Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study

My Health Coach: Community members' perspectives on a mobile health tool for adults with fetal alcohol spectrum disorders

Objectives

Fetal alcohol spectrum disorders (FASD) affect the health and development of people across the lifespan. Adults with FASD experience significant barriers to care. Accessible and scalable solutions are needed. In partnership with members of the International Adult Leadership Collaborative of FASD Changemakers, an international group of adults with FASD, we developed a mobile health (mHealth) application based on self-determination theory (SDT), called "My Health Coach," to promote self-management and health advocacy.

Methods

This project follows an established user-centered design approach to app development and evaluation, allowing for feedback loops promoting iterative change. Research staff and ALC members co-led online focus groups (n = 26) and an online follow-up survey (n = 26) with adults with FASD to elicit feedback on completed design prototypes. Focus group transcriptions and surveys underwent systemic thematic and theoretical framework analysis.

Results

Analyses show overall positive impressions of the My Health Coach app. Participants were enthusiastic about the proposed features and tools the app will provide. Discussions and free responses revealed SDT constructs (autonomy, competence, relatedness) are a strong fit with participants' perceived outcomes shared in their evaluation of the prototype. Interesting recommendations were made for additional features that would further promote SDT constructs.

Conclusions

This project demonstrates advantages of community-engaged partnerships in FASD research. Adults with FASD have a strong interest in scalable mHealth tools and described the acceptability of our initial design. App features and tools promoted SDT constructs.

Preferred outcome measures in treatments for challenging behaviour in individuals with intellectual disabilities: Results of an inclusive Delphi method

BACKGROUND

Interventions for challenging behaviours in individuals with intellectual disabilities benefit from outcome monitoring that takes clients' preferences into account. We determined clients' and representatives' preferred outcome domains and measures to secure their involvement in treatment decisions for challenging behaviours.

METHOD

We used an inclusive Delphi method. A focus group of individuals with mild intellectual disabilities and representatives of those with moderate and severe intellectual disabilities prepared the first round by assisting us in collecting possible outcomes. Panels of individuals with intellectual disabilities and representatives were composed to achieve consensus on instruments for preferred outcome domains.

RESULTS

Preferred outcome domains were behaviour, side-effects of psychotropic drugs, quality of life, daily functioning, caregiver burden and family quality of life. Corresponding outcome measures included self-report, interview and proxy-scales, including spoken versions.

CONCLUSION

Including the preferred domains on outcomes of interventions for challenging behaviours is recommended. Research on corresponding outcome measures is necessary.

Use of Delphi in health sciences research: A narrative review

The use of the Delphi technique is prevalent across health sciences research, and it is used to identify priorities, reach consensus on issues of importance and establish clinical guidelines. Thus, as a form of expert opinion research, it can address fundamental questions present in healthcare. However, there is little guidance on how to conduct them, resulting in heterogenous Delphi studies and methodological confusion. Therefore, the purpose of this review is to introduce the use of the Delphi method, assess the application of the Delphi technique within health sciences research, discuss areas of methodological uncertainty and propose recommendations. Advantages of the use of Delphi include anonymity, controlled feedback, flexibility for the choice of statistical analysis, and the ability to gather participants from geographically diverse areas. Areas of methodological uncertainty worthy of further discussion broadly include experts and data management. For experts, the definition and number of participants remain issues of contention, while there are ongoing difficulties with expert selection and retention. For data management, there are issues with data collection, defining consensus and methods of data analysis, such as percent agreement, central tendency, measures of dispersion, and inferential statistics. Overall, the use of Delphi addresses important issues present in health sciences research, but methodological issues remain. It is likely that the aggregation of future Delphi studies will eventually pave the way for more comprehensive reporting guidelines and subsequent methodological clarity.

Personalized and Self-Management: Systematic Search and Evaluation Quality Factors and User Preference of Drug Reference Apps in Taiwan

Background: Drug reference apps promote self-management and improve the efficiency and quality of work for physicians, nurses, pharmacists, and patients. This study aimed to describe a systematic and stepwise process to identify drug reference apps in Taiwan, assess the quality of these apps, and analyze the influential factors for user ratings. Methods: A two-step algorithm (KESS) consisting of keyword growing and systematic search was proposed. Seven independent reviewers were trained to evaluate these apps using Mobile App Rating Scale (MARS). A logistic regression model was fitted and average marginal effects (AME) were calculated to identify the effects of factors for higher user ratings. Results: A total of 23 drug reference apps in Taiwan were identified and analyzed. Generally, these drug reference apps were evaluated as acceptable quality with an average MARS score of 3.23. Higher user engagement, more functionality, better aesthetics, and more information associated with higher user ratings. Navigation is the most influential factor on higher user ratings (AME: 13.15%) followed by performance (AME: 11.03%), visual appeal (AME: 10.87%), credibility (AME: 10.67%), and quantity of information (AME: 10.42%). Conclusions: User experience and information clearly affect user ratings of drug reference apps. Five key factors should be considered when designing drug reference apps.

Telemedicine Treatment and Care for Patients with Intellectual Disability

In recent years, telemedicine has been developing very dynamically. The development of new technologies allows their use in the treatment of dermatological, cardiological, endocrine and other diseases. However, there are few reports on the use of digital technologies in the mental health care of people with intellectual disabilities. Intellectual disability is a disease that affects a large number of people. Patients suffering from intellectual disability encounter barriers that make it difficult for them to fully use telemedicine, however, these barriers can be overcome with appropriate support and adaptation. A review of the literature on telemedicine solutions in the care of people with intellectual disabilities indicates that the applications support the communication of these people with the doctor, enable simple behavioral interventions, stimulate cooperation in treatment, provide simple medical education as well as record medical data for the doctor. The authors present the potential risks related to the use of telemedicine solutions for people with intellectual disabilities as well as the project of creating a new, multi-module telemedicine system.

A key performance indicators redefinition initiative at a school of pharmacy using a modified Delphi consensus technique

Objective:

The Outcomes and Assessment Committee at the Virginia Commonwealth University School of Pharmacy was tasked with refining the school’s key performance indicators (KPIs) to improve programmatic assessment by focusing on the most important measures.

Methods:

Initially, 56 KPIs were tracked, nine of which were university mandated, divided into 10 modules: admissions, community outreach, continuing education, diversity, faculty experience and success, fundraising, graduate program, research and scholarship, staff experience and success, and student experience and success. Using a three-round Delphi consensus technique, KPIs were reviewed by faculty and staff. Each participant responded whether they considered each KPI to be essential or not essential for school quality assessment and improvement. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively.

Results:

Of 109 faculty and staff invited, 49 participated in the first round, 51 in the second, and 42 in the third. At the end of the third round, accumulated consensus was achieved for 35 out of 88 (39.8%) KPIs that were considered essential and 3 out of 88 (3.4%) that were considered non-essential. Consensus percentage per module was: 15.4% (2/13) admissions, 28.6% (2/7) community outreach, 33.3% (3/9) continuing education, 27.3% (3/11) diversity, 62.5% (5/8) faculty experience and success, 55.6% (5/9) fundraising, 40% (4/10) graduate program, 33.3% (3/9) research and scholarship, 57.1% (4/7) staff experience and success, and 66.7% (4/6) student experience and success.

Conclusions:

Ultimately, 35 KPIs achieved consensus as essential to measure achievement of benchmarks for the school, which totals 44 KPIs, including nine university mandated KPIs. The process facilitated faculty and staff involvement in KPI selection and achieved improved focus for programmatic assessment.

Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach

BACKGROUND

Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6% of the general population, and the prevalence of T2DM is predicted to rise to 45.36% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives.

OBJECTIVE

The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps.

METHODS

In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care.

RESULTS

In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; P<.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user's goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; P<.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients' app use compliance during clinical visits (6.91), and flexibility and customization (7.91).

CONCLUSIONS

This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts' opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic.

Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts

Background

Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids.

Objective

The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs.

Methods

A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs—the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1.

Results

An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users.

Conclusions

The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients.