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Buis LR, Kim J, Sen A, Chen D, Dawood K, Kadri R, Muladore R, Plegue M, Richardson CR, Djuric Z, McNaughton C, Hutton D, Robert LP, Park SY, Levy P. The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e57863. [PMID: 38941601 PMCID: PMC11245662 DOI: 10.2196/57863] [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: 02/28/2024] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease-related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. OBJECTIVE We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. METHODS We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). RESULTS We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). CONCLUSIONS Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12601.
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Junhan Kim
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Dongru Chen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katee Dawood
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rachelle Muladore
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Melissa Plegue
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Family Medicine, Brown University, Providence, RI, United States
| | - Zora Djuric
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace McNaughton
- Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - David Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lionel P Robert
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Phillip Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [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: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Khruakhorn S, Jirasakulsuk N, Saengpromma P. Effectiveness of Telerehabilitation for Correcting Posture in Elderly with Thoracic Kyphosis in Urban Thailand. Int J Telerehabil 2023; 15:e6566. [PMID: 38162942 PMCID: PMC10754235 DOI: 10.5195/ijt.2023.6566] [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] [Indexed: 01/03/2024] Open
Abstract
Introduction Thoracic kyphosis (TK) is an abnormal thoracic spine. Telerehabilitation and conventional physical therapy were compared for correct posture in the thoracic angle, forward head posture, back muscle strength, and cost-effectiveness. Method Twenty-two Thai women 60 years of age and over, with thoracic angles over 45 degrees, participated in this study. Participants were randomly allocated into a telerehabilitation group (TG) or a control group (CG). TG and CG underwent a thoracic corrective exercise program for 1 hour each session, three times per week for 8 weeks. Result Thoracic angle, forward head posture, and back muscle strength improved (P < .05) in both groups. Furthermore, cost-effectiveness showed the cost of intervention in TG lower than CG, approximately 133.78 US$. Conclusion Our study showed no difference in telepractice program efficacy and effectiveness compared to in-person treatment in the clinic. Thus, telerehabilitation may be an alternative treatment for the elderly who cannot travel to the hospital.
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Affiliation(s)
- Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Thailand
| | - Nathaphon Jirasakulsuk
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Thailand
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Shiba SK, Temple CA, Krasnoff J, Dilchert S, Smarr BL, Robishaw J, Mason AE. Assessing Adherence to Multi-Modal Oura Ring Wearables From COVID-19 Detection Among Healthcare Workers. Cureus 2023; 15:e45362. [PMID: 37849583 PMCID: PMC10578453 DOI: 10.7759/cureus.45362] [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: 03/17/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Background Identifying early signs of a SARS-CoV-2 infection in healthcare workers could be a critical tool in reducing disease transmission. To provide this information, both daily symptom surveys and wearable device monitoring could have utility, assuming there is a sufficiently high level of participant adherence. Purpose The aim of this study is to evaluate adherence to a daily symptom survey and a wearable device (Oura Ring) among healthcare professionals (attending physicians and other clinical staff) and trainees (residents and medical students) in a hospital setting during the early stages of the COVID-19 pandemic. Methods In this mixed-methods observational study, the data were a subset (N=91) of those collected as part of the larger TemPredict Study. Demographic data analyses were conducted with descriptive statistics. Participant adherence to the wearable device protocol was reported as the percentage of days that sleep was recorded, and adherence to the daily survey was reported as the percentage of days with submitted surveys. Comparisons for the primary (wearable and survey adherence of groups) and secondary (adherence patterns among subgroups) outcomes were conducted using descriptive statistics, two-tailed independent t-tests, and Welch's ANOVA with post hoc analysis using Games-Howell. Results Wearable device adherence was significantly higher than the daily symptom survey adherence for most participants. Overall, participants were highly adherent to the wearable device, wearing the device an average of 87.8 ± 11.6% of study nights compared to survey submission, showing an average of 63.8 ± 27.4% of study days. In subgroup analysis, we found that healthcare professionals (HCPs) and medical students had the highest adherence to wearing the wearable device, while medical residents had lower adherence in both wearable adherence and daily symptom survey adherence. Conclusions These results indicated high participant adherence to wearable devices to monitor for impending infection in the course of a research study conducted as part of clinical practice. Subgroup analysis indicated HCPs and medical students maintained high adherence, but residents' adherence was lower, which is likely multifactorial, with differences in work demands and stress contributing to the findings. These results can guide the development of adherence strategies for a wearable device to increase the quality of data collection and assist in disease detection in this and future pandemics.
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Affiliation(s)
- Steven K Shiba
- Department of Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Caroline A Temple
- Department of Pediatrics, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Joanne Krasnoff
- Department of Biomedical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Stephan Dilchert
- Department of Management, The City University of New York Baruch College Zicklin School of Business, New York, USA
| | - Benjamin L Smarr
- Shu Chien-Gene Lay Department of Bioengineering, University of California San Diego, San Diego, USA
- Halıcıoğlu Data Science Institute, University of California San Diego, San Diego, USA
| | - Janet Robishaw
- Department of Biomedical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Ashley E Mason
- Osher Center for Integrative Health, University of California San Francisco, San Francisco, USA
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Mbuagbaw L, Chen LH, Aluko E, Stevens-Uninsky M, Eze-Onuorah ACJ, Garcia MC, Stech L, Atkin-Jones T, Rehman N, Raifu A. Empirical progression criteria thresholds for feasibility outcomes in HIV clinical trials: a methodological study. Pilot Feasibility Stud 2023; 9:96. [PMID: 37316946 DOI: 10.1186/s40814-023-01342-x] [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: 01/10/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Pilot and feasibility trials use predetermined thresholds for feasibility outcomes to decide if a larger trial is feasible. These thresholds may be derived from the literature, observational data, or clinical experience. The aim of this study was to determine empirical estimates for feasibility outcomes to inform future HIV pilot randomized trials. METHODS We conducted a methodological study of HIV clinical trials indexed in the past 5 years (2017-2021) in the PubMed database. We included trials of people living with HIV individually randomized to any type of intervention and excluded pilot trials and cluster randomized trials. Screening and data extraction were conducted in duplicate. We computed estimates for recruitment, randomization, non-compliance, lost to follow-up, discontinuation, and the proportion analyzed using a random effects meta-analysis of proportions and reported these estimates according to the following subgroups: use of medication, intervention type, trial design, income level, WHO region, participant type, comorbidities, and source of funding. We report estimates with 95% confidence intervals. RESULTS We identified 2122 studies in our search, of which 701 full texts were deemed relevant, but only 394 met our inclusion criteria. We found the following estimates: recruitment (64.1%; 95% CI 57.7 to 70.3; 156 trials); randomization (97.1%; 95% CI 95.8 to 98.3; 187 trials); non-compliance (3.8%; 95% CI 2.8 to 4.9; 216 trials); lost to follow-up (5.8%; 95% CI 4.9 to 6.8; 251 trials); discontinuation (6.5%; 95% CI 5.5 to 7.5; 215 trials); analyzed (94.2%; 95% CI 92.9 to 95.3; 367 trials). There were differences in estimates across most subgroups. CONCLUSION These estimates may be used to inform the design of HIV pilot randomized trials with careful consideration of variations due to some of the subgroups investigated.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada.
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
| | - Lucy Huizhu Chen
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eunice Aluko
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Maya Stevens-Uninsky
- Department of Global Health, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | | | - Larysa Stech
- Public Health, Faculty of Applied Sciences, Brock University, St. Catharines, ON, Canada
| | - Tariq Atkin-Jones
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
| | - Amidu Raifu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada
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Bhattacharjee A, Williams JJ, Meyerhoff J, Kumar H, Mariakakis A, Kornfield R. Investigating the Role of Context in the Delivery of Text Messages for Supporting Psychological Wellbeing. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2023; 2023:494. [PMID: 37223844 PMCID: PMC10201989 DOI: 10.1145/3544548.3580774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Without a nuanced understanding of users' perspectives and contexts, text messaging tools for supporting psychological wellbeing risk delivering interventions that are mismatched to users' dynamic needs. We investigated the contextual factors that influence young adults' day-to-day experiences when interacting with such tools. Through interviews and focus group discussions with 36 participants, we identified that people's daily schedules and affective states were dominant factors that shape their messaging preferences. We developed two messaging dialogues centered around these factors, which we deployed to 42 participants to test and extend our initial understanding of users' needs. Across both studies, participants provided diverse opinions of how they could be best supported by messages, particularly around when to engage users in more passive versus active ways. They also proposed ways of adjusting message length and content during periods of low mood. Our findings provide design implications and opportunities for context-aware mental health management systems.
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Affiliation(s)
| | | | | | - Harsh Kumar
- Computer Science, University of Toronto, Canada
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Western B, Demmelmaier I, Vistad I, Hansen BH, Stenling A, Henriksen HB, Nordin K, Blomhoff R, Berntsen S. How many days of continuous physical activity monitoring reliably represent time in different intensities in cancer survivors. PLoS One 2023; 18:e0284881. [PMID: 37093874 PMCID: PMC10124860 DOI: 10.1371/journal.pone.0284881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Physical activity (PA) monitoring is applied in a growing number of studies within cancer research. However, no consensus exists on how many days PA should be monitored to obtain reliable estimates in the cancer population. The objective of the present study was to determine the minimum number of monitoring days required for reliable estimates of different PA intensities in cancer survivors when using a six-days protocol. Furthermore, reliability of monitoring days was assessed stratified on sex, age, cancer type, weight status, and educational level. METHODS Data was obtained from two studies where PA was monitored for seven days using the SenseWear Armband Mini in a total of 984 cancer survivors diagnosed with breast, colorectal or prostate cancer. Participants with ≥22 hours monitor wear-time for six days were included in the reliability analysis (n = 736). The intra-class correlation coefficient (ICC) and the Spearman Brown prophecy formula were used to assess the reliability of different number of monitoring days. RESULTS For time in light PA, two monitoring days resulted in reliable estimates (ICC >0.80). Participants with BMI ≥25, low-medium education, colorectal cancer, or age ≥60 years required one additional monitoring day. For moderate and moderate-to-vigorous PA, three monitoring days yielded reliable estimates. Participants with BMI ≥25 or breast cancer required one additional monitoring day. Vigorous PA showed the largest within subject variations and reliable estimates were not obtained for the sample as a whole. However, reliable estimates were obtained for breast cancer survivors (4 days), females, BMI ≥30, and age <60 years (6 days). CONCLUSION Shorter monitoring periods may provide reliable estimates of PA levels in cancer survivors when monitored continuously with a wearable device. This could potentially lower the participant burden and allow for less exclusion of participants not adhering to longer protocols.
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Affiliation(s)
- Benedikte Western
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Ingrid Demmelmaier
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ingvild Vistad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway
| | - Bjørge Herman Hansen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Andreas Stenling
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Hege Berg Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Goodwin BM, Olney CM, Ferguson JE, Hansen AH, Eddy B, Goldish G, Morrow MM, Vos-Draper TL. Visualization of user interactions with a pressure mapping mobile application for wheelchair users at risk for pressure injuries. Assist Technol 2022; 34:444-453. [PMID: 33395558 PMCID: PMC8433259 DOI: 10.1080/10400435.2020.1862938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction wit h AW-Shift©. The date and time of system interactions were recorded for six participants with SCI over 7 days (five males/one female, five manual users/one power user, 55.3 ± 17.3 years old, 10.6 ± 6.5 years since injury). Circular frequency plots were created to visualize the time and frequency participants brought the app to the foreground of their phone and received alerts and reminders to complete weight shifts. While some participants used the system regularly throughout the day, others primarily used it before 8am; highlighting the system's importance for regular spot checks and morning wheelchair setup. Participant adherence to weight shift reminders was low suggesting the live pressure map may be more useful. Circular frequency plots can be used by clinicians to more easily review large amounts of patient data. Future work will investigate raw pressure mat data and create a closed-loop weight shift detection algorithm.
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Affiliation(s)
- Brianna M. Goodwin
- Division of Health Care Policy and Research, Department of Health Sciences Research Mayo Clinic, Rochester, Minnesota, USA,Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Christine M. Olney
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,College of Design, University of Minnesota, Minneapolis, Minnesota, USA
| | - John E. Ferguson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew H. Hansen
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Byron Eddy
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gary Goldish
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa M. Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research Mayo Clinic, Rochester, Minnesota, USA,Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Tamara L. Vos-Draper
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA,Center for Allied Health Professions, Program in Occupational Therapy, University of Minnesota, Minneapolis, Minnesota, USA
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Leahey TM, Blackman Carr LT, Denmat Z, Fernandes D, Gorin AA. Effectiveness of "run-ins" at predicting adherence in a behavioral weight loss efficacy trial. Contemp Clin Trials 2022; 114:106678. [PMID: 35007787 PMCID: PMC8934261 DOI: 10.1016/j.cct.2022.106678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
There is limited research on whether run-in procedures predict participant adherence during behavioral efficacy trials. This study examined whether information from behavioral run-ins (food diary completion, questionnaire completion, and staff interview) predict intervention adherence, trial retention, and trial outcomes in a behavioral weight loss trial. Using run-in data, trial staff predicted which participants would have high, moderate, or low trial adherence. Participants with predicted high or moderate adherence were randomized. Results showed that predicted high adherers had better intervention adherence (session attendance and completion of self-monitoring records) and superior trial outcomes (i.e. weight loss). Run-in data did not predict trial retention. Results suggest that run-ins may be effective at identifying participants adherent to intervention protocols, thereby enhancing internal validity of behavioral efficacy trials.
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Affiliation(s)
- Tricia M Leahey
- University of Connecticut, Department of Allied Health Sciences, Koons Hall, 358 Mansfield Rd., Unit 1101, Storrs, CT 06269-1101, USA.
| | - Loneke T Blackman Carr
- University of Connecticut, Department of Nutritional Sciences, Roy E. Jones Bldg., 27 Mander Rd., Unit 4017, Storrs, CT 06269-1101, USA.
| | - Zeely Denmat
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy, 2006 Hillside Rd., Unit 1248, Storrs, CT 06269-1101, USA.
| | - Denise Fernandes
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy, 2006 Hillside Rd., Unit 1248, Storrs, CT 06269-1101, USA.
| | - Amy A Gorin
- University of Connecticut, Department of Psychological Sciences, Bousfield Psychology Building, 406 Babbidge Rd, Unit 1020, Storrs, CT 06269-1101, USA.
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Association between behavioral phenotypes and sustained use of smartphones and wearable devices to remotely monitor physical activity. Sci Rep 2021; 11:21501. [PMID: 34728746 PMCID: PMC8563736 DOI: 10.1038/s41598-021-01021-y] [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: 04/19/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Smartphones and wearable devices can be used to remotely monitor health behaviors, but little is known about how individual characteristics influence sustained use of these devices. Leveraging data on baseline activity levels and demographic, behavioral, and psychosocial traits, we used latent class analysis to identify behavioral phenotypes among participants randomized to track physical activity using a smartphone or wearable device for 6 months following hospital discharge. Four phenotypes were identified: (1) more agreeable and conscientious; (2) more active, social, and motivated; (3) more risk-taking and less supported; and (4) less active, social, and risk-taking. We found that duration and consistency of device use differed by phenotype for wearables, but not smartphones. Additionally, "at-risk" phenotypes 3 and 4 were more likely to discontinue use of a wearable device than a smartphone, while activity monitoring in phenotypes 1 and 2 did not differ by device type. These findings could help to better target remote-monitoring interventions for hospitalized patients.
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Chong MS, Sit JWH, Karthikesu K, Chair SY. Effectiveness of technology-assisted cardiac rehabilitation: A systematic review and meta-analysis. Int J Nurs Stud 2021; 124:104087. [PMID: 34562846 DOI: 10.1016/j.ijnurstu.2021.104087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objectives of this review were to identify different technology-assisted interventions in cardiac rehabilitation, to explore and examine the effectiveness of technology-assisted cardiac rehabilitation. DESIGN A systematic review and meta-analysis. METHODS A systematic search was performed on six electronic databases: CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO to identify randomised controlled trials from 2010 to 2020. Selection of studies was performed by screening the titles, abstracts and full texts, and two reviewers independently and critically appraised the included studies using the revised Cochrane risk of bias tool for randomized trials (RoB 2). RESULTS Nine randomised controlled trials met the inclusion criteria; five studies with some bias concerns related to allocation concealment (n = 2) and measurement of outcome (n = 4), and four studies were of low risk of bias. The pooled effect size showed comparable effectiveness between technology-assisted cardiac rehabilitation and conventional/centre-based cardiac rehabilitation on modifiable coronary risk factors (systolic and diastolic blood pressure, total cholesterol, p>0.05), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.62, p = 0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p = 0.47). Narrative synthesis was performed for adherence to prescribed exercise sessions in cardiac rehabilitation. No significant adverse events occurred. The adverse events that did occur were self-reported, mostly unrelated to the interventions with technology and the number of events was comparable between both groups. Inconsistent results were found across the studies. This review revealed lack of self-efficacy and behaviour change theories/strategies, and educational emphasis among studies. CONCLUSIONS The results in the meta-analysis have indicated that technology-assisted cardiac rehabilitation demonstrated comparable results to conventional/centre-based cardiac rehabilitation. Technology-assisted cardiac rehabilitation is a potential alternative not only to remove cardiac rehabilitation barriers but also in the midst of current prolonged pandemic. Future studies on technology-assisted cardiac rehabilitation with the emphasis behavior change theories/strategies and education are required.
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Affiliation(s)
- Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR.
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Karthijekan Karthikesu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
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12
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Kuenze C, Pfeiffer K, Pfeiffer M, Driban JB, Pietrosimone B. Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 56:555-564. [PMID: 34375982 DOI: 10.4085/1062-6050-203-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients. OBJECTIVE To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR. DESIGN Single-blinded feasibility study. SETTING University community. PATIENTS OR OTHER PARTICIPANTS Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR. INTERVENTION(S) All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor. MAIN OUTCOME MEASURE(S) Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points). RESULTS Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period. CONCLUSIONS Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.
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Affiliation(s)
- Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing.,Department of Orthopedics, Michigan State University, East Lansing
| | - Karin Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing
| | - Matthew Pfeiffer
- Department of Orthopedics, Michigan State University, East Lansing
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, MA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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13
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Goldberg SB, Bolt DM, Davidson RJ. Data Missing Not at Random in Mobile Health Research: Assessment of the Problem and a Case for Sensitivity Analyses. J Med Internet Res 2021; 23:e26749. [PMID: 34128810 PMCID: PMC8277392 DOI: 10.2196/26749] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/01/2021] [Accepted: 05/06/2021] [Indexed: 01/29/2023] Open
Abstract
Background Missing data are common in mobile health (mHealth) research. There has been little systematic investigation of how missingness is handled statistically in mHealth randomized controlled trials (RCTs). Although some missing data patterns (ie, missing at random [MAR]) may be adequately addressed using modern missing data methods such as multiple imputation and maximum likelihood techniques, these methods do not address bias when data are missing not at random (MNAR). It is typically not possible to determine whether the missing data are MAR. However, higher attrition in active (ie, intervention) versus passive (ie, waitlist or no treatment) conditions in mHealth RCTs raise a strong likelihood of MNAR, such as if active participants who benefit less from the intervention are more likely to drop out. Objective This study aims to systematically evaluate differential attrition and methods used for handling missingness in a sample of mHealth RCTs comparing active and passive control conditions. We also aim to illustrate a modern model-based sensitivity analysis and a simpler fixed-value replacement approach that can be used to evaluate the influence of MNAR. Methods We reanalyzed attrition rates and predictors of differential attrition in a sample of 36 mHealth RCTs drawn from a recent meta-analysis of smartphone-based mental health interventions. We systematically evaluated the design features related to missingness and its handling. Data from a recent mHealth RCT were used to illustrate 2 sensitivity analysis approaches (pattern-mixture model and fixed-value replacement approach). Results Attrition in active conditions was, on average, roughly twice that of passive controls. Differential attrition was higher in larger studies and was associated with the use of MAR-based multiple imputation or maximum likelihood methods. Half of the studies (18/36, 50%) used these modern missing data techniques. None of the 36 mHealth RCTs reviewed conducted a sensitivity analysis to evaluate the possible consequences of data MNAR. A pattern-mixture model and fixed-value replacement sensitivity analysis approaches were introduced. Results from a recent mHealth RCT were shown to be robust to missing data, reflecting worse outcomes in missing versus nonmissing scores in some but not all scenarios. A review of such scenarios helps to qualify the observations of significant treatment effects. Conclusions MNAR data because of differential attrition are likely in mHealth RCTs using passive controls. Sensitivity analyses are recommended to allow researchers to assess the potential impact of MNAR on trial results.
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Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, United States.,Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, United States
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin - Madison, Madison, WI, United States
| | - Richard J Davidson
- Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, United States.,Department of Psychology, University of Wisconsin - Madison, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin - Madison, Madison, WI, United States
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14
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm 2021; 37:271-319. [PMID: 33850572 PMCID: PMC8022003 DOI: 10.1002/joa3.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de TelessaúdeHospital das Clínicasand Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queensand School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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15
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. Ann Noninvasive Electrocardiol 2021; 26:e12795. [PMID: 33513268 PMCID: PMC7935104 DOI: 10.1111/anec.12795] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queens, and School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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16
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Figueroa CA, Vittinghoff E, Aguilera A, Fukuoka Y. Differences in objectively measured daily physical activity patterns related to depressive symptoms in community dwelling women - mPED trial. Prev Med Rep 2021; 22:101325. [PMID: 33659156 PMCID: PMC7890210 DOI: 10.1016/j.pmedr.2021.101325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022] Open
Abstract
Physical activity (PA) is an effective depression treatment. However, knowledge on how variation in day-to-day PA relates to depression in women is lacking. The purposes of this study were to 1) compare overall objectively measured baseline daily steps and duration of moderate to vigorous PA (MVPA) and 2) examine differences in steps and MVPA on days of the week between women aged 25–65 years, who were physically inactive, with high and low depressive symptoms, enrolled in a run-in period of the mobile phone based physical activity education (mPED) trial. The Center for Epidemiological Studies Depression Scale was used to categorize low/high depressive symptom groups. We used linear mixed-effects models to examine the associations between steps and MVPA and depression-status overall and by day of the week, adjusting for selected demographic variables and their interactions with day of the week. 274 women were included in the final analysis, of which 58 had high depressive symptoms. Overall physical activity levels did not differ. However, day of the week modified the associations of depression with MVPA (p = 0.015) and daily steps (p = 0.08). Women with high depression were characterized by reduced activity at the end of the week (Posthoc: Friday: 791 fewer steps, 95% CI: 73–1509, p = 0.03; 8.8 lower MVPA, 95% CI: 2.16–15.5, p = 0.0098) compared to women with low depression, who showed increased activity. Day of the week might be an important target for personalization of physical activity interventions. Future work should evaluate potential causes of daily activity alterations in depression in women.
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Affiliation(s)
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California, San Francisco, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, United States.,Zuckerberg San Francisco General Hospital, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, United States
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17
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2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:4-54. [PMID: 35265889 PMCID: PMC8890358 DOI: 10.1016/j.cvdhj.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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18
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu YF, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circ Arrhythm Electrophysiol 2021; 14:e009204. [PMID: 33573393 PMCID: PMC7892205 DOI: 10.1161/circep.120.009204] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | | | | | | | - Yu-Feng Hu
- Taipei Veterans General Hospital, Taiwan (Y.-F.H.)
| | | | | | | | | | | | | | - Reena Mehra
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | - Alex Page
- University of Rochester, NY (J.-P.C., A.P., J.S.S.)
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL (R. Passman)
| | | | - Ewa Piotrowicz
- National Institute of Cardiology, Warsaw, Poland (E.P., R. Piotrowicz)
| | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | | | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - David Slotwiner
- Cardiology Division, New York-Presbyterian Queens, NY (D.S.)
| | | | - Emma Svennberg
- Karolinska University Hospital, Stockholm, Sweden (E.S.)
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19
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE / HRS / EHRA / APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:7-48. [PMID: 36711170 PMCID: PMC9708018 DOI: 10.1093/ehjdh/ztab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, Cleveland, OH, USA,Correspondence: Niraj Varma, Cleveland Clinic, Cleveland, OH, USA.
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health, Policy and Research, Weill Cornell Medicine, New York, NY, USA
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20
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Musiimenta A, Tumuhimbise W, Pinkwart N, Katusiime J, Mugyenyi G, Atukunda EC. A mobile phone-based multimedia intervention to support maternal health is acceptable and feasible among illiterate pregnant women in Uganda: Qualitative findings from a pilot randomized controlled trial. Digit Health 2021; 7:2055207620986296. [PMID: 33717497 PMCID: PMC7917428 DOI: 10.1177/2055207620986296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Uganda's maternal mortality rate remains unacceptably high. Mobile phones can potentially provide affordable means of accessing maternal health services even among the otherwise hard-to-reach populations. Evidence about the acceptability and feasibility of mobile phone-based interventions targeting illiterate women, however, is limited. OBJECTIVE To assess the acceptability and feasibility of a mobile phone-based multimedia application (MatHealth app) to support maternal health amongst illiterate pregnant women in rural southwestern Uganda. METHODS 80 pregnant women initiating antenatal care from Mbarara regional referral hospital were enrolled in a pilot randomized controlled trial and followed until six weeks after delivery. The 40 women in the intervention group received a MatHealth app composed of educational videos/audios, clinic appointment reminders, and the calling function. Qualitative interviews on acceptability of this technology were carried out with 30 of the intervention participants. An inductive, content analytic approach was used to analyze qualitative data. Quantitative feasibility data were recorded and summarized descriptively. RESULTS Participants reported that the intervention is acceptable as it enabled them adopt good maternal health practices, enhanced social support from spouses, provided clinic appointment reminders, and facilitated communication with healthcare providers. Challenges included: phone sharing (74%), accidental deletion of the application 15 (43%), lack of electricity 15 (43%), and inability to set up a reminder function 20 (57%). CONCLUSION The MatHealth app is an acceptable and feasible intervention among illiterate women, in a resource limited setting. Future efforts should focus on optimized application design, spouse orientation, and incorporating economic support to overcome the challenges we encountered.
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Affiliation(s)
- Angella Musiimenta
- Department of Information Technology, Mbarara, Mbarara University of Science and Technology, Uganda
- Angels Compassion Organisation, Mbarara, Uganda
| | - Wilson Tumuhimbise
- Department of Information Technology, Mbarara, Mbarara University of Science and Technology, Uganda
| | - Niels Pinkwart
- Computer Science Department, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jane Katusiime
- Department of Information Technology, Mbarara, Mbarara University of Science and Technology, Uganda
| | - Godfrey Mugyenyi
- Department of Information Technology, Mbarara, Mbarara University of Science and Technology, Uganda
| | - Esther C Atukunda
- Department of Information Technology, Mbarara, Mbarara University of Science and Technology, Uganda
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21
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Jennings Mayo-Wilson L, Coleman J, Timbo F, Ssewamala FM, Linnemayr S, Yi GT, Kang BA, Johnson MW, Yenokyan G, Dodge B, Glass NE. Microenterprise Intervention to Reduce Sexual Risk Behaviors and Increase Employment and HIV Preventive Practices Among Economically-Vulnerable African-American Young Adults (EMERGE): A Feasibility Randomized Clinical Trial. AIDS Behav 2020; 24:3545-3561. [PMID: 32494942 PMCID: PMC7667139 DOI: 10.1007/s10461-020-02931-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement.Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Indiana University School of Public Health, Department of Applied Health Science, 1025 E. 7th Street, Bloomington, IN USA
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Jessica Coleman
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fatmata Timbo
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Fred M. Ssewamala
- The Brown School, Washington University in St. Louis, Goldfarb, One Brookings, Drive, St. Louis, MO USA
| | | | - Grace T. Yi
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Bee-Ah Kang
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Matthew W. Johnson
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5510 Nathan Shock Drive, Baltimore, MD USA
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe Street, Baltimore, MD USA
| | - Brian Dodge
- Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD USA
| | - Nancy E. Glass
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD USA
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22
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Sánchez-González D, Rojo-Pérez F, Rodríguez-Rodríguez V, Fernández-Mayoralas G. Environmental and Psychosocial Interventions in Age-Friendly Communities and Active Ageing: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8305. [PMID: 33182710 PMCID: PMC7696667 DOI: 10.3390/ijerph17228305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023]
Abstract
Background: The academic literature contains little information regarding the interventions that create age-friendly cities and communities in order to promote active ageing. Objectives: A systematic review was carried out to determine the available empirical evidence in relation to the characteristics, content and effectiveness of interventions aimed at improving environmental and psychosocial risk factors for older people, from the perspective of age-friendly communities and the promotion of active ageing. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the studies retained in this review were identified through a systematic search of the academic literature in selected electronic databases including Web of Science and Scopus. Independent critical appraisal and data extraction were conducted by two reviewers. The checklist was used to assess the quality of the articles. Findings: The search identified 1020 potentially eligible documents, of which 11 satisfied the established criteria. Non-exhaustive practices prevailed over rigorous investigations, with a high proportion of studies observed to be of low methodological quality and at high risk of bias. This reflected the predominance of uncontrolled interventions. Environmental interventions were focused on reducing risk and adapting the everyday environmental setting, while psychosocial interventions prioritised social strategies (behavioural changes, promotion of participation) and training. Interventions were more effective in certain domains of age-friendly cities and communities such as transportation and housing, followed by increased participation as a lifestyle-related behavioural change. The inferred changes were associated with providing information and enhancing skills; modifying access, barriers, exposures, and opportunities; enhancing services and support; continuity and effectiveness of changes over time; and modifying policies based on the bottom-up approach of age-friendly cities and communities (AFCC). Discussion and conclusion: Interventions focused on personal and organisational aspects might have positive effects in the longer term. However, fewer changes would be observed in interventions revolving around changing lifestyles owing to the impact of complex multi-causal factors. The relative effectiveness in terms of health calls into question the design of interventions and the supposed "friendliness" of certain communities. There is a need to encourage sound longitudinal research aimed at providing key knowledge for the implementation and evaluation of public policies, and to encourage age-friendly community programmes to promote active ageing.
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Affiliation(s)
- Diego Sánchez-González
- Department of Geography, National Distance Education University (UNED), 28040 Madrid, Spain
| | - Fermina Rojo-Pérez
- Research Group on Ageing (GIE-CSIC), Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain; (F.R.-P.); (V.R.-R.); (G.F.-M.)
- Ageing Network of the Latin American Population Association (ALAP), Rio de Janeiro, Brazil
| | - Vicente Rodríguez-Rodríguez
- Research Group on Ageing (GIE-CSIC), Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain; (F.R.-P.); (V.R.-R.); (G.F.-M.)
- Ageing Network of the Latin American Population Association (ALAP), Rio de Janeiro, Brazil
| | - Gloria Fernández-Mayoralas
- Research Group on Ageing (GIE-CSIC), Institute of Economics, Geography and Demography (IEGD), Spanish National Research Council (CSIC), 28037 Madrid, Spain; (F.R.-P.); (V.R.-R.); (G.F.-M.)
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23
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Meyerowitz-Katz G, Ravi S, Arnolda L, Feng X, Maberly G, Astell-Burt T. Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e20283. [PMID: 32990635 PMCID: PMC7556375 DOI: 10.2196/20283] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/05/2023] Open
Abstract
Background Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have significant issues with sustained use, with up to 98% of people only using the app for a short time before dropping out and/or dropping use down to the point where the app is no longer effective at helping to manage disease. Objective Our objectives are to systematically appraise and perform a meta-analysis on dropout rates in apps for chronic disease and to qualitatively synthesize possible reasons for these dropout rates that could be addressed in future interventions. Methods MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, Cochrane CENTRAL (Central Register of Controlled Trials), and Embase were searched from 2003 to the present to look at mobile health (mHealth) and attrition or dropout. Studies, either randomized controlled trials (RCTs) or observational trials, looking at chronic disease with measures of dropout were included. Meta-analysis of attrition rates was conducted in Stata, version 15.1 (StataCorp LLC). Included studies were also qualitatively synthesized to examine reasons for dropout and avenues for future research. Results Of 833 studies identified in the literature search, 17 were included in the review and meta-analysis. Out of 17 studies, 9 (53%) were RCTs and 8 (47%) were observational trials, with both types covering a range of chronic diseases. The pooled dropout rate was 43% (95% CI 29-57), with observational studies having a higher dropout rate (49%, 95% CI 27-70) than RCTs in more controlled scenarios, which only had a 40% dropout rate (95% CI 16-63). The studies were extremely varied, which is represented statistically in the high degree of heterogeneity (I2>99%). Qualitative synthesis revealed a range of reasons relating to attrition from app-based interventions, including social, demographic, and behavioral factors that could be addressed. Conclusions Dropout rates in mHealth interventions are high, but possible areas to minimize attrition exist. Reducing dropout rates will make these apps more effective for disease management in the long term. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019128737; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128737
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Affiliation(s)
- Gideon Meyerowitz-Katz
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown NSW, Australia.,School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Sumathy Ravi
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown NSW, Australia
| | - Leonard Arnolda
- School of Health and Society, University of Wollongong, Wollongong, Australia.,Illawarra Health & Medical Research Institute, Wollongong, Australia
| | - Xiaoqi Feng
- School of Health and Society, University of Wollongong, Wollongong, Australia.,School of Public Health and Community Medicine, University of New South Wales, Kingsford NSW, Australia.,Menzies Centre for Health Policy, University of Sydney, Camperdown NSW, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Western Sydney Local Health District, Blacktown NSW, Australia.,Menzies Centre for Health Policy, University of Sydney, Camperdown NSW, Australia
| | - Thomas Astell-Burt
- School of Health and Society, University of Wollongong, Wollongong, Australia.,Menzies Centre for Health Policy, University of Sydney, Camperdown NSW, Australia
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24
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Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study. Disabil Health J 2020; 14:100990. [PMID: 33011113 DOI: 10.1016/j.dhjo.2020.100990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND School settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD. OBJECTIVE To examine the feasibility of a 12-week school-based Fitbit© program for youth with ASD. METHODS Six classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students' experience with the fitness trackers. RESULTS Out of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities. CONCLUSIONS A school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.
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25
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Lindgren T, Hooper J, Fukuoka Y. Perceptions and Experiences of Women Participating in a Digital Technology-Based Physical Activity Intervention (the mPED Trial): Qualitative Study. JMIR Public Health Surveill 2019; 5:e13570. [PMID: 31859677 PMCID: PMC6942195 DOI: 10.2196/13570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/22/2019] [Accepted: 09/06/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Despite the benefits of regular physical activity, women in every age group have lower activity levels than men, and few women meet the recommended levels of physical activity. Digital technologies have been useful in increasing physical activity during the course of an interventional study. However, sustaining that activity once the clinical trial was complete was a major challenge. OBJECTIVE This study aimed to describe the experiences and perspectives of physically inactive women who completed the mobile phone-based physical activity education (mPED), a randomized controlled trial, at 12 months. METHODS Of 210 women who were enrolled in the mPED trial, 203 completed a 12-month open-ended exit interview and survey through phone. The participants were asked about their physical activity levels; their digital technology use; what they learned from, liked, and would change about the trial; their motivations to keep active post-trial; and their advice for other women. Interviews were transcribed verbatim and thematically analyzed using the brief survey qualitative description. Descriptive statistics were used to describe the survey data with the significance level set at P<.05. RESULTS In the 12-month survey, a greater proportion of the participants in the intervention group, compared with the control group, reported that they regularly wore a pedometer or physical activity tracker (49.3%, 66/143 vs 26.1%, 18/69; P=.002) and engaged in brisk walking (54.5%, 73/134 vs 30.4%, 21/69; P=.001). The experiences and perceptions of physical activity of physically inactive women over time were embedded in a complex interplay of internal and external factors. A total of 6 interactive themes emerged as critical in supporting continued engagement in physical activity postintervention: tracking, technology versus personal touch, accountability, resources and environment, motivation, and habit formation. Technology allowed for self-tracking, which supported internal accountability. However, tracking by another person (personal touch) was needed for external accountability. Resources and environment underpinned the relationship among the themes of tracking, technology versus personal touch, accountability, motivation, and habit formation. CONCLUSIONS Future research is needed to identify the best ways to harness this dynamic process in promoting and sustaining physical activity among inactive women. Digital technology is evolving at an exponential rate and provides new opportunities to transform research into new approaches to promote physical activity. TRIAL REGISTRATION ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/1471-2485-11-933.
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Affiliation(s)
- Teri Lindgren
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Julie Hooper
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Yoshimi Fukuoka
- Physiological Nursing, Univesity of California, San Francisco, San Francisco, CA, United States
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26
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Yang X, Ma L, Zhao X, Kankanhalli A. Factors influencing user's adherence to physical activity applications: A scoping literature review and future directions. Int J Med Inform 2019; 134:104039. [PMID: 31865054 DOI: 10.1016/j.ijmedinf.2019.104039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although mobile app-delivered physical activity (PA) interventions have the potential to promote exercise, poor adherence to these apps is a common issue impeding their effectiveness. Gaining insights into the factors that influence PA app adherence is an important priority for app developers and intervention designers. OBJECTIVE The objective of this study is to perform a literature review to synthesize the factors influencing PA app adherence and to identify directions for future research in this area. METHODS A scoping review of prior research was conducted to uncover the factors influencing PA app adherence. Seven online journal databases were searched for relevant articles published from January 1, 2014, to December 31, 2018. The initial search identified 5,572 articles. After a screening and eligibility check based on inclusion criteria, 24 articles were finally selected. The definition of PA app adherence in this review could be categorized along four dimensions derived from previous studies: i.e., frequency of PA app usage, intention/motivation to sustain use of the PA app, degree of function use within the PA app, and the duration of PA app usage. RESULTS Of the 24 included studies (both qualitative and quantitative), 12 studies were conducted in the U.S. The methods and study designs varied considerably, with the study durations ranging from 2 weeks to 24 months. The synthesized evidence indicates that 89 distinct factors influenced PA app adherence, and these could be classified into three categories: Personal Factors (n = 28), Technology Features (n = 53), and Contextual Factors (n = 8). Nine more detailed sub-categories were also compiled. Factors in sub-categories, such as psychological factors, health-related factors and predefined goals, are essential for physical activity behavior change experts to implement interventions. Factors in technology features, including PA tracking, PA goal setting and customization of exercise, are specifically useful for PA app developers or PA intervention designers. Overall, evidence of causal factors was limited. Only 5 of the 24 articles explored causal factors that affect PA app adherence. Furthermore, longitudinal studies with long durations were also limited. CONCLUSIONS Uncovering the factors influencing PA app adherence is critical as it can expand our current knowledge and provide guidance for app-delivered PA interventions, as well as the design of PA apps. This scoping review identified and categorized factors that influence PA app adherence in prior studies. Based on the evidence synthesized, users are paying more attention to the "playfulness" and personalized features of PA apps, in addition to basic functional requirements. Also, app glitches are the most common factors found to negatively influence app adherence. Several important directions for future research are highlighted in this review, especially the design of studies to explore causality.
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Affiliation(s)
- Xiaotian Yang
- School of Management, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Lin Ma
- School of Management, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Xi Zhao
- School of Management, Xi'an Jiaotong University, Xi'an 710049, China; The Key Lab of the Ministry of Education for process control & Efficiency Engineering, Xi'an 710049, China.
| | - Atreyi Kankanhalli
- Department of Information Systems and Analytics, National University of Singapore, Singapore.
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27
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Nahum-Shani I, Smith SN, Spring BJ, Collins LM, Witkiewitz K, Tewari A, Murphy SA. Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support. Ann Behav Med 2019; 52:446-462. [PMID: 27663578 PMCID: PMC5364076 DOI: 10.1007/s12160-016-9830-8] [Citation(s) in RCA: 849] [Impact Index Per Article: 169.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual's state can change rapidly, unexpectedly, and in his/her natural environment. Purpose Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap. Methods Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration. Conclusions As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.
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Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N Smith
- Division of General Medicine, Department of Internal Medicine and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Bonnie J Spring
- Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Linda M Collins
- TheMethodology Center andDepartment ofHuman Development & Family Studies, Penn State, State College, PA, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Ambuj Tewari
- Department of Statistics and Department of EECS, University of Michigan, Ann Arbor, MI, USA
| | - Susan A Murphy
- Department of Statistics, and Institute for Social Research,University of Michigan, Ann Arbor, MI, USA
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28
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Mayo-Wilson LJ, Glass NE, Ssewamala FM, Linnemayr S, Coleman J, Timbo F, Johnson MW, Davoust M, Labrique A, Yenokyan G, Dodge B, Latkin C. Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial. Trials 2019; 20:439. [PMID: 31315685 PMCID: PMC6637550 DOI: 10.1186/s13063-019-3529-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages (“nudges”) that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. Methods/design In total, 40 young adults who are African-American, aged 18–24, live in Baltimore City, have experienced at least one episode of homelessness in the last 12 months, are unemployed or underemployed (fewer than 10 h per week), are not enrolled in school, own a cell phone with text messaging, and report at least one episode of unprotected or unsafe sex in the prior 12 months will be recruited from two community-based organizations providing residential supportive services to urban youth. Participants will undergo a 3-week run-in period and thereafter be randomly assigned to one of two groups with active interventions for 20 weeks. The first group (“comparison”) will receive text messages with information on job openings. The second group (“experimental”) will receive text messages with information on job openings plus information on HIV prevention and business educational sessions, a mentored apprenticeship, and a start-up grant, and business and HIV prevention text messages based on principles from behavioral economics. The two primary outcomes relate to the feasibility of conducting a larger trial. Secondary outcomes relate to employment, sexual risk behaviors, and HIV preventive practices. All participants will be assessed using an in-person questionnaire at pre-intervention (prior to randomization) and at 3 weeks post-intervention. To obtain repeated, longitudinal measures, participants will be assessed weekly using text message surveys from pre-intervention up to 3 weeks post-intervention. Discussion This study will be one of the first U.S.-based feasibility randomized clinical trials of an HIV prevention microenterprise intervention for economically-vulnerable African-American young adults. The findings will inform whether and how to conduct a larger efficacy trial for HIV risk reduction in this population. Trial registration ClinicalTrials.gov, NCT03766165. Registered on 4 December 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3529-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA. .,Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, USA.
| | - Nancy E Glass
- Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD, USA
| | - Fred M Ssewamala
- Washington University in St. Louis, The Brown School, Goldfarb, One Brookings, Drive, St. Louis, MO, USA
| | | | - Jessica Coleman
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Fatmata Timbo
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Matthew W Johnson
- Behavioral Pharmacology Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, USA
| | - Melissa Davoust
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Alain Labrique
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
| | - Brian Dodge
- Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 737, Baltimore, MD, USA
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29
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Fukuoka Y, Haskell W, Lin F, Vittinghoff E. Short- and Long-term Effects of a Mobile Phone App in Conjunction With Brief In-Person Counseling on Physical Activity Among Physically Inactive Women: The mPED Randomized Clinical Trial. JAMA Netw Open 2019; 2:e194281. [PMID: 31125101 PMCID: PMC6632135 DOI: 10.1001/jamanetworkopen.2019.4281] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Mobile phone applications (apps) and activity trackers allow researchers to remotely deliver an intervention and monitor physical activity but have not been rigorously evaluated for longer periods. OBJECTIVE To determine whether a mobile phone-based physical activity education app, in conjunction with brief in-person counseling, increases and then maintains levels of physical activity. DESIGN, SETTING, AND PARTICIPANTS In this parallel randomized clinical trial, community-dwelling physically inactive women recruited between May 2011 and April 2014 were randomized in equal proportions into the control (n = 69), regular (n = 71), and plus (n = 70) groups. Data were analyzed using intention to treat from September 16, 2016, through June 30, 2018. INTERVENTIONS The regular and plus groups were instructed to use the app on their mobile phone and an accelerometer every day for 3 months and attend brief in-person counseling. During the 6-month maintenance period, the plus group continued to use the app and accelerometer, while the regular group stopped using the app but continued using the accelerometer. The control group used the accelerometer throughout. MAIN OUTCOMES AND MEASURES The primary and secondary outcomes were daily accelerometer-measured total steps and time spent in moderate to vigorous physical activity (MVPA). RESULTS The 210 participants had a mean (SD) age of 52.4 (11.0) years. At baseline, the mean (SD) daily total steps by accelerometer in the control, regular, and plus groups were 5384 (2920), 5063 (2526), and 5837 (3235), respectively. During the 3-month intervention period, daily steps and MVPA increased in the combined regular and plus groups compared with the control group (between-group differences, 2060 steps per day; 95% CI, 1296-2825 steps per day; P < .001 and 18.2 min/d MVPA; 95% CI, 10.9-25.4 min/d MVPA; P < .001). During the subsequent 6-month maintenance period, mean activity level remained higher in the combined plus and regular groups than among controls (between-group difference, 1360 steps per day; 95% CI, 694-2026 steps per day; P <. 001), but trends in total daily steps and MVPA were similar in the plus and regular groups. CONCLUSIONS AND RELEVANCE In this trial, the intervention groups substantially increased their physical activity. However, use of both the app and accelerometer for an additional 6 months after the initial 3-month intervention did not help to maintain increases in physical activity compared with continued use of the accelerometer alone. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01280812.
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing, Institute for Health & Aging, School of Nursing, University of California, San Francisco
| | - William Haskell
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
| | - Feng Lin
- Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California, San Francisco
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30
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Laursen DRT, Paludan-Müller AS, Hróbjartsson A. Randomized clinical trials with run-in periods: frequency, characteristics and reporting. Clin Epidemiol 2019; 11:169-184. [PMID: 30809104 PMCID: PMC6377048 DOI: 10.2147/clep.s188752] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Run-in periods are occasionally used in randomized clinical trials to exclude patients after inclusion, but before randomization. In theory, run-in periods increase the probability of detecting a potential treatment effect, at the cost of possibly affecting external and internal validity. Adequate reporting of exclusions during the run-in period is a prerequisite for judging the risk of compromised validity. Our study aims were to assess the proportion of randomized clinical trials with run-in periods, to characterize such trials and the types of run-in periods and to assess their reporting. Materials and methods This was an observational study of 470 PubMed-indexed randomized controlled trial publications from 2014. We compared trials with and without run-in periods, described the types of run-in periods and evaluated the completeness of their reporting by noting whether publications stated the number of excluded patients, reasons for exclusion and baseline characteristics of the excluded patients. Results Twenty-five trials reported a run-in period (5%). These were larger than other trials (median number of randomized patients 217 vs 90, P=0.01) and more commonly industry trials (11% vs 3%, P<0.01). The run-in procedures varied in design and purpose. In 23 out of 25 trials (88%), the run-in period was incompletely reported, mostly due to missing baseline characteristics. Conclusion Approximately 1 in 20 trials used run-in periods, though much more frequently in industry trials. Reporting of the run-in period was often incomplete, precluding a meaningful assessment of the impact of the run-in period on the validity of trial results. We suggest that current trials with run-in periods are interpreted with caution and that updates of reporting guidelines for randomized trials address the issue.
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Affiliation(s)
- David Ruben Teindl Laursen
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark, .,Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark, .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark,
| | | | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark, .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark, .,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark,
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Katzman WB, Gladin A, Lane NE, Wong S, Liu F, Jin C, Fukuoka Y. Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study. JMIR Aging 2019; 2:e12199. [PMID: 31363712 PMCID: PMC6664796 DOI: 10.2196/12199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training.
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Affiliation(s)
- Wendy B Katzman
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Amy Gladin
- Rehabilitation Services, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Nancy E Lane
- Department of Medicine, University of California, Davis CA, USA
| | - Shirley Wong
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Felix Liu
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - Chengshi Jin
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, USA
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, School of Nursing/ Institute for Health & Aging, University of California, San Francisco CA, USA
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Xu X, Tupy S, Robertson S, Miller AL, Correll D, Tivis R, Nigg CR. Successful adherence and retention to daily monitoring of physical activity: Lessons learned. PLoS One 2018; 13:e0199838. [PMID: 30235221 PMCID: PMC6147478 DOI: 10.1371/journal.pone.0199838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/14/2018] [Indexed: 11/30/2022] Open
Abstract
Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability.
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Affiliation(s)
- Xiaomeng Xu
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
- * E-mail:
| | - Samantha Tupy
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
| | - Stephen Robertson
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
| | - Ashley L. Miller
- Department of Psychology, University of Oregon, Eugene, Oregon, United State of America
| | - Danielle Correll
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, United States of America
| | - Rick Tivis
- Idaho Center for Health Research, Idaho State University, Meridian, Idaho, United States of America
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, Idaho, United States of America
| | - Claudio R. Nigg
- Office of Public Health Studies, University of Hawai’i at Manoa, Honolulu, Hawaii, United States of America
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Fukuoka Y, Lindgren TG, Mintz YD, Hooper J, Aswani A. Applying Natural Language Processing to Understand Motivational Profiles for Maintaining Physical Activity After a Mobile App and Accelerometer-Based Intervention: The mPED Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10042. [PMID: 29925491 PMCID: PMC6031900 DOI: 10.2196/10042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background Regular physical activity is associated with reduced risk of chronic illnesses. Despite various types of successful physical activity interventions, maintenance of activity over the long term is extremely challenging. Objective The aims of this original paper are to 1) describe physical activity engagement post intervention, 2) identify motivational profiles using natural language processing (NLP) and clustering techniques in a sample of women who completed the physical activity intervention, and 3) compare sociodemographic and clinical data among these identified cluster groups. Methods In this cross-sectional analysis of 203 women completing a 12-month study exit (telephone) interview in the mobile phone-based physical activity education study were examined. The mobile phone-based physical activity education study was a randomized, controlled trial to test the efficacy of the app and accelerometer intervention and its sustainability over a 9-month period. All subjects returned the accelerometer and stopped accessing the app at the last 9-month research office visit. Physical engagement and motivational profiles were assessed by both closed and open-ended questions, such as “Since your 9-month study visit, has your physical activity been more, less, or about the same (compared to the first 9 months of the study)?” and, “What motivates you the most to be physically active?” NLP and cluster analysis were used to classify motivational profiles. Descriptive statistics were used to compare participants’ baseline characteristics among identified groups. Results Approximately half of the 2 intervention groups (Regular and Plus) reported that they were still wearing an accelerometer and engaging in brisk walking as they were directed during the intervention phases. These numbers in the 2 intervention groups were much higher than the control group (overall P=.01 and P=.003, respectively). Three clusters were identified through NLP and named as the Weight Loss group (n=19), the Illness Prevention group (n=138), and the Health Promotion group (n=46). The Weight Loss group was significantly younger than the Illness Prevention and Health Promotion groups (overall P<.001). The Illness Prevention group had a larger number of Caucasians as compared to the Weight Loss group (P=.001), which was composed mostly of those who identified as African American, Hispanic, or mixed race. Additionally, the Health Promotion group tended to have lower BMI scores compared to the Illness Prevention group (overall P=.02). However, no difference was noted in the baseline moderate-to-vigorous intensity activity level among the 3 groups (overall P>.05). Conclusions The findings could be relevant to tailoring a physical activity maintenance intervention. Furthermore, the findings from NLP and cluster analysis are useful methods to analyze short free text to differentiate motivational profiles. As more sophisticated NL tools are developed in the future, the potential of NLP application in behavioral research will broaden. Trial Registration ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/70IkGagAJ)
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing/Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Teri G Lindgren
- School of Nursing, Rutgers University, Newark, NJ, United States
| | - Yonatan Dov Mintz
- Department of Industrial Engineering and Operations Research, University of California, Berkeley, Berkeley, CA, United States
| | - Julie Hooper
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Anil Aswani
- Department of Industrial Engineering and Operations Research, University of California, Berkeley, Berkeley, CA, United States
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Fukuoka Y, Zhou M, Vittinghoff E, Haskell W, Goldberg K, Aswani A. Objectively Measured Baseline Physical Activity Patterns in Women in the mPED Trial: Cluster Analysis. JMIR Public Health Surveill 2018; 4:e10. [PMID: 29391341 PMCID: PMC5814604 DOI: 10.2196/publichealth.9138] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Determining patterns of physical activity throughout the day could assist in developing more personalized interventions or physical activity guidelines in general and, in particular, for women who are less likely to be physically active than men. OBJECTIVE The aims of this report are to identify clusters of women based on accelerometer-measured baseline raw metabolic equivalent of task (MET) values and a normalized version of the METs ≥3 data, and to compare sociodemographic and cardiometabolic risks among these identified clusters. METHODS A total of 215 women who were enrolled in the Mobile Phone Based Physical Activity Education (mPED) trial and wore an accelerometer for at least 8 hours per day for the 7 days prior to the randomization visit were analyzed. The k-means clustering method and the Lloyd algorithm were used on the data. We used the elbow method to choose the number of clusters, looking at the percentage of variance explained as a function of the number of clusters. RESULTS The results of the k-means cluster analyses of raw METs revealed three different clusters. The unengaged group (n=102) had the highest depressive symptoms score compared with the afternoon engaged (n=65) and morning engaged (n=48) groups (overall P<.001). Based on a normalized version of the METs ≥3 data, the moderate-to-vigorous physical activity (MVPA) evening peak group (n=108) had a higher body mass index (P=.03), waist circumference (P=.02), and hip circumference (P=.03) than the MVPA noon peak group (n=61). CONCLUSIONS Categorizing physically inactive individuals into more specific activity patterns could aid in creating timing, frequency, duration, and intensity of physical activity interventions for women. Further research is needed to confirm these cluster groups using a large national dataset. TRIAL REGISTRATION ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/6vVyLzwft).
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Affiliation(s)
- Yoshimi Fukuoka
- Department of Physiological Nursing/Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, United States
| | - Mo Zhou
- Department of Industrial Engineering and Operations Research, University of California, Berkeley, Berkeley, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - William Haskell
- Stanford Prevention Research Center, Stanford University, Palo Alto, CA, United States
| | - Ken Goldberg
- Department of Industrial Engineering and Operations Research, University of California, Berkeley, Berkeley, CA, United States.,Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA, United States
| | - Anil Aswani
- Department of Industrial Engineering and Operations Research, University of California, Berkeley, Berkeley, CA, United States
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Fukuoka Y, Lisha NE, Vittinghoff E. Comparing Asian American Women's Knowledge, Self-Efficacy, and Perceived Risk of Heart Attack to Other Racial and Ethnic Groups: The mPED Trial. J Womens Health (Larchmt) 2017; 26:1012-1019. [PMID: 28418750 DOI: 10.1089/jwh.2016.6156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare knowledge and awareness of heart attacks/heart disease and perceived risk for future heart attack in Asian/Pacific Islander women, compared to other racial and ethnic groups. MATERIALS AND METHODS In this cross-sectional study, 318 women enrolled in a mobile phone-based physical activity education trial were analyzed. Heart attack knowledge, self-efficacy for recognizing and responding to heart attack symptoms, and perceived risk for a future heart attack were measured. Analyses were conducted using logistic, proportional odds, and linear regression models, depending on the outcome and adjusting for age. Pairwise differences between Asian/Pacific Islanders and the other four groups were assessed using a Bonferroni correction (p < 0.0125). RESULTS Asian/Pacific Islander women had significantly lower total scores for knowledge of heart attack and self-efficacy for heart attack recognition and care seeking behavior compared to the Caucasian women (p = 0.001 and p = 0.002, respectively). However, perceived risk did not differ among the groups. Forty-six percent of the Asian American women, compared to 25% of Caucasian women, falsely believed "breast cancer is the number one cause of death for women (p = 0.002)." In addition, Asian/Pacific Islander women were less likely to report "arm pain, numbness, tingling, or radiating" as one of the heart attack symptoms compared to the Caucasian and the multiracial group (34%, 63% [p < 0.001], and 66% [p = 0.004], respectively). CONCLUSIONS These findings highlight the urgent need to develop effective, tailored campaigns to close the knowledge gap between Asian/Pacific Islander women and Caucasian women.
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Affiliation(s)
- Yoshimi Fukuoka
- 1 Department of Physiological Nursing, Institute for Health & Aging, School of Nursing, University of California , San Francisco, San Francisco, California
| | - Nadra E Lisha
- 2 Institute for Health & Aging, University of California , San Francisco, San Francisco, California
| | - Eric Vittinghoff
- 3 Department of Epidemiology & Biostatistics, University of California , San Francisco, San Francisco, California
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Partridge SR, McGeechan K, Bauman A, Phongsavan P, Allman-Farinelli M. Improved confidence in performing nutrition and physical activity behaviours mediates behavioural change in young adults: Mediation results of a randomised controlled mHealth intervention. Appetite 2016; 108:425-433. [PMID: 27818304 DOI: 10.1016/j.appet.2016.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 10/29/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of weight gain disproportionally affects young adults. Understanding the underlying behavioural mechanisms of change in mHealth nutrition and physical activity interventions designed for young adults is important for enhancing and translating effective interventions. PURPOSE First, we hypothesised that knowledge, self-efficacy and stage-of-change for nutrition and physical activity behaviours would improve, and second, that self-efficacy changes in nutrition and physical activity behaviours mediate the behaviour changes observed in an mHealth RCT for prevention of weight gain. METHODS Young adults, aged 18-35 years at risk of weight gain (n = 250) were randomly assigned to an mHealth-program, TXT2BFiT, consisting of a three-month intensive phase and six-month maintenance phase or to a control group. Self-reported online surveys at baseline, three- and nine-months assessed nutrition and physical activity behaviours, knowledge, self-efficacy and stage-of-change. The mediating effect of self-efficacy was assessed in multiple PROCESS macro-models for three- and nine-month nutrition and physical activity behaviour change. RESULTS Young adults randomised to the intervention increased and maintained knowledge of fruit requirements (P = 0.029) compared to controls. Intervention participants' fruit and takeaway behaviours improved to meet recommendations at nine months, with a greater proportion progressing to action or maintenance stage-of-change (P < 0.001 and P = 0.012 respectively) compared to controls. Intervention participants' vegetable and physical activity behaviours did not meet recommendations, thereby halting progress to action or maintenance stage-of-change. Indirect effects of improved nutrition and physical activity behaviours at three- and nine-months in the intervention group were explained by changes in self-efficacy, accounting for 8%-37% of the total effect. CONCLUSIONS This provides insights into how the mHealth intervention achieved part of its effects and the importance of improving self-efficacy to facilitate improved eating and physical activity behaviours in young adults.
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Affiliation(s)
- Stephanie R Partridge
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
| | - Kevin McGeechan
- Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
| | - Adrian Bauman
- Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
| | - Philayrath Phongsavan
- Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
| | - Margaret Allman-Farinelli
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, NSW 2006, Australia.
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Fukuoka Y, Haskell W, Vittinghoff E. New insights into discrepancies between self-reported and accelerometer-measured moderate to vigorous physical activity among women - the mPED trial. BMC Public Health 2016; 16:761. [PMID: 27514368 PMCID: PMC4982411 DOI: 10.1186/s12889-016-3348-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022] Open
Abstract
Background The aims of this report were 1) to describe the duration of moderate to vigorous physical activity (MVPA) and the proportion of participants meeting the recommended criterion of at least 150 min of MVPA per week as measured by the 7 Day Physical Activity Recall Questionnaire (7D-PAR) and accelerometer among women who were enrolled in the mPED trial; 2) to assess the level of agreement of the two measures using a Bland-Altman plot; and 3) to describe the positive and negative predictive values (PPV and NPV, respectively) of meeting the guidelines by calculating the percentage of women meeting the physical activity recommendation by the 7D-PAR who also met this recommendation based on data from the accelerometer. Methods Baseline data on duration of MVPA from the mPED trial were analyzed for 215 women. Among the women who met the recommended criterion by the 7D-PAR (self-report), we calculated the proportion of individuals who also met it by the accelerometer (objective measure). A Bland Altman Plot was used to assess concordance between the two measures. Results The mean age was 52.4 (±11.2) years; 54.4 % were white; and 48.8 % were single or divorced. While median MVPA was 160 min/week by the 7D-PAR, it was only 24 min/week in the accelerometer. A total of 117 women met the 150-min criterion by the 7D-PAR. Of these, only 18 also met the criterion by the objective measure (PPV 15.4 %, 95 % CI 9.4–23.2 %). Among the 98 women who did not meet the criterion by the 7D-PAR, none met it by the accelerometer (NPV 100 %). A Bland Altman plot showed the mean difference of +145 min between the two measures with a 95 % limit of agreement at + 471 to −181 min. Conclusions The large discrepancy between the self-reported and objective measures of MVPA meeting the 150-min criterion suggests that self-reported physical activity measures should be used with caution in intervention studies. While our data suggest that self-report could be used to identify a physically inactive sample, it would be likely to over-estimate the proportions of women who become active in one or both arms of trials of interventions promoting MVPA. Trial registration ClinicalTrials.gov NCT01280812
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Affiliation(s)
- Yoshimi Fukuoka
- Institute for Health & Aging / Department of Physiological Nursing, School of Nursing, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, 94118, USA.
| | - William Haskell
- Stanford Prevention Research Center, Stanford University, 1070 Arastradero Rd. Suite 100, Palo Alto, CA, 94304, USA
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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Tsoh JY. Tweeting about physical activity: can tweeting the walk help keeping the walk? Mhealth 2016; 2:6. [PMID: 28293584 PMCID: PMC5344104 DOI: 10.3978/j.issn.2306-9740.2016.02.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/25/2016] [Indexed: 11/14/2022] Open
Abstract
Vickey and Breslin's research (published on mHealth, November 2015 issue) that involved analyzing nearly 2 million fitness tweets revealed a low percentage of mobile fitness app users meeting the recommended physical activity level. This commentary explores contextual and psychological factors that may underlie the observed low physical activity levels among these mobile fitness app users. Much remains unknown about how best to leverage technologies and social media support to promote adherence to physical activity recommendations. With the use of innovative and validated content mining strategies and taking consideration of relevant contextual and psychological factors associated with tweeting, tweets on physical activity offer a valuable data source to help us better understand: How can we mobilize people to 'tweet the walk' and 'keep the walk'?
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Affiliation(s)
- Janice Y Tsoh
- Department of Psychiatry, University of California, San Francisco, CA, USA
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