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Tock WL. Motivation for Health Promotion in Cancer Survivors: An Evolutionary Concept Analysis. ANS Adv Nurs Sci 2024; 47:202-217. [PMID: 34693911 DOI: 10.1097/ans.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Motivation for health promotion is an essential concept in health care research, as it pertains to an individual's ability to adapt to the adversity of chronic illnesses, including cancer. Adopting Rodgers' evolutionary method of concept analysis, the objective of this article is to clarify the concept based on its existing operationalization noted in cancer survivorship literature. Through a close examination of the construction of the concept, this article facilitates the understanding of concept as it relates to the field of cancer survivorship care, which in turn helps provide guidance for developing health promotion intervention targeted at cancer survivors.
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Affiliation(s)
- Wing Lam Tock
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
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Rogers LQ, Pekmezi D, Schoenberger-Godwin YM, Fontaine KR, Ivankova NV, Kinsey AW, Hoenemeyer T, Martin MY, Pisu M, Farrell D, Wall J, Waugaman K, Oster RA, Kenzik K, Winters-Stone K, Demark-Wahnefried W. Using the TIDieR checklist to describe development and integration of a web-based intervention promoting healthy eating and regular exercise among older cancer survivors. Digit Health 2023; 9:20552076231182805. [PMID: 37434730 PMCID: PMC10331096 DOI: 10.1177/20552076231182805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Objective To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the AiM, Plan, and act on LIFestYles (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. Methods The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. Results A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. Conclusions Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.
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Affiliation(s)
- Laura Q. Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA, USA
| | - Yu-Mei Schoenberger-Godwin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R. Fontaine
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA, USA
| | - Nataliya V. Ivankova
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber W. Kinsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y. Martin
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Maria Pisu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Kaitlyn Waugaman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Oster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Lane CL, Brady O, Mayer JM. Comprehensive Assessment of Implementation Factors Related to Worksite Exercise in Firefighters. J Occup Environ Med 2022; 64:e13-e19. [PMID: 34670259 PMCID: PMC8818327 DOI: 10.1097/jom.0000000000002418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study sought to identify key implementation factors to a 12-month worksite exercise intervention in career firefighters. METHODS Implementation factors related to the hybrid type 1 effectiveness-implementation trial were assessed by exercise adherence, implementation questionnaires, focus groups, and observations from stakeholders. RESULTS The primary identified implementation themes spanned intrapersonal, interpersonal, and institutional factors including: 1. Time and desire to exercise on shift; 2. Financial incentives to exercise; 3. Structured fitness programs; 4. Group competition, cohesion, and camaraderie; 5. Leadership engagement and support; and 6. Health, fitness, and occupational preparedness benefits. CONCLUSIONS Future worksite exercise programs should address the barriers and facilitators identified herein and consider utilizing a hybrid delivery approach combining supervised and telehealth exercise interventions to optimize enthusiasm, adherence and improve safety and health.
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Affiliation(s)
- Charity L Lane
- US Spine and Sport Foundation, San Diego, California (Ms Lane and Dr Mayer); Tampa, FL (Mr Brady)
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Sotirova MB, McCaughan EM, Ramsey L, Flannagan C, Kerr DP, O'Connor SR, Blackburn NE, Wilson IM. Acceptability of online exercise-based interventions after breast cancer surgery: systematic review and narrative synthesis. J Cancer Surviv 2021; 15:281-310. [PMID: 32930924 PMCID: PMC7966228 DOI: 10.1007/s11764-020-00931-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE eHealth and mHealth approaches are increasingly used to support cancer survivors. This review aimed to examine adherence, acceptability and satisfaction with Internet-based self-management programmes for post-surgical cancer rehabilitation and to identify common components of such interventions. METHODS Nine electronic databases were searched from inception up to February 15, 2020, for relevant quantitative and qualitative studies evaluating Internet-based cancer rehabilitation interventions. Studies were required to include an exercise or physical activity-based self-management intervention and a measure of adherence, acceptability or user satisfaction with the programme. Two independent reviewers performed all data extraction and quality assessment procedures. Data were synthesized using a narrative approach. RESULTS Six hundred ninety-six potential papers were identified and screened. Eleven met the inclusion criteria. Interventions had wide variations in levels of adherence, but the majority were reported as being acceptable to the users. Increased acceptability and user satisfaction were associated with interventions which were seen as time and cost-efficient, requiring acquisition of minimal or no new skills, which used coherent language, or which provided tailored information. The majority contained behaviour change components such as goal setting. CONCLUSIONS Despite high levels of heterogeneity between studies, Internet-based approaches may be an acceptable method for the delivery of self-management interventions in post-surgical cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS There is a need for further studies exploring factors associated with increased user engagement and usage of digital interventions in cancer rehabilitation settings. These findings should be used to help develop interventions prior to testing their effectiveness in adequately powered randomized controlled trials.
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Affiliation(s)
- Mariya B Sotirova
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK.
| | - Eilís M McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, Northern Ireland, UK
| | - Lucia Ramsey
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Coleraine, Northern Ireland, UK
| | - Daniel P Kerr
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Sean R O'Connor
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicole E Blackburn
- Institute of Nursing and Health Research, Ulster University, Jordanstown, Northern Ireland, UK
| | - Iseult M Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
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Skiba MB, McElfresh JJ, Howe CL, Crane TE, Kopp LM, Jacobs ET, Thomson CA. Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2020; 9:315-327. [DOI: 10.1089/jayao.2019.0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Meghan B. Skiba
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer J. McElfresh
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Carol L. Howe
- University of Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Tracy E. Crane
- Department of Biobehavioral Sciences, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Lisa M. Kopp
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Moore G, Wilding H, Gray K, Castle D. Participatory Methods to Engage Health Service Users in the Development of Electronic Health Resources: Systematic Review. J Particip Med 2019; 11:e11474. [PMID: 33055069 PMCID: PMC7434099 DOI: 10.2196/11474] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/29/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023] Open
Abstract
Background When health service providers (HSP) plan to develop electronic health (eHealth) resources for health service users (HSU), the latter’s involvement is essential. Typically, however, HSP, HSU, and technology developers engaged to produce the resources lack expertise in participatory design methodologies suited to the eHealth context. Furthermore, it can be difficult to identify an established method to use, or determine how to work stepwise through any particular process. Objective We sought to summarize the evidence about participatory methods and frameworks used to engage HSU in the development of eHealth resources from the beginning of the design process. Methods We searched for studies reporting participatory processes in initial development of eHealth resources from 2006 to 2016 in 9 bibliographic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Emcare, Cochrane Library, Web of Science, ACM Guide to Computing Literature, and IEEE Xplore. From 15,117 records initially screened on title and abstract for relevance to eHealth and early participatory design, 603 studies were assessed for eligibility on full text. The remaining 90 studies were rated by 2 reviewers using the Mixed Methods Appraisal Tool Version 2011 (Pluye et al; MMAT) and analyzed with respect to health area, purpose, technology type, and country of study. The 30 studies scoring 90% or higher on MMAT were included in a detailed qualitative synthesis. Results Of the 90 MMAT-rated studies, the highest reported (1) health areas were cancer and mental disorders, (2) eHealth technologies were websites and mobile apps, (3) targeted populations were youth and women, and (4) countries of study were the United States, the United Kingdom, and the Netherlands. Of the top 30 studies the highest reported participatory frameworks were User-Centered Design, Participatory Action Research Framework, and the Center for eHealth Research and Disease Management (CeHRes) Roadmap, and the highest reported model underpinning development and engagement was Social Cognitive Theory. Of the 30 studies, 4 reported on all the 5 stages of the CeHRes Roadmap. Conclusions The top 30 studies yielded 24 participatory frameworks. Many studies referred to using participatory design methods without reference to a framework. The application of a structured framework such as the CeHRes Roadmap and a model such as Social Cognitive Theory creates a foundation for a well-designed eHealth initiative that ensures clarity and enables replication across participatory design projects. The framework and model need to be clearly articulated and address issues that include resource availability, responsiveness to change, and the criteria for good practice. This review creates an information resource for future eHealth developers, to guide the design of their eHealth resource with a framework that can support further evaluation and development. Trial Registration PROSPERO CRD42017053838; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53838
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Affiliation(s)
- Gaye Moore
- Mental Health Executive Services, St Vincent's Hospital, Melbourne, Fitzroy, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Helen Wilding
- Mental Health Executive Services, St Vincent's Hospital, Melbourne, Fitzroy, Australia.,Library Service, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia
| | - David Castle
- Mental Health Executive Services, St Vincent's Hospital, Melbourne, Fitzroy, Australia.,Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Ghanvatkar S, Kankanhalli A, Rajan V. User Models for Personalized Physical Activity Interventions: Scoping Review. JMIR Mhealth Uhealth 2019; 7:e11098. [PMID: 30664474 PMCID: PMC6352015 DOI: 10.2196/11098] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/01/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023] Open
Abstract
Background Fitness devices have spurred the development of apps that aim to motivate users, through interventions, to increase their physical activity (PA). Personalization in the interventions is essential as the target users are diverse with respect to their activity levels, requirements, preferences, and behavior. Objective This review aimed to (1) identify different kinds of personalization in interventions for promoting PA among any type of user group, (2) identify user models used for providing personalization, and (3) identify gaps in the current literature and suggest future research directions. Methods A scoping review was undertaken by searching the databases PsycINFO, PubMed, Scopus, and Web of Science. The main inclusion criteria were (1) studies that aimed to promote PA; (2) studies that had personalization, with the intention of promoting PA through technology-based interventions; and (3) studies that described user models for personalization. Results The literature search resulted in 49 eligible studies. Of these, 67% (33/49) studies focused solely on increasing PA, whereas the remaining studies had other objectives, such as maintaining healthy lifestyle (8 studies), weight loss management (6 studies), and rehabilitation (2 studies). The reviewed studies provide personalization in 6 categories: goal recommendation, activity recommendation, fitness partner recommendation, educational content, motivational content, and intervention timing. With respect to the mode of generation, interventions were found to be semiautomated or automatic. Of these, the automatic interventions were either knowledge-based or data-driven or both. User models in the studies were constructed with parameters from 5 categories: PA profile, demographics, medical data, behavior change technique (BCT) parameters, and contextual information. Only 27 of the eligible studies evaluated the interventions for improvement in PA, and 16 of these concluded that the interventions to increase PA are more effective when they are personalized. Conclusions This review investigates personalization in the form of recommendations or feedback for increasing PA. On the basis of the review and gaps identified, research directions for improving the efficacy of personalized interventions are proposed. First, data-driven prediction techniques can facilitate effective personalization. Second, use of BCTs in automated interventions, and in combination with PA guidelines, are yet to be explored, and preliminary studies in this direction are promising. Third, systems with automated interventions also need to be suitably adapted to serve specific needs of patients with clinical conditions. Fourth, previous user models focus on single metric evaluations of PA instead of a potentially more effective, holistic, and multidimensional view. Fifth, with the widespread adoption of activity monitoring devices and mobile phones, personalized and dynamic user models can be created using available user data, including users’ social profile. Finally, the long-term effects of such interventions as well as the technology medium used for the interventions need to be evaluated rigorously.
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Affiliation(s)
- Suparna Ghanvatkar
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Atreyi Kankanhalli
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
| | - Vaibhav Rajan
- Department of Information Systems and Analytics, School of Computing, National University of Singapore, Singapore, Singapore
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Finne E, Glausch M, Exner AK, Sauzet O, Stölzel F, Seidel N. Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials. Cancer Manag Res 2018; 10:5125-5143. [PMID: 30464612 PMCID: PMC6215922 DOI: 10.2147/cmar.s170064] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated. Methods This study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I2), and moderator effects in terms of regression coefficients. Results This study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18–0.37) on PA, and I2=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES. Conclusion Certain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.
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Affiliation(s)
- Emily Finne
- School of Public Health, Bielefeld University, Bielefeld, Germany,
| | - Melanie Glausch
- University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | | | - Odile Sauzet
- School of Public Health, Bielefeld University, Bielefeld, Germany, .,Center for Statistics (ZeSt), Bielefeld University, Bielefeld, Germany
| | - Friederike Stölzel
- University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Nadja Seidel
- University Cancer Center, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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NOBAKHT Z, RASSAFIANI M, HOSSEINI SA. A Web-Based Caring Training for Caregivers of Children with Cerebral Palsy: Development and Evaluation. IRANIAN JOURNAL OF CHILD NEUROLOGY 2018; 12:65-84. [PMID: 30279710 PMCID: PMC6160627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/15/2017] [Accepted: 09/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Caregivers of children with cerebral palsy (CP) have to spend a long time to take care of their children. We aimed to develop a user-friendly web-based intervention for training parents of children with CP and evaluate the process of development using modified CeHRes roadmap. MATERIALS & METHODS The study was conducted from September 2016 to September 2017 in Tehran, Iran. We did it in four main steps including determining the needs of users, content development, design, operational development and evaluation. RESULTS The website for caregiver training provided nine general topics and had the possibility that the caregivers could determine their educational priorities. Moreover, the users could share their experiences with other users and could ask questions from an expert. Ten caregivers completed a usability questionnaire after four weeks of use. The average score of 70.5 out of 100 was shown among caregivers. The average score of all statements was above three on a Likert scale between 1 and 5. CONCLUSION The website has the possibilities including registering caregivers of children with CP, the possibility to confirm registration with an SMS and the possibility to determine the caregiver educational priorities. It has the usability for training caregivers of children with CP.
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Affiliation(s)
- Zahra NOBAKHT
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi RASSAFIANI
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Seyed Ali HOSSEINI
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Ryu B, Kim N, Heo E, Yoo S, Lee K, Hwang H, Kim JW, Kim Y, Lee J, Jung SY. Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper. J Med Internet Res 2017; 19:e401. [PMID: 29217503 PMCID: PMC5740264 DOI: 10.2196/jmir.8867] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Personal health record (PHR)-based health care management systems can improve patient engagement and data-driven medical diagnosis in a clinical setting. OBJECTIVE The purpose of this study was (1) to demonstrate the development of an electronic health record (EHR)-tethered PHR app named MyHealthKeeper, which can retrieve data from a wearable device and deliver these data to a hospital EHR system, and (2) to study the effectiveness of a PHR data-driven clinical intervention with clinical trial results. METHODS To improve the conventional EHR-tethered PHR, we ascertained clinicians' unmet needs regarding PHR functionality and the data frequently used in the field through a cocreation workshop. We incorporated the requirements into the system design and architecture of the MyHealthKeeper PHR module. We constructed the app and validated the effectiveness of the PHR module by conducting a 4-week clinical trial. We used a commercially available activity tracker (Misfit) to collect individual physical activity data, and developed the MyHealthKeeper mobile phone app to record participants' patterns of daily food intake and activity logs. We randomly assigned 80 participants to either the PHR-based intervention group (n=51) or the control group (n=29). All of the study participants completed a paper-based survey, a laboratory test, a physical examination, and an opinion interview. During the 4-week study period, we collected health-related mobile data, and study participants visited the outpatient clinic twice and received PHR-based clinical diagnosis and recommendations. RESULTS A total of 68 participants (44 in the intervention group and 24 in the control group) completed the study. The PHR intervention group showed significantly higher weight loss than the control group (mean 1.4 kg, 95% CI 0.9-1.9; P<.001) at the final week (week 4). In addition, triglyceride levels were significantly lower by the end of the study period (mean 2.59 mmol/L, 95% CI 17.6-75.8; P=.002). CONCLUSIONS We developed an innovative EHR-tethered PHR system that allowed clinicians and patients to share lifelog data. This study shows the effectiveness of a patient-managed and clinician-guided health tracker system and its potential to improve patient clinical profiles. TRIAL REGISTRATION ClinicalTrials.gov NCT03200119; https://clinicaltrials.gov/ct2/show/NCT03200119 (Archived by WebCite at http://www.webcitation.org/6v01HaCdd).
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Affiliation(s)
- Borim Ryu
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Nari Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Eunyoung Heo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Keehyuck Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Hee Hwang
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Yoojung Kim
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic Of Korea
| | - Joongseek Lee
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Republic Of Korea
| | - Se Young Jung
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
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Alley SJ, Schoeppe S, Rebar AL, Hayman M, Vandelanotte C. Age differences in physical activity intentions and implementation intention preferences. J Behav Med 2017; 41:406-415. [DOI: 10.1007/s10865-017-9899-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/20/2017] [Indexed: 12/30/2022]
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Wittmann D, Mehta A, Northouse L, Dunn R, Braun T, Duby A, An L, Arab L, Bangs R, Bober S, Brandon J, Coward M, Dunn M, Galbraith M, Garcia M, Giblin J, Glode M, Koontz B, Lowe A, Mitchell S, Mulhall J, Nelson C, Paich K, Saigal C, Skolarus T, Stanford J, Walsh T, Pollack CE. TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial. BMC Cancer 2017; 17:664. [PMID: 28969611 PMCID: PMC5625773 DOI: 10.1186/s12885-017-3652-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 09/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment. METHODS The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes. DISCUSSION The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.
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Affiliation(s)
- D Wittmann
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA.
| | - A Mehta
- Emory University, Atlanta, GA, USA
| | - L Northouse
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - R Dunn
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - T Braun
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - A Duby
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - L An
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - L Arab
- University of California-Los Angeles, California, Los Angeles, USA
| | - R Bangs
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - S Bober
- Dana Farber Cancer Center and Harvard University, Boston, MA, USA
| | - J Brandon
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - M Coward
- University of North Carolina, Chapel Hill, NC, USA
| | - M Dunn
- University of North Carolina, Chapel Hill, NC, USA
| | - M Galbraith
- University of Colorado-Denver, Denver, CO, USA
| | - M Garcia
- University of California-San Francisco, San Francisco, CA, USA
| | - J Giblin
- Emory University, Atlanta, GA, USA
| | - M Glode
- University of Colorado-Denver, Denver, CO, USA
| | - B Koontz
- Duke University, Durham, NC, USA
| | - A Lowe
- Prostate Cancer Foundation-Australia, St Leonards, Australia
| | - S Mitchell
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - J Mulhall
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - C Nelson
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - K Paich
- TrueNTH Movember Foundation, Michigan, USA
| | - C Saigal
- University of California-Los Angeles, California, Los Angeles, USA
| | - T Skolarus
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
- VA Ann Arbor Healthcare System, HSRD Center for Clinical Management Research, Ann Arbor, USA
| | - J Stanford
- Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - T Walsh
- University of Washington, Seattle, Washington, USA
| | - C E Pollack
- Johns Hopkins University, Baltimore, MD, USA
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Golsteijn RHJ, Bolman C, Volders E, Peels DA, de Vries H, Lechner L. Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer 2017. [PMID: 28651586 PMCID: PMC5485671 DOI: 10.1186/s12885-017-3397-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems. Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands Methods The OncoActive intervention was developed through systematic adaptation of a proven effective, evidence-based, computer-tailored PA intervention for adults over fifty, called Active Plus. The Intervention Mapping (IM) protocol was used to guide the systematic adaptation. A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed. Change objectives, theoretical methods and applications and the actual program content were adapted to address the specific needs, beliefs and cancer-related issues of prostate and colorectal CPS. Intervention participants received tailored PA advice three times, on internet and with printed materials, and a pedometer to set goals to improve PA. Pre- and pilot tests showed that the intervention was highly appreciated (target group) and regarded safe and feasible (healthcare professionals). The effectiveness of the intervention is being evaluated in a randomized controlled trial (RCT) (n = 428), consisting of an intervention group and a usual care waiting-list control group, with follow-up measurements at three, six and twelve months. Participants are recruited from seventeen hospitals and with posters, flyers and calls in several media. Discussion Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored. Trial registration The study is registered in the Dutch Trial Register (NTR4296) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4296.
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Affiliation(s)
- R H J Golsteijn
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands.
| | - C Bolman
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - E Volders
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - D A Peels
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - H de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - L Lechner
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
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Short CE, James EL, Rebar AL, Duncan MJ, Courneya KS, Plotnikoff RC, Crutzen R, Bidargaddi N, Vandelanotte C. Designing more engaging computer-tailored physical activity behaviour change interventions for breast cancer survivors: lessons from the iMove More for Life study. Support Care Cancer 2017. [PMID: 28624949 DOI: 10.1007/s00520-017-3786-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Participating in regular physical activity is a recommended cancer recovery strategy for breast cancer survivors. However, tailored support services are not widely available and most survivors are insufficiently active to obtain health benefits. Delivering tailored programs via the Internet offers one promising approach. However, recent evaluations of such programs suggest that major improvements are needed to ensure programs meet the needs of users and are delivered in an engaging way. Understanding participants' experiences with current programs can help to inform the next generation of systems. PURPOSE The purposes of this study are to explore breast cancer survivor's perspectives of and experiences using a novel computer-tailored intervention and to describe recommendations for future iterations. METHODS Qualitative data from a sub-sample of iMove More for Life study participants were analysed thematically to identify key themes. Participants long-term goals for participating in the program were explored by analysing open-ended data extracted from action plans completed during the intervention (n = 370). Participants negative and positive perceptions of the website and recommendations for improvement were explored using data extracted from open-ended survey items collected at the immediate intervention follow-up (n = 156). RESULTS The majority of participants reported multi-faceted goals, consisting of two or more outcomes they hoped to achieve within a year. While clear themes were identified (e.g. 'being satisfied with body weight'), there was considerable variability in the scope of the goal (e.g. desired weight loss ranged from 2 to 30 kg). Participants' perceptions of the website were mixed, but clear indications were provided of how intervention content and structure could be improved. CONCLUSIONS This study provides insight into how to better accommodate breast cancer survivors in the future and ultimately design more engaging computer-tailored interventions.
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Affiliation(s)
- C E Short
- School of Medicine, Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, Australia.
| | - E L James
- School of Medicine and Public Health, Priority Research Centre for Physical Activity and Nutrition & Priority Research Centre in Health Behaviour, University of Newcastle, Callaghan, Australia
| | - A L Rebar
- School of Human, Health and Social Sciences, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia
| | - M J Duncan
- School of Education, Priority Research Centre for Physical Activity and Nutrition, Callaghan, University of Newcastle, Callaghan, Australia
| | - K S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - R C Plotnikoff
- School of Education, Priority Research Centre for Physical Activity and Nutrition, Callaghan, University of Newcastle, Callaghan, Australia
| | - R Crutzen
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - N Bidargaddi
- School of Medicine, Personal Health Informatics Group, Flinders University, Clovelly Park, Australia
| | - C Vandelanotte
- School of Education, Priority Research Centre for Physical Activity and Nutrition, Callaghan, University of Newcastle, Callaghan, Australia
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Lee JE, Lee DE, Kim K, Shim JE, Sung E, Kang JH, Hwang JY. Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students. Nutr Res Pract 2017; 11:247-256. [PMID: 28584582 PMCID: PMC5449382 DOI: 10.4162/nrp.2017.11.3.247] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/OBJECTIVES Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.
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Affiliation(s)
- Ji Eun Lee
- Department of Foodservice Management and Nutrition, Sangmyung University, 20 Hongjimun 2-gil, Jongno-gu, Seoul 03016, Korea
| | - Da Eun Lee
- Department of Foodservice Management and Nutrition, Sangmyung University, 20 Hongjimun 2-gil, Jongno-gu, Seoul 03016, Korea
| | - Kirang Kim
- Department of Food Science and Nutrition, Dankook University, Chungnam 31116, Korea
| | - Jae Eun Shim
- Department of Food and Nutrition, Daejeon University, Daejeon 34520, Korea
| | - Eunju Sung
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul 04551, Korea
| | - Ji-Yun Hwang
- Department of Foodservice Management and Nutrition, Sangmyung University, 20 Hongjimun 2-gil, Jongno-gu, Seoul 03016, Korea
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M Quintiliani L, Mann DM, Puputti M, Quinn E, Bowen DJ. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors. JMIR Cancer 2016. [PMID: 28410174 DOI: 10.2196/cancer.5305.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. OBJECTIVE The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. METHODS The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing-based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. RESULTS Ten women participated; they had a mean age of 59 years (SD 6), 50% belonged to a racial or ethnic minority group, 50% had some college or less, and 40% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100% of participants completed all 4 calls with the counselor. Most (90%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change -3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). CONCLUSIONS Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02387671; https://clinicaltrials.gov/ct2/show/NCT02387671 (Archived by WebCite at http://www.webcitation.org/6hGEuttbZ).
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Devin M Mann
- Boston University, Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston, MA, United States
| | - Marissa Puputti
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Emily Quinn
- Boston University, School of Public Health, Data Coordinating Center, Boston, MA, United States
| | - Deborah J Bowen
- University of Washington, School of Medicine, Department of Bioethics & Humanities, Seattle, WA, United States
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17
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Quintiliani LM, Mann DM, Puputti M, Quinn E, Bowen DJ. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors. JMIR Cancer 2016; 2:e4. [PMID: 27761518 PMCID: PMC5066594 DOI: 10.2196/cancer.5305] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/17/2016] [Accepted: 03/18/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. OBJECTIVE The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. METHODS The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing-based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. RESULTS Ten women participated; they had a mean age of 59 years (SD 6), 50% belonged to a racial or ethnic minority group, 50% had some college or less, and 40% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100% of participants completed all 4 calls with the counselor. Most (90%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change -3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). CONCLUSIONS Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02387671; https://clinicaltrials.gov/ct2/show/NCT02387671 (Archived by WebCite at http://www.webcitation.org/6hGEuttbZ).
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Devin M Mann
- Boston University, Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston, MA, United States
| | - Marissa Puputti
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Emily Quinn
- Boston University, School of Public Health, Data Coordinating Center, Boston, MA, United States
| | - Deborah J Bowen
- University of Washington, School of Medicine, Department of Bioethics & Humanities, Seattle, WA, United States
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18
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Arens-Volland AG, Spassova L, Bohn T. Promising approaches of computer-supported dietary assessment and management-Current research status and available applications. Int J Med Inform 2015; 84:997-1008. [PMID: 26321486 DOI: 10.1016/j.ijmedinf.2015.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this review was to analyze computer-based tools for dietary management (including web-based and mobile devices) from both scientific and applied perspectives, presenting advantages and disadvantages as well as the state of validation. METHODS For this cross-sectional analysis, scientific results from 41 articles retrieved via a medline search as well as 29 applications from online markets were identified and analyzed. RESULTS Results show that many approaches computerize well-established existing nutritional concepts for dietary assessment, e.g., food frequency questionnaires (FFQ) or dietary recalls (DR). Both food records and barcode scanning are less prominent in research but are frequently offered by commercial applications. Integration with a personal health record (PHR) or a health care workflow is suggested in the literature but is rarely found in mobile applications. CONCLUSIONS It is expected that employing food records for dietary assessment in research settings will be increasingly used when simpler interfaces, e.g., barcode scanning techniques, and comprehensive food databases are applied, which can also support user adherence to dietary interventions and follow-up phases of nutritional studies.
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Affiliation(s)
- Andreas G Arens-Volland
- Luxembourg Institute of Science and Technology, IT for Innovative Services (ITIS) Department, 5, avenue des Hauts-Fourneaux, L-4362 Esch/Alzette, Luxembourg.
| | - Lübomira Spassova
- Luxembourg Institute of Science and Technology, IT for Innovative Services (ITIS) Department, 5, avenue des Hauts-Fourneaux, L-4362 Esch/Alzette, Luxembourg
| | - Torsten Bohn
- Luxembourg Institute of Science and Technology, Environmental Research and Innovation (ERIN) Department, 41, rue du Brill, L-4422 Belvaux, Luxembourg
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Santiago-Rivas M, Velicer WF, Redding C. Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection. Psychol Health 2015; 30:1433-49. [PMID: 26040293 DOI: 10.1080/08870446.2015.1056791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant. DESIGN Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention. MAIN OUTCOME MEASURES Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use. RESULTS With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126-.614), and the pros predicted the outcomes (r = .181-.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes. CONCLUSION In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.
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Affiliation(s)
- Marimer Santiago-Rivas
- a Department of Oncological Sciences , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Wayne F Velicer
- b Cancer Prevention Research Center , University of Rhode Island , Kingston , RI , USA
| | - Colleen Redding
- b Cancer Prevention Research Center , University of Rhode Island , Kingston , RI , USA
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Davis SW, Oakley-Girvan I. mHealth Education Applications Along the Cancer Continuum. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:388-394. [PMID: 25482319 DOI: 10.1007/s13187-014-0761-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The majority of adults worldwide own a mobile phone, including those in under-resourced communities. Mobile health (mhealth) education technologies present a promising mechanism for improving cancer prevention, treatment, and follow-up. The purpose of this study was to summarize the literature related to mobile phone (mhealth) applications for patient education specific to cancer and identify current recommendations from randomized studies. In particular, we were interested in identifying mobile phone applications along the cancer continuum, from cancer prevention to survivorship. The authors identified 28 articles reporting on mobile applications for patients related to cancer. Articles were identified in all categories along the cancer continuum, including health professional involvement in application development. Of these, six involved direct patient education, and eight focused on improving patient/professional communication and patient self-management. However, only six of the studies were randomized interventions. The potential for mobile applications to help overcome the "health care gap" has not yet been realized in the studies from the USA that were reviewed for this paper. However, early recommendations are emerging that support the use of mHealth communications to change behaviors for cancer prevention, early detection, and symptom management and improved patient-provider communication. Recommendations include short messages, use of multiple modalities as patient characteristics dictate comfort with mHealth communication, and the inclusion of patients and health professionals to develop and test applications. Tailoring mHealth to particular cultures, languages, and ethnic groups may also represent a unique possibility to provide accessible information and education at minimal cost for under-resourced communities and individuals.
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Affiliation(s)
- Sharon Watkins Davis
- Cancer Prevention Institute of California, 2201 Walnut Ave., Suite 300, Fremont, CA, 94538, USA,
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van Genugten L, van Empelen P, Oenema A. Intervention use and action planning in a web-based computer-tailored weight management program for overweight adults: randomized controlled trial. JMIR Res Protoc 2014; 3:e31. [PMID: 25057122 PMCID: PMC4129126 DOI: 10.2196/resprot.2599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/11/2013] [Accepted: 03/13/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are many online interventions aiming for health behavior change but it is unclear how such interventions and specific planning tools are being used. OBJECTIVE The aim of this study is to identify which user characteristics were associated with use of an online, computer-tailored self-regulation intervention aimed at prevention of weight gain; and to examine the quality of the goals and action plans that were generated using the online planning tools. METHODS Data were obtained with a randomized controlled effect evaluation trial in which the online computer-tailored intervention was compared to a website containing generic information about prevention of weight gain. The tailored intervention included self-regulation techniques such as personalized feedback, goal setting, action planning, monitoring, and other techniques aimed at weight management. Participants included 539 overweight adults (mean age 46.9 years, mean body mass index [BMI] 28.03 kg/m(2), 31.2% male, 11% low education level) recruited from the general population. Use of the intervention and its planning tools were derived from server registration data. Physical activity, fat intake, motivational factors, and self-regulation skills were self-reported at baseline. Descriptive analyses and logistic regression analyses were used to analyze the results. RESULTS Use of the tailored intervention decreased sharply after the first modules. Visiting the first tailored intervention module was more likely among participants with low levels of fat intake (OR 0.77, 95% CI 0.62-0.95) or planning for change in PA (OR 0.23, 95% CI 0.05-0.97). Revisiting the intervention was more likely among participants high in restrained eating (OR 2.45, 95% CI 1.12-5.43) or low in proactive coping skills for weight control (OR 0.28, 95% CI 0.10-0.76). The planning tools were used by 5%-55% of the participants, but only 20%-75% of the plans were of good quality. CONCLUSIONS This study showed that psychological factors such as self-regulation skills and action planning were associated with repeated use of an online, computer-tailored self-regulation intervention aimed at prevention of weight gain among adults being overweight. Use of the intervention was not optimal, with a limited number of participants who visited all the intervention modules. The use of the action and coping planning components of the intervention was mediocre and the quality of the generated plans was low, especially for the coping plans. It is important to identify how the use of action planning and coping planning components in online interventions can be promoted and how the quality of plans generated through these tools can be improved. TRIAL REGISTRATION Netherlands Trial Register: NTR1862; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1862 (Archived by WebCite at http://www.webcitation.org/6QG1ZPIzZ).
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Affiliation(s)
- Lenneke van Genugten
- Erasmus University Medical Center, Department of Public Health, Rotterdam, Netherlands.
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22
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Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY. A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Int J Nurs Stud 2014; 51:1557-67. [PMID: 24856854 DOI: 10.1016/j.ijnurstu.2014.04.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/23/2014] [Accepted: 04/22/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Regular exercise and dietary practices have been shown to affect the health-related quality of life (HRQOL) and survival of breast cancer patients. OBJECTIVE The current study aimed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients. DESIGN A 12-week randomized, controlled trial. SETTING Oncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea. PARTICIPANTS Fifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0-III cancers within 2 years prior to the study were recruited. METHODS Participants were randomly assigned to either the intervention group, which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies (n=29), or to the control group, which used a 50-page educational booklet on exercise and diet (n=28). The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables (F&V) per day, dietary quality, HRQOL, anxiety, depression, fatigue, motivational readiness, and self-efficacy. RESULTS The proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week; ate 5 servings of F&V per day; and had overall improvements in dietary quality, physical functioning and appetite loss (HRQOL), fatigue, and motivational readiness was greater in the intervention group than in the control group. The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group. A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy, although further research with a larger sample size is required to enable definitive conclusions.
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Affiliation(s)
- Myung Kyung Lee
- Kyungpook National University, College of Nursing, Daegu, South Korea
| | - Young Ho Yun
- Cancer Research Institute, Seoul National University Hospital and College of Medicine, Seoul, South Korea; Research Institute and Hospital, National Cancer Center, Goyang-si, South Korea.
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Eun Sook Lee
- Research Institute and Hospital, National Cancer Center, Goyang-si, South Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Young Noh
- Cancer Research Institute, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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23
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Bantum EO, Albright CL, White KK, Berenberg JL, Layi G, Ritter PL, Laurent D, Plant K, Lorig K. Surviving and thriving with cancer using a Web-based health behavior change intervention: randomized controlled trial. J Med Internet Res 2014; 16:e54. [PMID: 24566820 PMCID: PMC3961702 DOI: 10.2196/jmir.3020] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/02/2014] [Accepted: 01/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Given the substantial improvements in cancer screening and cancer treatment in the United States, millions of adult cancer survivors live for years following their initial cancer diagnosis and treatment. However, latent side effects can occur and some symptoms can be alleviated or managed effectively via changes in lifestyle behaviors. OBJECTIVE The purpose of this study was to test the effectiveness of a six-week Web-based multiple health behavior change program for adult survivors. METHODS Participants (n=352) were recruited from oncology clinics, a tumor registry, as well as through online mechanisms, such as Facebook and the Association of Cancer Online Resources (ACOR). Cancer survivors were eligible if they had completed their primary cancer treatment from 4 weeks to 5 years before enrollment. Participants were randomly assigned to the Web-based program or a delayed-treatment control condition. RESULTS In total, 303 survivors completed the follow-up survey (six months after completion of the baseline survey) and participants in the Web-based intervention condition had significantly greater reductions in insomnia and greater increases in minutes per week of vigorous exercise and stretching compared to controls. There were no significant changes in fruit and vegetable consumption or other outcomes. CONCLUSIONS The Web-based intervention impacted insomnia and exercise; however, a majority of the sample met or exceeded national recommendations for health behaviors and were not suffering from depression or fatigue at baseline. Thus, the survivors were very healthy and well-adjusted upon entry and their ability to make substantial health behavior changes may have been limited. Future work is discussed, with emphasis placed on ways in which Web-based interventions can be more specifically analyzed for benefit, such as in regard to social networking. TRIAL REGISTRATION Clinicaltrials.gov NCT00962494; http://www.clinicaltrials.gov/ct2/show/NCT00962494 (Archived by WebCite at http://www.webcitation.org/6NIv8Dc6Q).
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Affiliation(s)
- Erin O'Carrol Bantum
- University of Hawaii Cancer Center, Cancer Prevention & Control, Honolulu, HI, United States.
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