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Mehrotra S, Bhattacharjya S, Shetty RS. Self-management interventions among community-dwelling older adults with type 2 diabetes mellitus: a scoping review protocol. BMJ Open 2024; 14:e084743. [PMID: 39181548 DOI: 10.1136/bmjopen-2024-084743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Globally, the number of older adults is increasing rapidly; simultaneously, there is an epidemiological shift toward chronic diseases. One such chronic disease is type 2 diabetes mellitus (DM) which is caused either by the inability to produce insulin or due to the ineffective use of insulin. In recent years, self-management programmes for chronic conditions have gained importance, especially among occupational therapists. Though there is an increasing focus on 'self-management interventions' among older adults, there is still a lack of such interventions for older adults with type 2 DM in low- or middle-income countries (LMICs). OBJECTIVES Summarise the existing literature on self-management intervention programmes for community-dwelling older adults with type 2 DM; identify the principles, practices and criteria that define a self-management intervention programme for community-dwelling older adults with type 2 DM in LMICs. METHODS This present study will be a scoping review, combining quantitative and qualitative literature with a parallel results convergent synthesis design. The synthesis applies to analysing existing principles and practices that influence the selection and application of 'diabetes self-management intervention' among older adults in community settings with type 2 DM in LMICs. ETHICS AND DISSEMINATION As a secondary analysis, this scoping review does not require ethics approval. The final review results will be submitted for publication in a peer-reviewed journal in the rehabilitation, diabetes, occupational therapy or health promotion-related fields. Other dissemination strategies may be an oral presentation at international conferences or through various social media networks.
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Affiliation(s)
- Shashank Mehrotra
- Department of Occupational Therapy, Manipal College of Health Professions,Manipal Academy of Higher Education, Manipal, Karnataka, India-576104
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, Georgia, USA
| | - Ranjitha S Shetty
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India -576104
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Citoni B, Figliuzzi I, Presta V, Volpe M, Tocci G. Home Blood Pressure and Telemedicine: A Modern Approach for Managing Hypertension During and After COVID-19 Pandemic. High Blood Press Cardiovasc Prev 2022; 29:1-14. [PMID: 34855154 PMCID: PMC8638231 DOI: 10.1007/s40292-021-00492-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
Hypertension is the most common cardiovascular risk factor for acute cardiovascular outcomes, including acute coronary disease, stroke, chronic kidney disease and congestive heart failure. Despite the fact that it represents the most prevalent risk factor in the general population, mostly in elderly individuals, its awareness is still relatively low, being about one third of patients living with undiagnosed hypertension and high risk of experiencing acute cardiovascular events. In addition, though recent improvement in pharmacological and non-pharmacological therapeutic options, hypertension is largely uncontrolled, with about 35-40% of treated hypertensive patients achieving the recommended therapeutic targets. Among different modern interventions proposed for improving blood pressure control in treated hypertensive patients, a systematic adoption of home BP monitoring has demonstrated to be one of the most effective. Indeed, it improves patients' awareness of the disease and adherence to prescribed medications and allows tailoring and personalizing BP lowering therapies. Home BP monitoring is particularly suitable for telemedicine and mobile-health solutions. Indeed, in specific conditions, when face-to-face interactions between patients and physicians are not allowed or even suspended, as in case of COVID-19 pandemic, telemedicine may ensure effective management of hypertension, as well as other cardiovascular and non-cardiovascular comorbidities. This review will summarize strengths and limitations of telemedicine in the clinical management of hypertension with a particular focus on the lessons learned during the COVID-19 pandemic.
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Affiliation(s)
- Barbara Citoni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Ilaria Figliuzzi
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Vivianne Presta
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy.
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Lu X, Yang H, Xia X, Lu X, Lin J, Liu F, Gu D. Interactive Mobile Health Intervention and Blood Pressure Management in Adults. Hypertension 2019; 74:697-704. [PMID: 31327259 DOI: 10.1161/hypertensionaha.119.13273] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite the availability of effective drugs, blood pressure (BP) control remains poor among most populations. To explore the effects of interactive mobile health (mhealth) intervention on BP management and find out the optimal target population, we performed a systematic review and meta-analysis of randomized controlled trials to estimate the pooled effects of mhealth intervention on BP control. PubMed, EMBASE, Cochrane Library, and CNKI were searched to identify eligible randomized controlled trials published between January 15, 2007 and April 28, 2019, and bibliographies of eligible articles were further reviewed. Random-effect models were utilized to pool estimates of net changes in systolic BP and diastolic BP between mhealth intervention group and control group. Eleven randomized controlled trials met the inclusion criteria, with a total sample size of 4271 participants. Compared with the control group, mhealth intervention was associated with significant changes in systolic BP and diastolic BP of -3.85 mm Hg; 95% CI, -4.74 to -2.96 and -2.19 mm Hg; 95% CI, -3.16 to -1.23, respectively. Subgroup analyses revealed consistent effects across study duration and intervention intensity subgroups. In addition, participants with inadequate BP control at recruitment might gain more benefits with mhealth intervention. Therefore, interactive mhealth intervention may be a useful tool for improving BP control among adults, especially among those with inadequate BP control.
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Affiliation(s)
- Xiaomei Lu
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.).,Community Health Service Center Management Office, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen 518 001, China (Xiaomei Lu, J.L.)
| | - Huijun Yang
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.)
| | - Xue Xia
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.)
| | - Xiangfeng Lu
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.)
| | - Jinchun Lin
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.).,Community Health Service Center Management Office, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen 518 001, China (Xiaomei Lu, J.L.)
| | - Fangchao Liu
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.)
| | - Dongfeng Gu
- From the Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Xiaomei Lu, H.Y., X.X., Xiangfeng Lu, J.L., F.L., .D.G.)
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Mazoteras Pardo V, Losa Iglesias ME, López Chicharro J, Becerro de Bengoa Vallejo R. The QardioArm App in the Assessment of Blood Pressure and Heart Rate: Reliability and Validity Study. JMIR Mhealth Uhealth 2017; 5:e198. [PMID: 29246880 PMCID: PMC5747597 DOI: 10.2196/mhealth.8458] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Self-measurement of blood pressure is a priority strategy for managing blood pressure. OBJECTIVE The aim of this study was to evaluate the reliability and validity of blood pressure and heart rate following the European Society of Hypertension's international validation protocol, as measured with the QardioArm, a fully automatic, noninvasive wireless blood pressure monitor and mobile app. METHODS A total of 100 healthy volunteers older than 25 years from the general population of Ciudad Real, Spain, participated in a test-retest validation study with two measurement sessions separated by 5 to 7 days. In each measurement session, seven systolic blood pressure, diastolic blood pressure, and heart rate assessments were taken, alternating between the two devices. The test device was the QardioArm and the previously validated criterion device was the Omron M3. Sessions took place at a single study site with an evaluation room that was maintained at an appropriate temperature and kept free from noises and distractions. RESULTS The QardioArm displayed very consistent readings both within and across sessions (intraclass correlation coefficients=0.80-0.95, standard errors of measurement=2.5-5.4). The QardioArm measurements corresponded closely to those from the criterion device (r>.96) and mean values for the two devices were nearly identical. The QardioArm easily passed all validation standards set by the European Society of Hypertension International Protocol. CONCLUSIONS The QardioArm mobile app has validity and it can be used free of major measurement error.
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Mathiesen AS, Thomsen T, Jensen T, Schiøtz C, Langberg H, Egerod I. The influence of diabetes distress on digital interventions for diabetes management in vulnerable people with type 2 diabetes: A qualitative study of patient perspectives. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 9:41-47. [PMID: 29067269 PMCID: PMC5651295 DOI: 10.1016/j.jcte.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Digital interventions for improving diabetes management in Type 2 diabetes mellitus (T2DM) are used universally. Digital interventions are defined as any intervention accessed and taking input from people with T2DM in the form of a web-based or mobile phone-based app to improve diabetes self-management. However, the current confidence in digital interventions threatens to augment social inequalities in health, also known as the "digital divide". To counteract dissemination of the digital divide, we aimed to assess the potential of a tailored digital intervention for improving diabetes management in vulnerable people with T2DM. METHODS A qualitative design using semi-structured in-depth interviews to explore the perspectives of 12 vulnerable people with T2DM. Interviews were analyzed using inductive content analysis. Vulnerability was defined by the presence of one or more comorbidities, one or more lifestyle risk factors, poor diabetes management, low educational level and low health literacy. RESULTS The main themes identified were: "Dealing with diabetes distress" characterized by psychological avoidance mechanisms; "Suffering informational confusion" dealing with inconsistent information; "Experiencing digital alienation" dealing with loss of freedom when technology invades the private sphere; and "Missing the human touch" preferring human interaction over digital contact. CONCLUSION Vulnerable people with T2DM are unprepared for digital interventions for disease management. Experiencing diabetes distress may be an intermediate mechanism leading to nonadherence to digital interventions and the preference for human interaction in vulnerable people with T2DM. Future interventions could include a designated caregiver and an allocated buddy to provide support and assist uptake of digital interventions for diabetes management.
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Affiliation(s)
- Anne Sophie Mathiesen
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.,University of Copenhagen, Faculty of Health & Medical Sciences, Denmark
| | - Tonny Jensen
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Charlotte Schiøtz
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Dept. of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Henrik Pontoppidansvej 6,1, DK-2200 Copenhagen, Denmark
| | - Ingrid Egerod
- University of Copenhagen, Faculty of Health & Medical Sciences, Denmark.,Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Nicholl BI, Sandal LF, Stochkendahl MJ, McCallum M, Suresh N, Vasseljen O, Hartvigsen J, Mork PJ, Kjaer P, Søgaard K, Mair FS. Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review. J Med Internet Res 2017; 19:e179. [PMID: 28550009 PMCID: PMC5466697 DOI: 10.2196/jmir.7290] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/13/2017] [Accepted: 03/18/2017] [Indexed: 01/07/2023] Open
Abstract
Background Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health. Objective The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes? Methods Bibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively. Results Of the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm. Conclusions The literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak.
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Affiliation(s)
- Barbara I Nicholl
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Louise F Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mette J Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Marianne McCallum
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Nithya Suresh
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ottar Vasseljen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Paul J Mork
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Frances S Mair
- General Practice & Primary Care, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies. PATIENT EDUCATION AND COUNSELING 2017; 100:616-635. [PMID: 28029572 PMCID: PMC5380218 DOI: 10.1016/j.pec.2016.10.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To understand the experiences of patients and healthcare professionals (HCPs) using self-management digital interventions (DIs) for chronic physical health conditions. METHODS A systematic search was conducted in 6 electronic databases. Qualitative studies describing users' experiences of self-management DIs were included, and authors' interpretations were synthesised using meta-ethnography. RESULTS 30 papers met the inclusion criteria, covering a range of DIs and chronic conditions, including hypertension, asthma and heart disease. The review found that patients monitoring their health felt reassured by the insight this provided, and perceived they had more meaningful consultations with the HCP. These benefits were elicited by simple tele-monitoring systems as well as multifaceted DIs. Patients appeared to feel more reliant on HCPs if they received regular feedback from the HCP. HCPs focused mainly on their improved clinical control, and some also appreciated patients' increased understanding of their condition. CONCLUSIONS Patients using self-management DIs tend to feel well cared for and perceive that they adopt a more active role in consultations, whilst HCPs focus on the clinical benefits provided by DIs. PRACTICE IMPLICATIONS DIs can simultaneously support patient condition management, and HCPs' control of patient health. Tele-monitoring physiological data can promote complex behaviour change amongst patients.
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Affiliation(s)
- Katherine Morton
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Laura Dennison
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK.
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Lucy Yardley
- Academic unit of Psychology, University of Southampton, Southampton, UK.
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Band R, Bradbury K, Morton K, May C, Michie S, Mair FS, Murray E, McManus RJ, Little P, Yardley L. Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach. Implement Sci 2017; 12:25. [PMID: 28231840 PMCID: PMC5324312 DOI: 10.1186/s13012-017-0553-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/09/2017] [Indexed: 01/16/2023] Open
Abstract
Background This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Person-Based Approach to intervention development emphasises the use of qualitative research to ensure that the intervention is acceptable, persuasive, engaging and easy to implement. Methods Our intervention planning process comprised two parallel, integrated work streams, which combined theory-, evidence- and person-based elements. The first work stream involved collating evidence from a mixed methods feasibility study, a systematic review and a synthesis of qualitative research. This evidence was analysed to identify likely barriers and facilitators to uptake and implementation as well as design features that should be incorporated in the HOME BP intervention. The second work stream used three complementary approaches to theoretical modelling: developing brief guiding principles for intervention design, causal modelling to map behaviour change techniques in the intervention onto the Behaviour Change Wheel and Normalisation Process Theory frameworks, and developing a logic model. Results The different elements of our integrated approach to intervention planning yielded important, complementary insights into how to design the intervention to maximise acceptability and ease of implementation by both patients and health professionals. From the primary and secondary evidence, we identified key barriers to overcome (such as patient and health professional concerns about side effects of escalating medication) and effective intervention ingredients (such as providing in-person support for making healthy behaviour changes). Our guiding principles highlighted unique design features that could address these issues (such as online reassurance and procedures for managing concerns). Causal modelling ensured that all relevant behavioural determinants had been addressed, and provided a complete description of the intervention. Our logic model linked the hypothesised mechanisms of action of our intervention to existing psychological theory. Conclusion Our integrated approach to intervention development, combining theory-, evidence- and person-based approaches, increased the clarity, comprehensiveness and confidence of our theoretical modelling and enabled us to ground our intervention in an in-depth understanding of the barriers and facilitators most relevant to this specific intervention and user population. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0553-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Band
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Katherine Bradbury
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Katherine Morton
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, Scotland
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
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Romano MF, Sardella MV, Alboni F. Web Health Monitoring Survey: A New Approach to Enhance the Effectiveness of Telemedicine Systems. JMIR Res Protoc 2016; 5:e101. [PMID: 27268949 PMCID: PMC4914780 DOI: 10.2196/resprot.5187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/25/2016] [Accepted: 05/13/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Aging of the European population and interest in a healthy population in western countries have contributed to an increase in the number of health surveys, where the role of survey design, data collection, and data analysis methodology is clear and recognized by the whole scientific community. Survey methodology has had to couple with the challenges deriving from data collection through information and communications technology (ICT). Telemedicine systems have not used patients as a source of information, often limiting them to collecting only biometric data. A more effective telemonitoring system would be able to collect objective and subjective data (biometric parameters and symptoms reported by the patients themselves), and to control the quality of subjective data collected: this goal be achieved only by using and merging competencies from both survey methodology and health research. OBJECTIVE The objective of our study was to propose new metrics to control the quality of data, along with the well-known indicators of survey methodology. Web questionnaires administered daily to a group of patients for an extended length of time are a Web health monitoring survey (WHMS) in a telemedicine system. METHODS We calculated indicators based on paradata collected during a WHMS study involving 12 patients, who signed in to the website daily for 2 months. RESULTS The patients' involvement was very high: the patients' response rate ranged between 1.00 and 0.82, with an outlier of 0.65. Item nonresponse rate was very low, ranging between 0.0% and 7.4%. We propose adherence to the chosen time to connect to the website as a measure of involvement and cooperation by the patients: the difference from the median time ranged between 11 and 24 minutes, demonstrating very good cooperation and involvement from all patients. To measure habituation to the questionnaire, we also compared nonresponse rates to the items between the first and the second month of the study, and found no significant difference. We computed the time to complete the questionnaire both as a measure of possible burden for patient, and to detect the risk of automatic responses. Neither of these hypothesis was confirmed, and differences in time to completion seemed to depend on health conditions. Focus groups with patients confirmed their appreciation for this "new" active role in a telemonitoring system. CONCLUSIONS The main and innovative aspect of our proposal is the use of a Web questionnaire to virtually recreate a checkup visit, integrating subjective (patient's information) with objective data (biometric information). Our results, although preliminary and if need of further study, appear promising in proposing more effective telemedicine systems. Survey methodology could have an effective role in this growing field of research and applications.
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