Web-Based Intervention for Women With Type 1 Diabetes in Pregnancy and Early Motherhood: Critical Analysis of Adherence to Technological Elements and Study Design

Social support via Internet communication technology for diabetes self-management: a scoping review

Background

The global prevalence of diabetes has been increasing over the past 30 years, leading to a rise in complications; diabetes is the leading cause of amputations, blindness, and kidney failure in developed countries. Diabetes self-management is challenging due to the complex lifestyle changes required. Social support from family and friends plays a crucial role in overcoming barriers to healthy behavior choices. Integrating Internet and communication technologies with social support interventions has the potential to improve diabetes self-management.

Methods

A scoping review was conducted by searching PubMed, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Association for Computing Machinery (ACM) Digital Library databases for studies combining diabetes, Internet and communication technologies, and social support interventions. Inclusion criteria focused on adult patients with diabetes and primarily Internet and communication technologies-based strategies to initiate and enhance social support. Data abstraction included study population, design, outcomes, social support domains emphasized, support relationship intervention strategy, and Internet and communication technologies modality.

Results

The review identified 39 articles and 33 unique studies representing 27 unique interventions utilizing peer web forums, interactive voice recordings, messaging-based interventions (including Short Message Service and instant messaging), and email as Internet and communication technologies modalities. Various outcomes were reported, including improvements in perception of social support, psychosocial well-being, behavior changes, and clinical outcomes. Existing support relationships may be more effective in promoting behavior change and clinical outcomes compared to developing new relationships. Studies that explicitly measured patients' perception of support consistently showed improvements in psycho-social, behavioral, and clinical outcomes.

Conclusions

This scoping review highlights the pivotal role of social support in diabetes self-management. By integrating Internet and communication technologies into interventions, diverse modalities such as web forums and text messaging have shown promise in enhancing patients' perception of support and improving psychosocial well-being, behavior changes, and clinical outcomes. The emphasis on leveraging existing support relationships, rather than establishing new ones, underscores the effectiveness of personalized, patient-centered approaches. These findings provide essential insights for healthcare strategies, emphasizing the need to harness technology and existing social networks to empower individuals in managing diabetes effectively.

Understanding the self-management experiences and support needs during pregnancy among women with pre-existing diabetes: a qualitative descriptive study

BACKGROUND

With the increasing prevalence of pre-existing type 1 and type 2 diabetes in pregnancy and their associated perinatal risks, there is a need to focus on interventions to achieve optimal maternal glycemia to improve pregnancy outcomes. One strategy focuses on improving diabetes self-management education and support for expectant mothers with diabetes. This study's objective is to describe the experience of managing diabetes during pregnancy and identify the diabetes self-management education and support needs during pregnancy among women with type 1 and type 2 diabetes.

METHODS

Using a qualitative descriptive study design, we conducted semi-structured interviews with 12 women with pre-existing type 1 or 2 diabetes in pregnancy (type 1 diabetes, n = 6; type 2 diabetes, n = 6). We employed conventional content analyses to derive codes and categories directly from the data.

RESULTS

Four themes were identified that related to the experiences of managing pre-existing diabetes in pregnancy; four others were related to the self-management support needs in this population. Women with diabetes described their experiences of pregnancy as terrifying, isolating, mentally exhausting and accompanied by a loss of control. Self-management support needs reported included healthcare that is individualized, inclusive of mental health support and support from peers and the healthcare team.

CONCLUSIONS

Women with diabetes in pregnancy experience feelings of fear, isolation and a loss of control, which may be improved through personalized management protocols that avoid "painting everybody with the same brush" as well as peer support. Further examination of these simple interventions may yield important impacts on women's experience and sense of connection.

In the need of a digital cicerone in healthcare? - Guidance for parents

OBJECTIVE

To explore parents' experiences using digital tools in relation to pregnancy, labor and birth, and the child's first 18 months.

BACKGROUND

Parents find relevant information using digital healthcare tools, material obtained from professionals, as well as personal opinions and experiences that vary in quality.

METHOD

Fifteen parents were interviewed and data were analyzed beginning with content analysis and followed by thematic analysis.

RESULTS

The main theme was insecurity and responsibility for own choices and knowledge. Parents use digital tools to take responsibility for their insecurity and need for knowledge when entering parenthood.

CONCLUSION

The parents' experiences highlighted that (1) insecurity can be both eased and enhanced using digital tools, (2) they took responsibility for feelings of insecurity and the search for knowledge, and (3) they needed knowledge to make the right choices and feel secure that these choices are made in the best interest of their new family.

Expecting parents' use of digital sources in preparation for parenthood in a digitalised society - a systematic review

Background

In today's society, people are experiencing the rapid development of digitalisation. Expecting parents may have difficulties evaluating the information online; they are not always sure which sources of information are trustworthy, and this exacerbates their feelings of anxiety. More research is needed to broaden the knowledge about how their use of digital sources may influence their health.

Question

The focus of this study was to explore expecting parents' use of digital sources and how this influences their health during pregnancy.

Methods

A systematic review covered the thematic analysis of 39 articles.

Findings

The analysis resulted in the following theme: The digitalised society involves both opportunities and challenges, and expecting parents express a need for a variety of digital sources to improve their health, and sub-themes: Digital sources could promote parents' health and well-being in a digitalised society; Consuming digital health information facilitates understanding, different feelings and social connections; and A variety of digital sources may facilitate parental identification and adaption to parenthood.

Conclusion

Different digital sources in our digitalised society mean access to information and opportunities to extend social connections for expecting parents. This can promote their ability to understand and adapt to parenthood, as well as to improve their health and well-being and make the parental transition. However, professional support during face-to-face consultations cannot always be exchanged to digital sources. It is important to base digital sources devoted to expecting parents and digitalisation overall on multi-sectorial collaborations and coordination between different organisations and the digital sources they provide.

Parents' Perceptions About Future Digital Parental Support-A Phenomenographic Interview Study

Background: Parents use digital sources (such as the internet or online forums and applications) during pregnancy and after childbirth to receive informative support. Research shows that there is further need for innovation development in digital parental support despite informative support available in digital form. Purpose: To explore parents' perceptions of future digital parental support concerning pregnancy and the first 18 months of parenthood. Method: A phenomenographic interview study with an inductive approach including 15 semi-structured interviews was conducted. Results: The analysis process resulted in three descriptive categories: Opportunities for virtual and in-person meetings, Individualized digital parental support, and Professional knowledge and trustworthiness concerning future digital parental support. Conclusion: The results broaden the knowledge about how future digital parental support can be designed to facilitate the functional, interactive, and critical digital health literacy of new and would-be parents. To succeed, healthcare organizations should allow healthcare professionals to assume an active role in developing digital parental support, both as health educators (i.e., providing parents with knowledge) and facilitators (i.e., facilitating parents' use of digital parental support). However, parents perceived that future digital parental support should complement standard care instead of replacing in-person meetings with healthcare professionals.

Telehealth Increases Access to Brief Behavioral Interventions in Orofacial Pain Clinic during COVID-19 Pandemic: A Retrospective Study

Objective

Aim of the study was to test if orofacial pain patients were more likely to start and complete a brief psychological intervention for managing certain chronic orofacial pain conditions (physical self-regulation, PSR) via telehealth (during the COVID-19 pandemic) vs. in-person (prior to the COVID-19 pandemic). Exploratory aim was to describe demographic factors that may influence the patients to start and complete PSR.

Methods

Retrospective medical charts of all patients seen at a university-affiliated tertiary orofacial pain clinic between July–December 2019 (in person, pre-pandemic) and July–December 2020 (telehealth, during pandemic) were reviewed. Charts were examined for demographic information and to compare the number of patients who started and completed PSR during each study period (chi-squared test).

Results

Of 248 new patients seen in the clinic during 2019 period, 25 started PSR in-person (10.08%). Of 252 new patients seen during 2020 period, 53 started PSR via telehealth (21.03%). Patients were more likely to start PSR (OR = 6.21, p<.001, CI = 2.499 to 15.435) and more likely to complete all three sessions of PSR (OR = 5.69, p<.001, CI = 2.352 to 13.794) when it was offered via telehealth than in-person. Among those who started PSR via telehealth, patients from metropolitan areas were more likely to start the intervention than those from non-metropolitan areas (p=.045).

Conclusions

Offering brief psychological pain interventions via telehealth in tertiary orofacial pain clinics has demonstrated feasibility and may improve willingness to participate in psychological treatments. Results need to be replicated with prospective data as modality was confounded with pandemic in the current study.

Effects of and Lessons Learned from an Internet-Based Physical Activity Support Program (with and without Physiotherapist Telephone Counselling) on Physical Activity Levels of Breast and Prostate Cancer Survivors: The PABLO Randomized Controlled Trial

BACKGROUND

We developed an Internet-based physical activity (PA) support program (IPAS), which is embedded in a patient portal. We evaluated the effectiveness and costs of IPAS alone (online only) or IPAS combined with physiotherapist telephone counselling (blended care), compared to a control group.

METHODS

Breast or prostate cancer survivors, 3-36 months after completing primary treatment, were randomized to 6-months access to online only, blended care, or a control group. At baseline and 6-month post-baseline, minutes of moderate-to-vigorous PA (MVPA) were measured by accelerometers. Secondary outcomes were self-reported PA, fatigue, mood, health-related quality of life, attitude toward PA, and costs. (Generalized) linear models were used to compare the outcomes between groups.

RESULTS

We recruited 137 survivors (participation rate 11%). We did not observe any significant between-group differences in MVPA or secondary outcomes. Adherence was rather low and satisfaction scores were low to moderate, with better scores for blended care. Costs for both interventions were low.

CONCLUSIONS

Recruitment to the study was challenging and the interventions were less efficacious than anticipated, which led to lessons learned for future trials. Suggestions for future research are as follows: improved accessibility of the support program, increased frequency of support, and use of activity trackers.

mHealth Apps as Effective Persuasive Health Technology: Contextualizing the "Necessary" Functionalities

Persuasive health technology (PHT) is any technology purposely designed to influence, reinforce, change, or shape health-related attitudes or behaviors. Behavioral interventions can be developed for the purpose of maintaining or improving a person's health status. Delivering behavioral interventions via PHTs is a promising approach for encouraging healthy behaviors among individuals and populations. Important attributes of all PHTs include their functionalities. A functionality refers to any useful features, functions, capabilities, or technologies associated with computer hardware or software. Creating effective PHTs requires a deliberate selection of appropriate functionalities for supporting specific behavioral interventions. The number and types of functionalities necessary to create an effective PHT will be specific to the context of each project, influenced by project objectives, stakeholder goals, behavioral interventions, and a variety of real-world constraints. Selecting appropriate functionalities can be challenging. Fortunately, there are frameworks and models developed specifically for guiding the design of PHTs. The Persuasive Systems Design model describes 4 categories, and 28 design principles for creating effective persuasive interventions. These same design principles could also be useful for guiding the selection of appropriate functionalities.

Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review

BACKGROUND

Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users.

OBJECTIVE

The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine.

METHODS

An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies.

RESULTS

Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models.

CONCLUSIONS

The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group's social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.