplementation. RESULTS Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before the intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B12 (-9.6% [SD = 27%] vs. -9.3% [SD = 30%]; p = 0.48) or calcium/vitamin D (-12.3% [SD = 29%] vs. -11.5% [SD = 32%]; p = 0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5) was seen immediately after the intervention (intervention group 0.00 [SD = 1.3] vs. control group -1.2 [SD = 3.5]; p = 0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies. CONCLUSIONS The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation 1 year post bariatric surgery.
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Affiliation(s)
- Kristina Spetz
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
| | - Mari Hult
- Division of Upper Abdominal Diseases, Karolinska University Hospital, and Unit of Gastroenterology, Department of Medicine (Huddinge)Karolinska InstitutetStockholmSweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
| | - Stephanie Bonn
- Clinical Epidemiology Division, Department of Medicine (Solna)Karolinska InstitutetStockholmSweden
| | - Sanna Svedjeholm
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, and Center for ObesityAcademic Specialist Center, Stockholm Health ServicesStockholmSweden
| | - Ellen Andersson
- Department of Surgery and Department of Biomedical and Clinical SciencesLinköping UniversityNorrköpingSweden
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20
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Jakob R, Harperink S, Rudolf AM, Fleisch E, Haug S, Mair JL, Salamanca-Sanabria A, Kowatsch T. Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review. J Med Internet Res 2022; 24:e35371. [PMID: 35612886 PMCID: PMC9178451 DOI: 10.2196/35371] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/31/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. OBJECTIVE This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. METHODS A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. RESULTS The literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%). CONCLUSIONS This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app's intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data.
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Affiliation(s)
- Robert Jakob
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Samira Harperink
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Aaron Maria Rudolf
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland
| | - Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
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21
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Fotteler ML, Mühlbauer V, Brefka S, Mayer S, Kohn B, Holl F, Swoboda W, Gaugisch P, Risch B, Denkinger M, Dallmeier D. The Effectiveness of Assistive Technologies for Older Adults and the Influence of Frailty: Systematic Literature Review of Randomized Controlled Trials. JMIR Aging 2022; 5:e31916. [PMID: 35377322 PMCID: PMC9016506 DOI: 10.2196/31916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 12/05/2022] Open
Abstract
Background The use of assistive technologies (ATs) to support older people has been fueled by the demographic change and technological progress in many countries. These devices are designed to assist seniors, enable independent living at home or in residential facilities, and improve quality of life by addressing age-related difficulties. Objective We aimed to evaluate the effectiveness of ATs on relevant outcomes with a focus on frail older adults. Methods A systematic literature review of randomized controlled trials evaluating ATs was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Ovid Medline, PsycINFO, SocIndex, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Register of Controlled Trials), and IEEEXplore databases were searched from January 1, 2009, to March 15, 2019. ATs were included when aiming to support the domains autonomy, communication, or safety of older people with a mean age ≥65 years. Trials performed within a laboratory setting were excluded. Studies were retrospectively categorized according to the physical frailty status of participants. Results A total of 19 trials with a high level of heterogeneity were included in the analysis. Six device categories were identified: mobility, personal disease management, medication, mental support, hearing, and vision. Eight trials showed significant effectiveness in all or some of the primary outcome measures. Personal disease management devices seem to be the most effective, with four out of five studies showing significant improvement of disease-related outcomes. Frailty could only be assessed for seven trials. Studies including participants with significant or severe impairment showed no effectiveness. Conclusions Different ATs show some promising results in well-functioning but not in frail older adults, suggesting that the evaluated ATs might not (yet) be suitable for this subgroup. The uncertainty of the effectiveness of ATs and the lack of high-quality research for many promising supportive devices were confirmed in this systematic review. Large studies, also including frail older adults, and clear standards are needed in the future to guide professionals, older users, and their relatives. Trial Registration PROSPERO CRD42019130249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130249
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Affiliation(s)
- Marina Liselotte Fotteler
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany.,Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Viktoria Mühlbauer
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Simone Brefka
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Sarah Mayer
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Brigitte Kohn
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany.,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Petra Gaugisch
- Fraunhofer-Institute for Industrial Engineering, Stuttgart, Germany
| | - Beate Risch
- Fraunhofer-Institute for Industrial Engineering, Stuttgart, Germany
| | - Michael Denkinger
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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22
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Perin MS, São-João T, Gallani MCBJ, Agbadje TT, Rodrigues RCM, Cornélio ME. A mobile phone application intervention to promote healthy salt intake among adults: Protocol for a randomized controlled study (Preprint). JMIR Res Protoc 2022; 11:e37853. [PMID: 35767347 PMCID: PMC9280466 DOI: 10.2196/37853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. Objective This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. Methods This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. Results Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. Conclusions Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. Trial Registration The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq International Registered Report Identifier (IRRID) DERR1-10.2196/37853
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Affiliation(s)
| | - Thais São-João
- College of Nursing, University of Rhode Island, Kingston, RI, United States
| | | | - Titilayo Tatiana Agbadje
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada
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23
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Anitha V, Nair S, Ravindran M, Uduman MS. Comparing the effectiveness of different postoperative counseling methods for post-keratoplasty patients. Indian J Ophthalmol 2022; 70:517-522. [PMID: 35086229 PMCID: PMC9023921 DOI: 10.4103/ijo.ijo_1285_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To compare various counseling methods for improving patient education, compliance, and administration of eye drops prescribed for post-optical keratoplasty patients and assess the most efficient counseling method. METHODS A prospective, questionnaire-based pilot study was conducted among 60 post-optical keratoplasty patients who were randomly assigned into three groups for postoperative eye drop counseling, namely group 1 (video counseling), group 2 (chart counseling), and group 3 (verbal counseling at Cornea department). The questionnaire was answered by the patients/attendants applying the eye drops on the first 3 consecutive visits. McNemar-Bowker test was used to compare responses in each group and the Kruskal-Wallis test was used to compare responses among the three groups. The Institutional Ethics Committee of Aravind Eye Hospital, Tirunelveli (Registration number ECR 816/Inst/Tn/2016) approved this study. RESULTS Results demonstrated improvement in various categories assessed regarding drop administration in all three groups, which assessed patients' knowledge, attitude, and hygiene. Although all three groups showed improvements during subsequent follow-up visits, the video-counseling method was found to be an effective means of communication. CONCLUSION Our study emphasizes that the nonverbal and noncontact means of communication by video demonstration would be an effective way of counseling. It can be considered in the present scenario of the pandemic as well.
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Affiliation(s)
- Venugopal Anitha
- Cornea, Anterior Segment, Refractive Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Shobita Nair
- Cornea and Refractive Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Paediatric and Strabismus Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohammed Sithiq Uduman
- BioStatistician, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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24
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Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
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Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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25
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Yang C, Zhu S, Lee DTF, Chair SY. Interventions for improving medication adherence in community-dwelling older people with multimorbidity: A systematic review and meta-analysis. Int J Nurs Stud 2021; 126:104154. [PMID: 34953373 DOI: 10.1016/j.ijnurstu.2021.104154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multimorbidity is highly prevalent amongst older people. Compared with those with a single disease, older people with multimorbidity are more susceptible to medication nonadherence, which causes adverse health outcomes and increased health care costs. The effectiveness of interventions for improving medication adherence in this population is still unclear. OBJECTIVE To evaluate the effectiveness of interventions to improve medication adherence for community-dwelling older people with multimorbidity. DESIGN Systematic review and meta-analysis. DATA SOURCES Ten databases: Airiti Library, China National Knowledge Infrastructure, Cochrane CENTRAL, EBSCO CINAHL, OVID EMBASE, OVID MEDLINE, Proquest Central, PsycINFO, Wanfang Database and Web of Science Core Collection. REVIEW METHODS Studies evaluating the effects of interventions on medication adherence in community-dwelling older people with multimorbidity were included. Two researchers independently performed the study selection, data extraction and risk assessment. Intervention effects were pooled by random-effects meta-analysis. RESULTS A total of nine studies with 3,292 participants were included. Studies on self-management interventions revealed a significant and modest improvement in medication adherence (n = 3 studies; SMD 0.52; 95% CI 0.04 to 0.99; p = 0.03, I2 = 43%). Studies using electronic health interventions demonstrated a small yet significant benefit for medication adherence (n = 2 studies; SMD 0.22; 95% CI 0.02 to 0.42; p = 0.03, I2 = 0%). There was no pooled significant effect of medication review on medication adherence (n = 4 studies; SMD -0.03; 95% CI -0.21 to 0.15; p = 0.74, I2 = 68%). Most of the studies failed to yield a significant improvement in patients' health outcomes. CONCLUSIONS Self-management interventions and electronic health interventions might be effective in improving medication adherence for older people with multimorbidity. Future adherence interventions are needed to demonstrate improvements in medication adherence and health outcomes. PROSPERO REGISTRATION NUMBER CRD42020150500.
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Affiliation(s)
- Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Song Zhu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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26
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The effect of visual interventions on illness beliefs and medication adherence for chronic conditions: A scoping review of the literature and mapping to behaviour change techniques (BCTs). Res Social Adm Pharm 2021; 18:3239-3262. [PMID: 34815181 DOI: 10.1016/j.sapharm.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Maintaining health with chronic conditions often involves taking multiple medications; however, approximately 50% of patients with chronic conditions are non-adherent to medication. Patients' illness beliefs inform health behaviour, including medication-taking. Research has shown that visuals accompanying health information increased patient comprehension and the accuracy of illness perceptions. To date, the influence of visuals on illness beliefs and medication adherence has not been comprehensively reviewed. OBJECTIVES The review aimed to collate available literature on visualisation interventions for illness beliefs and medication adherence in chronic conditions and identify key intervention characteristics. METHODS A scoping review was conducted according to recommended guidelines and the PRISMA-ScR statement. Searches used keywords relating to 'illness', 'visual', 'adherence', 'illness perception', 'intervention', and 'medication'. Six databases were searched from inception to 2019; reference-list searching provided additional articles. Articles were included if the study population had a chronic health condition, the intervention included a visual element, had a measure of illness beliefs or medication adherence. Data regarding intervention characteristics and outcomes were extracted. Behaviour change techniques (BCTs) were identified to provide further insight into intervention characteristics. RESULTS Initially, 18,012 articles were identified. Screening led to 293 full-text articles, ultimately resulting in 45 studies for final analysis. Forty-four were quantitative studies, 1 was qualitative. Studies were grouped into those using visuals to conceptualise a condition, medication reminders and educational interventions. Almost two-thirds of visual interventions were effective post-intervention, 3 sustained post-1-year, although many studies only assessed impact immediately post-intervention. BCTs from 'Natural consequences', 'Socialsupport' and 'Feedback and monitoring' categories were prevalent in effective interventions for both outcomes, particularly the 'Salience of consequences' BCT. CONCLUSIONS This comprehensive scoping review found that visual interventions can positively influence illness beliefs and medication adherence. These findings highlight the need to further evaluate the impact and sustainability of visual interventions.
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Chen Z, Qi H, Wang L. Study on the Types of Elderly Intelligent Health Management Technology and the Influencing Factors of Its Adoption. Healthcare (Basel) 2021; 9:healthcare9111494. [PMID: 34828539 PMCID: PMC8619684 DOI: 10.3390/healthcare9111494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
[Background]: In recent years, aging has become a global social problem. Intelligent health management technology (IHMT) provides solutions for the elderly to deal with various health risks. However, the elderly are facing many difficulties in using IHMT. Studying the application types of IHMT and the influencing factors of the elderly’s acceptance of it will help to improve the use behavior of the elderly. [Methods]: This paper summarizes the application types of IHMT, identifies the influencing factors of the elderly’s adaption of IHMT, and makes a systematic comment on the influencing factors. [Results]: We divide the different functions of IHMT for the elderly into four types: self-monitoring, medical care, remote monitoring, and health education. The influencing factors are divided into three types: individual, social, and technology. [Conclusions]: This study finds that IHMT’s application covers all aspects of the health services of the elderly. Among these applications, self-monitoring is the most used. We divided the influencing factors of the elderly’s acceptance of IHMT into three categories and nine subcategories, having 25 variables.
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Affiliation(s)
- Zhu Chen
- School of Nursing, Peking University, Beijing 100191, China;
| | - Huiying Qi
- Department of Health Informatics and Management, School of Health Humanities, Peking University, Beijing 100191, China;
- Correspondence: ; Tel.: +86-10-82805574
| | - Luman Wang
- Department of Health Informatics and Management, School of Health Humanities, Peking University, Beijing 100191, China;
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Liu N, Yin J, Tan SSL, Ngiam KY, Teo HH. Mobile health applications for older adults: a systematic review of interface and persuasive feature design. J Am Med Inform Assoc 2021; 28:2483-2501. [PMID: 34472601 PMCID: PMC8510293 DOI: 10.1093/jamia/ocab151] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes. MATERIALS AND METHODS We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort. RESULTS We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education. DISCUSSION Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously. CONCLUSIONS This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.
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Affiliation(s)
- Na Liu
- Discipline of Business Information Systems, The University of Sydney Business School, Sydney, Australia
| | - Jiamin Yin
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Sharon Swee-Lin Tan
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Kee Yuan Ngiam
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Hock Hai Teo
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
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Vieira LB, Reis AMM, Ramos CDÁ, dos Reis TM, Cassiani SHDB. The use of an electronic medication organizer device with alarm to improve medication adherence of older adults with hypertension. EINSTEIN-SAO PAULO 2021; 19:eAO6011. [PMID: 34586158 PMCID: PMC8439558 DOI: 10.31744/einstein_journal/2021ao6011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/10/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine whether the use of a monthly electronic medication organizer device equipped with an alarm clock, called Electronic System for Personal and Controlled Use of Medications (Supermed), improves medication adherence of older adults with hypertension. METHODS This is a quali-quantitative, prospective, before-and-after study performed with 32 older adult patients with diagnosis of hypertension, who were recruited at a Primary Care Unit in Brazil. RESULTS The main outcome measures were improvement of medication adherence and blood pressure control after intervention with Supermed. Regarding medication adherence, 81.2% of patients were "less adherent" in the pre-intervention period, and 96.9% were "more adherent" in the post-intervention period. This means that 78.1% of patients changed from "less adherent" to "more adherent" after the intervention with Supermed (p<0.001). The mean systolic and diastolic blood pressure differences between intervention day and post-intervention were 18.5mmHg (p<0.0001) and 4.3mmHg (p<0.007), respectively, and the differences between mean systolic and diastolic blood pressure between pre-intervention and post-intervention were 21.6mmHg (p<0.001) and 4.7mmHg (p<0.001) respectively. CONCLUSION The use of Supermed significantly improved self-reported medication adherence and blood pressure control in a hypertensive older adult population.
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Affiliation(s)
- Liliana Batista Vieira
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrazilEscola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Adriano Max Moreira Reis
- Universidade Federal de Minas GeraisFaculdade de FarmáciaBelo HorizonteMGBrazilFaculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Celso de Ávila Ramos
- Universidade José do Rosário VellanoAlfenasMGBrazilUniversidade José do Rosário Vellano, Alfenas, MG, Brazil.
| | - Tiago Marques dos Reis
- Universidade Federal de AlfenasAlfenasMGBrazilUniversidade Federal de Alfenas, Alfenas, MG, Brazil.
| | - Silvia Helena de Bortoli Cassiani
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrazilEscola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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Sumner J, Chong L, Bundele A, Wei Lim Y. Co-Designing Technology for Aging in Place: A Systematic Review. THE GERONTOLOGIST 2021; 61:e395-e409. [PMID: 32506136 PMCID: PMC8437501 DOI: 10.1093/geront/gnaa064] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a growing interest to involve older adults in the co-design of technology to maintain their well-being and independence. What remains unknown is whether the beneficial effects of co-designed solutions are greater than those reported for non co-designed solutions. The aim of this study was to evaluate the effects and experiences of co-designed technology that support older adults to age in place. RESEARCH DESIGN AND METHODS We conducted a systematic review to (a) investigate the health and well-being outcomes of co-designed technology for older adults (≥60 years), (b) identify co-design approaches and contexts where they are applied, and (c) identify barriers and facilitators of the co-design process with older adults. Searches were conducted in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), Scopus, OpenGrey, and Business Source Premiere. RESULTS We identified 14,649 articles and included 34 projects. Four projects reported health and well-being outcomes; the effects were inconsistent. Co-design processes varied greatly and in their intensity of older adult involvement. Common facilitators of and barriers to co-design included the building of relationships between stakeholders, stakeholder knowledge of problems and solutions, and expertise in the co-design methodology. DISCUSSION AND IMPLICATIONS The effect of co-designed technology on health and well-being was rarely studied and it was difficult to ascertain its impact. Future co-design efforts need to address barriers unique to older adults. Evaluation of the impact of co-designed technologies is needed and standardization of the definition of co-design would be helpful to researchers and designers.
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Affiliation(s)
- Jennifer Sumner
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Lin Siew Chong
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Anjali Bundele
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
| | - Yee Wei Lim
- Yong Loo Lin School of Medicine, Department of Medicine, National University of Singapore, Singapore
- Medical Affairs— Research Innovation & Enterprise, Alexandra Hospital, National University Health System, Singapore
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Sockolow PS, Buck HG, Shadmi E. An integrative review of chronic illness mHealth self-care interventions: Mapping technology features to patient outcomes. Health Informatics J 2021; 27:14604582211043914. [PMID: 34488478 DOI: 10.1177/14604582211043914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mobile health (mHealth)-hand-held technologies to address health priorities-has significant potential to answer the growing need for patient chronic illness self-care interventions. Previous reviews examined mHealth effect on patient outcomes. None have a detailed examination and mapping of specific technology features to targeted health outcomes. Examine recent chronic illness mHealth self-care interventions; map the study descriptors, mHealth technology features, and study outcomes. (1) Information extracted from PubMed, CINAHL, and Web of Science databases for clinical outcomes studies published 2010-January 2020; and (2) realist synthesis techniques for within and across case analysis. From 652 records, 32 studies were examined. Median study duration was 19.5 weeks. Median sample size was 62 participants. About 47% of interventions used solely patient input versus digital input; 50% sent tailored messages versus generic messages; 22% augmented the intervention with human interaction. Studies with positive clinical outcomes had higher use of digital input. Software descriptions were lacking. Most studies built interventions: only two incorporated target audience participation in development. We recommend researchers provide sufficient system description detail. Future research includes: data input characteristics; impact of augmentation with human interaction on outcomes; and development decisions.
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Ng R, Carter SR, El-Den S. The impact of mobile applications on medication adherence: a systematic review. Transl Behav Med 2021; 10:1419-1435. [PMID: 31384950 DOI: 10.1093/tbm/ibz125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In 2008, Apple and Android launched their Application or "App" stores. Since then, there has been a growing interest in using mobile apps for improving medication adherence. However, research on the efficacy of apps, in terms of improved medication adherence and clinical outcome and/or patient-related outcome measures (PROMs) is scarce. The objective of this research was to systematically review the impact of apps on consumers' medication adherence and to determine the effect on clinical outcome and/or PROM(s). A systematic literature search was conducted to identify publications aimed at improving medication adherence published from January 2008 to April 2018. All studies were assessed for risk of bias using either the Risk Of Bias In Non-randomized Studies-of Interventions or the revised tool for Risk of Bias in randomized trials tool, depending on study design. Eleven randomized controlled trials (RCTs) and 10 non-RCTs were included. All 11 RCTs showed improvements in adherence; however, only seven reported statistically significant improvements in at least one adherence measure. Nine RCTs also demonstrated improvements in clinical outcome/PROM(s), of which five were statistically significant, whereas two RCTs did not report on clinical outcome/PROM(s). Only two studies using non-RCT study designs showed statistically significant improvements in all measures of adherence and clinical outcome/PROM(s). The risk of bias was moderate or serious for all included studies. Even though the use of an app may improve adherence, it is difficult to draw conclusions regarding the impact of apps on medication adherence due to the high degree of heterogeneity across studies, from the methodological design to the features of the app and the measure of adherence.
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Affiliation(s)
- Ricki Ng
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Stephen R Carter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Sarira El-Den
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
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Habib B, Buckeridge D, Bustillo M, Marquez SN, Thakur M, Tran T, Weir DL, Tamblyn R. Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge. JAMIA Open 2021; 4:ooab050. [PMID: 34345805 PMCID: PMC8325487 DOI: 10.1093/jamiaopen/ooab050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/10/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events. Materials and Methods We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up. Results Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%). Conclusion The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial. Trial registration Clinicaltrials.gov, registration number NCT04676165.
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Affiliation(s)
- Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - David Buckeridge
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | | | - Manish Thakur
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University Health Center, Montreal, Canada
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Sound-level Monitoring Earphones With Smartphone Feedback as an Intervention to Promote Healthy Listening Behaviors in Young Adults. Ear Hear 2021; 42:1173-1182. [PMID: 33974781 DOI: 10.1097/aud.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES More than a billion adolescents and youngsters are estimated to be at risk of acquiring recreational noise-induced hearing loss (RNIHL) due to the unsafe use of personal audio systems. RNIHL is preventable; therefore, the present study aimed to determine (i) the accuracy and reliability of dbTrack (Westone) sound-level monitoring earphones and (ii) the effect of sound-level monitoring earphones with smartphone feedback and hearing-health information as an intervention to promote healthy listening behaviors in young adults. DESIGN The study consisted of two phases: the first phase investigated the accuracy and reliability of dbTrack sound-level monitoring earphones. Accuracy was determined by comparing earphone measurements to sound level meter measurements. Intradevice reliability was determined by comparing earphone measurements during test-retest conditions. Nineteen participants were recruited through convenience sampling to determine within-subject reliability by comparing in-ear sound levels measured by the earphones during test-retest conditions. For the second phase of the study, a single-group pretest-posttest design was utilized. Forty participants, recruited through snowball sampling, utilized the sound-level monitoring earphones with the accompanying dbTrack smartphone application for 4 weeks. The application's smartphone feedback was disabled during the first 2 weeks (pretest condition) and enabled during the last 2 weeks (posttest condition). Average daily intensities, durations, and sound dosages measured during pre- and posttest conditions were compared. RESULTS Phase 1 dbTrack earphone measurements were within 1 dB when compared with sound level meter measurements. Earphones were also within 1 dB in repeated measures across earphones and across participants. Phase 2 posttest average daily intensity decreased by 8.7 dB (18.3 SD), duration decreased by 7.6 minutes (46.6 SD), and sound dose decreased by 4128.4% (24965.5% SD). Differences in intensity and sound dose were significantly lower with a small and medium effect size, respectively. CONCLUSIONS This study's preliminary data indicate that dbTrack (Westone) sound-level monitoring earphones with a calibrated in-ear microphone can reliably and accurately measure personal audio systems sound exposure. Preliminary results also suggest that feedback on sound exposure using the accurate sound-level monitoring earphones with the accompanying dbTrack application can potentially promote safe listening behavior in young adults and reduce the risk of acquiring an RNIHL.
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Medicine self-administration errors in the older adult population: A systematic review. Res Social Adm Pharm 2021; 17:1877-1886. [PMID: 33811011 DOI: 10.1016/j.sapharm.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medicine self-administration errors (MSEs) are a longstanding issue in patient safety. Although many studies have examined MSEs in the general adult population, the MSEs that occur specifically in the older adult population and their contributing factors are not well understood. OBJECTIVE To identify the types of MSEs and their contributing factors among community-dwelling older adults. METHODS PubMed, Medline, Embase, CINAHL and Scopus were searched for primary studies published between January 1, 2014 and June 12, 2020. Studies which reported MSEs among community-dwelling older adults (≥50 years of age) and written in English were included in the review. RESULTS Eleven studies met the inclusion criteria. The most commonly reported MSE was a dosing error, followed by missed dose, wrong medicine, incorrect administration methods, wrong administration time and wrong frequency. Seven of the included studies also described factors which contributed to the occurrence of MSEs. The most commonly reported factor contributing to MSEs was complex treatment regimens due to use of multiple medicines. Other factors identified included cognitive decline, decline in physical abilities, lack of social support, lack of knowledge about treatment regimens and negative attitudes and beliefs towards medicines. In most cases, MSEs occurred when multiple contributing factors were present. CONCLUSION The literature highlights a number of types of MSEs and their contributing factors which occur in the older adult population. Given that many MSEs are preventable, future research is needed into how pharmacists can support the identification and mitigation of factors contributing to MSEs in the older adult population.
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Mustafa N, Safii NS, Jaffar A, Sani NS, Mohamad MI, Abd Rahman AH, Mohd Sidik S. Malay Version of the mHealth App Usability Questionnaire (M-MAUQ): Translation, Adaptation, and Validation Study. JMIR Mhealth Uhealth 2021; 9:e24457. [PMID: 33538704 PMCID: PMC7894394 DOI: 10.2196/24457] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) apps play an important role in delivering education, providing advice on treatment, and monitoring patients' health. Good usability of mHealth apps is essential to achieve the objectives of mHealth apps efficiently. To date, there are questionnaires available to assess the general system usability but not explicitly tailored to precisely assess the usability of mHealth apps. Hence, the mHealth App Usability Questionnaire (MAUQ) was developed with 4 versions according to the type of app (interactive or standalone) and according to the target user (patient or provider). Standalone MAUQ for patients comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. OBJECTIVE This study aimed to translate and validate the English version of MAUQ (standalone for patients) into a Malay version of MAUQ (M-MAUQ) for mHealth app research and usage in future in Malaysia. METHODS Forward and backward translation and harmonization of M-MAUQ were conducted by Malay native speakers who also spoke English as their second language. The process began with a forward translation by 2 independent translators followed by harmonization to produce an initial translated version of M-MAUQ. Next, the forward translation was continued by another 2 translators who had never seen the original MAUQ. Lastly, harmonization was conducted among the committee members to resolve any ambiguity and inconsistency in the words and sentences of the items derived with the prefinal adapted questionnaire. Subsequently, content and face validations were performed with 10 experts and 10 target users, respectively. Modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the M-MAUQ was assessed by 51 healthy young adult mobile phone users. Participants needed to install the MyFitnessPal app and use it for 2 days for familiarization before completing the designated task and answer the M-MAUQ. The MyFitnessPal app was selected because it is one among the most popular installed mHealth apps globally available for iPhone and Android users and represents a standalone mHealth app. RESULTS The content validity index for the relevancy and clarity of M-MAUQ were determined to be 0.983 and 0.944, respectively, which indicated good relevancy and clarity. The face validity index for understandability was 0.961, which indicated that users understood the M-MAUQ. The kappa statistic for every item in M-MAUQ indicated excellent agreement between the raters (κ ranging from 0.76 to 1.09). The Cronbach α for 18 items was .946, which also indicated good reliability in assessing the usability of the mHealth app. CONCLUSIONS The M-MAUQ fulfilled the validation criteria as it revealed good reliability and validity similar to the original version. M-MAUQ can be used to assess the usability of mHealth apps in Malay in the future.
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Affiliation(s)
- Norashikin Mustafa
- Dietetics Program and Center for Community Health Study, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Department of Nutrition Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nik Shanita Safii
- Dietetics Program and Center for Community Health Study, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aida Jaffar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Primary Care Unit, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Malaysia, Sg Besi, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor Samsiah Sani
- Center for Artificial Intelligence Technology, Faculty of Information Sciences and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mohd Izham Mohamad
- Sports Nutrition Center, National Sport Institute, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Abdul Hadi Abd Rahman
- Center for Artificial Intelligence Technology, Faculty of Information Sciences and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Sherina Mohd Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Pouls BPH, Vriezekolk JE, Bekker CL, Linn AJ, van Onzenoort HAW, Vervloet M, van Dulmen S, van den Bemt BJF. Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review. J Med Internet Res 2021; 23:e18901. [PMID: 33416501 PMCID: PMC7822716 DOI: 10.2196/18901] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.
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Affiliation(s)
- Bart P H Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam,, Amsterdam, Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marcia Vervloet
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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Harish V, Morgado F, Stern AD, Das S. Artificial Intelligence and Clinical Decision Making: The New Nature of Medical Uncertainty. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:31-36. [PMID: 32852320 DOI: 10.1097/acm.0000000000003707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Estimates in a 1989 study indicated that physicians in the United States were unable to reach a diagnosis that accounted for their patient's symptoms in up to 90% of outpatient patient encounters. Many proponents of artificial intelligence (AI) see the current process of moving from clinical data gathering to medical diagnosis as being limited by human analytic capability and expect AI to be a valuable tool to refine this process. The use of AI fundamentally calls into question the extent to which uncertainty in medical decision making is tolerated. Uncertainty is perceived by some as fundamentally undesirable and thus, for them, optimal decision making should be based on minimizing uncertainty. However, uncertainty cannot be reduced to zero; thus, relative uncertainty can be used as a metric to weigh the likelihood of various diagnoses being correct and the appropriateness of treatments. Here, the authors make the argument, using as examples the experiences of 2 AI systems, IBM Watson on Jeopardy and Watson for Oncology, that medical decision making based on relative uncertainty provides a better lens for understanding the application of AI to medicine than one that minimizes uncertainty. This approach to uncertainty has significant implications for how health care leaders consider the benefits and trade-offs of AI-assisted and AI-driven decision tools and ultimately integrate AI into medical practice.
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Affiliation(s)
- Vinyas Harish
- V. Harish is a fourth-year MD-PhD student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6364-2439
| | - Felipe Morgado
- F. Morgado is a fourth-year MD-PhD student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-3000-9455
| | - Ariel D Stern
- A.D. Stern is associate professor, Technology and Operations Management Unit, Harvard Business School, Harvard University, Cambridge, Massachusetts; ORCID: https://orcid.org/0000-0002-3586-1041
| | - Sunit Das
- S. Das is associate professor, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2146-4168
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Dasgupta D, Chaudhry B, Greeves K, Long J, Duarte M, Chawla N. A Tablet-based App for Successful Aging in Community-Dwelling Older Adults with Low Socioeconomic Status: A Feasibility Study (Preprint). JMIR Aging 2020. [DOI: 10.2196/26686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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42
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Kraef C, van der Meirschen M, Free C. Digital telemedicine interventions for patients with multimorbidity: a systematic review and meta-analysis. BMJ Open 2020; 10:e036904. [PMID: 33051232 PMCID: PMC7554457 DOI: 10.1136/bmjopen-2020-036904] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/15/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of digital telemedicine interventions designed to improve outcomes in patients with multimorbidity. DESIGN Systematic review and meta-analysis of available literature. DATA SOURCES MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the Database of Abstracts of Reviews of Effectiveness and hand searching. The search included articles from inception to 19 April 2019 without language restrictions. The search was updated on 7 June 2020 without additional findings. ELIGIBILITY CRITERIA Prospective interventional studies reporting multimorbid participants employing interventions with at least one digital telemedicine component were included. Primary outcomes were patient physical or mental health outcomes, health-related quality of life scores and the utilisation of health services. RESULTS Out of 5865 studies initially identified, 7 articles, reporting on 6 studies were retained (total of 699 participants). Four of these studies reported interventions including integration with usual care, two studies had interventions with no links to usual patient care. Follow-up periods lasted between 2 and 6 months. Among the studies with links to usual care, the primary outcomes were systolic blood pressure (SBP) (three studies), haemoglobin A1c (HbA1c) (three studies), total cholesterol (two studies) and self-perceived health status (one study). The evidence ranged from very low to moderate certainty. Meta-analysis showed a moderate decrease in SBP (8 mm Hg (95% CI 4.6 to 11.4)), a small to moderate decrease in HbA1c (0.46 mg/dL (95% CI 0.25 to 0.67)) and moderate decrease in total cholesterol (cholesterol 16.5 mg/dL (95% CI 8.1 to 25.0)) in the intervention groups. There was an absence of evidence for self-perceived health status. Among the studies with no links to usual care, time to hospitalisation (median time to hospitalisation 113.4 days intervention and 104.7 days control group, absolute difference 12.7 days) and the Minnesota Living with Heart Failure Questionnaire (intervention group 35.2 score points, control group 23.9 points, absolute difference 11.3, 95% CI 5.5 to 17.1) showed small reductions. The Personal Health Questionnaire (PHQ-8) showed no evidence of improvement (intervention 7.6 points, control 8.6 points, difference 1.0 points, 95% CI -22.9% to 11.9%). CONCLUSION Digital telemedicine interventions provided moderate evidence of improvements in measures of disease control but little evidence and no demonstrated benefits on health status. Further research is needed with clear descriptions of conditions, interventions and outcomes based on patients' and healthcare providers' preferences. PROSPERO REGISTRATION NUMBER CRD42019134872.
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Affiliation(s)
- Christian Kraef
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Marc van der Meirschen
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Free
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Granata N, Traversoni S, Kardas P, Kurczewska-Michalak M, Costa E, Midão L, Giardini A. Methodological features of quantitative studies on medication adherence in older patients with chronic morbidity: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:2132-2141. [PMID: 32402488 DOI: 10.1016/j.pec.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/07/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The growing number of chronic, multimorbid older adults encourages healthcare systems to cope with polypharmacy and non-adherence. However, methodology on how to provide effective interventions to enhance medication adherence is still object of debate. METHODS To describe methodological features of quantitative studies concerning older adults' medication adherence, by means of a PRISMA systematic review (Scopus, PubMed, Medline). A specific focus was devoted to theoretical models and to the ABC Taxonomy model, as stated by the EMERGE guidelines. RESULTS 55 papers were included. Most of the studies were conducted using randomized control trials (63.6%) and focused on a single disease only (72.7%). Most of the interventions were provided by a single professional figure (70.9%). Medication adherence was mainly evaluated by means of questionnaires (61.8%) and by clinical records (30.9%). Sixteen studies considered a theoretical model in the intervention framework. The Initiation phase (ABC Taxonomy) was the most neglected. CONCLUSIONS Future studies upon medication adherence should account real-life challenges such as multimorbidity, polypharmacy and interdisciplinarity, analyzing adherence as a complex, holistic process. PRACTICE IMPLICATIONS Theoretical models may be useful to enhance the soundness of the results, to ease their comparability, to calibrate tailored strategies and to plan patient-centered interventions.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy
| | - Silvia Traversoni
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy
| | - Przemysław Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | | | - Elísio Costa
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - Luís Midão
- UCIBIO/REQUIMTE, Faculty of Pharmacy and Porto4Ageing, University of Porto, Porto, Portugal
| | - Anna Giardini
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Montescano, Pavia, Italy.
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Mustafa N, Safii NS, Jaffar A, Sani NS, Mohamad MI, Abd Rahman AH, Mohd Sidik S. Malay Version of the mHealth App Usability Questionnaire (M-MAUQ): Translation, Adaptation, and Validation Study (Preprint).. [DOI: 10.2196/preprints.24457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Mobile health (mHealth) apps play an important role in delivering education, providing advice on treatment, and monitoring patients’ health. Good usability of mHealth apps is essential to achieve the objectives of mHealth apps efficiently. To date, there are questionnaires available to assess the general system usability but not explicitly tailored to precisely assess the usability of mHealth apps. Hence, the mHealth App Usability Questionnaire (MAUQ) was developed with 4 versions according to the type of app (interactive or standalone) and according to the target user (patient or provider). Standalone MAUQ for patients comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness.
OBJECTIVE
This study aimed to translate and validate the English version of MAUQ (standalone for patients) into a Malay version of MAUQ (M-MAUQ) for mHealth app research and usage in future in Malaysia.
METHODS
Forward and backward translation and harmonization of M-MAUQ were conducted by Malay native speakers who also spoke English as their second language. The process began with a forward translation by 2 independent translators followed by harmonization to produce an initial translated version of M-MAUQ. Next, the forward translation was continued by another 2 translators who had never seen the original MAUQ. Lastly, harmonization was conducted among the committee members to resolve any ambiguity and inconsistency in the words and sentences of the items derived with the prefinal adapted questionnaire. Subsequently, content and face validations were performed with 10 experts and 10 target users, respectively. Modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the M-MAUQ was assessed by 51 healthy young adult mobile phone users. Participants needed to install the MyFitnessPal app and use it for 2 days for familiarization before completing the designated task and answer the M-MAUQ. The MyFitnessPal app was selected because it is one among the most popular installed mHealth apps globally available for iPhone and Android users and represents a standalone mHealth app.
RESULTS
The content validity index for the relevancy and clarity of M-MAUQ were determined to be 0.983 and 0.944, respectively, which indicated good relevancy and clarity. The face validity index for understandability was 0.961, which indicated that users understood the M-MAUQ. The kappa statistic for every item in M-MAUQ indicated excellent agreement between the raters (κ ranging from 0.76 to 1.09). The Cronbach α for 18 items was .946, which also indicated good reliability in assessing the usability of the mHealth app.
CONCLUSIONS
The M-MAUQ fulfilled the validation criteria as it revealed good reliability and validity similar to the original version. M-MAUQ can be used to assess the usability of mHealth apps in Malay in the future.
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Buck HG, Shadmi E, Topaz M, Sockolow PS. An integrative review and theoretical examination of chronic illness mHealth studies using the Middle-Range Theory of Self-care of Chronic Illness. Res Nurs Health 2020; 44:47-59. [PMID: 32931601 DOI: 10.1002/nur.22073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
Self-management, or self-care, by individuals and/or families is a critical element in chronic illness management as more care shifts to the home setting. Mobile device-enhanced health care, or mHealth, is being touted as a means to support self-care. Previous mHealth reviews examined the effect of mHealth on patient outcomes, however, none used a theoretical lens to examine the interventions themselves. The aims of this integrative review were to examine recent (e.g., last 10 years) chronic illness mHealth empiric studies and (1) categorize self-care behaviors engaged in the intervention according to the Middle-Range Theory of Self-care of Chronic Illness, and (2) conduct an analysis of gaps in self-care theory domains and behaviors utilized. Methods included: (1) Best practice study identification, collection, and data extraction procedures and (2) realist synthesis techniques for within and across case analysis. From a pool of 652 records, 33 primarily North American clinical trials, published between 2010 and 2019 were examined. Most mHealth interventions used apps, clinician contact, and behavioral prompts with some wireless devices. Examination found self-care maintenance behaviors were supported in most (n = 30) trials whereas self-care monitoring (n = 12) and self-care management behaviors (n = 8) were less so. Few trials (n = 2) targeted all three domains. Investigation of specific behaviors uncovered an overexamination of physical activity and diet behaviors and an underexamination of equally important behaviors. By examining chronic illness mHealth interventions using a theoretical lens we have categorized current interventions, conducted a gap analysis uncovering areas for future study, and made recommendations to move the science forward.
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Affiliation(s)
- Harleah G Buck
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Efrat Shadmi
- Department of Nursing, University of Haifa, Haifa, Israel
| | - Maxim Topaz
- School of Nursing, Columbia University, New York City, New York, USA
| | - Paulina S Sockolow
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Lin TTC, Bautista JR, Core R. Seniors and mobiles: A qualitative inquiry of mHealth adoption among Singapore seniors. Inform Health Soc Care 2020; 45:360-373. [PMID: 32484720 DOI: 10.1080/17538157.2020.1755974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study examines how seniors in Singapore use mobile devices for healthcare purposes. METHODS Semi-structured interviews with 35 mobile phone users aged between 58-82 years old. RESULTS Seniors regard mobile phones as important personal devices for socialization, security, and emergency purposes. Most of the seniors consider mobile telephony (voice calls and text messaging) as an accessible platform to access healthcare. Perceived usefulness, ease of use, compatibility, technology anxiety, financial cost, and self-efficacy were identified as factors affecting the use of mHealth among seniors. Although a few adopt mHealth applications and mobile Internet for health-information seeking, some younger seniors show enthusiastic attitudes toward its adoption. Additionally, some seniors also have technology anxiety and resistance toward using mHealth applications. CONCLUSION Seniors use mobile phones for healthcare purposes in their daily life, and its use involves several facilitators and barriers. Interpersonal training is likely to reduce their anxiety and increase mHealth literacy and adoption. Theoretical and practical implications are discussed.
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Affiliation(s)
- Trisha T C Lin
- Department of Radio & Television, National Chengchi University, Taipei, Taiwan
| | - John Robert Bautista
- School of Information, The University of Texas at Austin, Austin, Texas, USA.,Center for Health Communication, The University of Texas at Austin, Austin, Texas, USA
| | - Rachel Core
- College of Arts and Sciences, Stetson University, DeLand, Florida, USA
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Peng Y, Wang H, Fang Q, Xie L, Shu L, Sun W, Liu Q. Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis. J Manag Care Spec Pharm 2020; 26:550-561. [PMID: 32223596 PMCID: PMC10391210 DOI: 10.18553/jmcp.2020.26.4.550] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medication adherence is frequently suboptimal in adults with chronic diseases, resulting in negative consequences. Traditional interventions to improve adherence are complex and not widely effective. Mobile applications may be a scalable means to support medication adherence. OBJECTIVE To investigate the effect of mobile apps on medication adherence in adults with chronic diseases. METHODS MEDLINE, EMBASE, CINAHL Plus, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials evaluating the effectiveness of any mobile application (app) intervention directed at patients with chronic disease to improve medication adherence in comparison with usual care. A random-effects model was used to pool the outcome data. Risk of bias and quality of study were assessed per Cochrane guidelines. RESULTS Fourteen studies were included in this systematic review involving 1,785 participants, 940 of whom were randomized to a mobile app intervention group and 845 to the usual care group. The meta-analysis showed that the use of mobile apps was associated with a significant improvement in patient adherence to medication (Cohen's d = 0.40, 95% CI = 0.27-0.52; P < 0.001), with a low quality of GRADE evidence. There was no evidence of publication bias (Egger's test; P = 0.81) or substantial heterogeneity (I2 = 29%). In the sensitivity analysis, our findings remained robust to change in inclusion criteria based on study quality (Cohen's d = 0.43, 95% CI = 0.33-0.54; P < 0.001). The included apps incorporated 9 features, sorted from high to low based on relative weights (RW): documentation (RW = 0.254), medication reminder (RW = 0.204), data sharing (RW = 0.148), feedback message (RW = 0.104), clinical decision support (RW = 0.097), education (RW = 0.081), customization (RW = 0.049), data statistics (RW = 0.041), and appointment reminder (RW = 0.041). In the subgroup analysis, the effect was not sensitive to study characteristics or app features (0.37 ≤ P ≤ 0.95). App acceptability was reported by participants in the intervention group in 8 studies: 144 of 156 participants (91.7%) were satisfied with all aspects of the apps. CONCLUSIONS Compared with conventional care, mobile apps are effective interventions to help improve medication adherence in adults with chronic diseases. Although promising, these results should be interpreted with caution given the low level of evidence and short intervention duration. Future research will not only need to identify ideal app features and the costs to providers but also need to improve the apps to make them user friendly, secure, and effective based on patient-centered theory. DISCLOSURES Funding for this study was provided by Chongqing Science and Technology Bureau (No. cstc2017shmsA130115). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no conflicts of interest to disclose.
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Affiliation(s)
- Yihang Peng
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Wang
- Department of Joint Surgery, Chongqing Medical University, Chongqing, China
| | - Qin Fang
- Department of Cardiovasology, Chongqing Medical University, Chongqing, China
| | - Liling Xie
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingzhi Shu
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjing Sun
- First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Liu
- School of Public Health & Management, Chongqing Medical University, Chongqing, China
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Older adults’ views on eHealth services: a systematic review of scientific journal articles. Int J Med Inform 2020; 135:104031. [DOI: 10.1016/j.ijmedinf.2019.104031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 01/06/2023]
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Gomis-Pastor M, Roig E, Mirabet S, T De Pourcq J, Conejo I, Feliu A, Brossa V, Lopez L, Ferrero-Gregori A, Barata A, Mangues MA. A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study. JMIR Mhealth Uhealth 2020; 8:e15957. [PMID: 32014839 PMCID: PMC7055830 DOI: 10.2196/15957] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. Objective The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. Methods A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. Results We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. Conclusions ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Jan T De Pourcq
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Irene Conejo
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Andreu Ferrero-Gregori
- Institute of Biomedical Research IIB Sant Pau, Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Anna Barata
- Moffitt Cancer Center, Florida, FL, United States
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
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Armitage LC, Kassavou A, Sutton S. Do mobile device apps designed to support medication adherence demonstrate efficacy? A systematic review of randomised controlled trials, with meta-analysis. BMJ Open 2020; 10:e032045. [PMID: 32005778 PMCID: PMC7045248 DOI: 10.1136/bmjopen-2019-032045] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the efficacy of app-based interventions designed to support medication adherence and investigate which behaviour change techniques (BCTs) used by the apps are associated with efficacy. DESIGN Systematic review of randomised controlled trials (RCTs), with meta-analysis. SETTING Medline/PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase and Web of Science were searched from 1990 to November 2018 for RCTs conducted in any healthcare setting. PARTICIPANTS Studies of participants of any age taking prescribed medication for any health condition and for any duration. INTERVENTION An app-based intervention delivered through a smartphone, tablet computer or personal digital assistant to help, support or advise about medication adherence. COMPARATOR One of (1) usual care, (2) a control app which did not use any BCTs to improve medication adherence or (3) a non-app-based comparator. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the pooled effect size of changes in medication adherence. The secondary outcome was the association between BCTs used by the apps and the effect size. RESULTS The initial search identified 13 259 citations. After title and abstract screening, full-text articles of 83 studies were screened for eligibility. Nine RCTs with 1159 recruited participants were included. The mean age of participants was >50 years in all but one study. Health conditions of target populations included cardiovascular disease, depression, Parkinson's disease, psoriasis and multimorbidity. The meta-analysis indicated that patients who use mobile apps to support them in taking medications are more likely to self-report adherence to medications (OR 2.120, 95% CI 1.635 to 2.747, n=988) than those in the comparator groups. Meta-regression of the BCTs did not reveal any significant associations with effect size. CONCLUSIONS App-based medication adherence interventions may have a positive effect on patient adherence. Larger scale studies are required to further evaluate this effect, including long-term sustainability, and intervention and participant characteristics that are associated with efficacy and app usage. PROSPERO REGISTRATION NUMBER PROSPERO Protocol Registration Number: CRD42017080150.
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Affiliation(s)
- Laura Catherine Armitage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Aikaterini Kassavou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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