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O'Connor H, Willcox JC, de Jersey S, Wright C, Wilkinson SA. Digital preconception interventions targeting weight, diet and physical activity: A systematic review. Nutr Diet 2024; 81:244-260. [PMID: 37845187 DOI: 10.1111/1747-0080.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
AIM Optimising preconception health increases the likelihood of conception, positively influences short- and long-term pregnancy outcomes and reduces intergenerational chronic disease risk. Our aim was to synthesise study characteristics and maternal outcomes of digital or blended (combining face to face and digital modalities) interventions in the preconception period. METHODS We searched six databases (PubMed, Cochrane, Embase, Web of Science, CINHAL and PsycINFO) from 1990 to November 2022 according to the PRISMA guidelines for randomised control trials, quasi-experimental trials, observation studies with historical control group. Studies were included if they targeted women of childbearing age, older than 18 years, who were not currently pregnant and were between pregnancies or/and actively trying to conceive. Interventions had to be delivered digitally or via digital health in combination with face-to-face delivery and aimed to improve modifiable behaviours, including dietary intake, physical activity, weight and supplementation. Studies that included women diagnosed with type 1 or 2 diabetes were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality criteria checklist. Study characteristics, intervention characteristics and outcome data were extracted. RESULTS Ten studies (total participants n=4,461) were included, consisting of nine randomised control trials and one pre-post cohort study. Seven studies received a low risk of bias and two received a neutral risk of bias. Four were digitally delivered and six were delivered using blended modalities. A wide range of digital delivery modalities were employed, with the most common being email and text messaging. Other digital delivery methods included web-based educational materials, social media, phone applications, online forums and online conversational agents. Studies with longer engagement that utilised blended delivery showed greater weight loss. CONCLUSION More effective interventions appear to combine both traditional and digital delivery methods. More research is needed to adequately test effective delivery modalities across a diverse range of digital delivery methods, as high heterogeneity was observed across the small number of included studies.
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Affiliation(s)
- Hannah O'Connor
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Jane C Willcox
- Faculty of Health, Charles Darwin University, Darwin, Northwest Territories, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Charlotte Wright
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Lifestyle Maternity, Brisbane, Queensland, Australia
- Department of Obstetric Medicine, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
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Cheng Z, Hao H, Tsofliou F, Katz MD, Zhang Y. Effects of online support and social media communities on gestational diabetes: A systematic review. Int J Med Inform 2023; 180:105263. [PMID: 37907014 DOI: 10.1016/j.ijmedinf.2023.105263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/10/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication in pregnancy that can lead to negative maternal and fetal outcomes. Online support interventions have been suggested as a potential tool to improve the management of GDM. OBJECTIVE This systematic review aimed to summarize the effectiveness of social media and online support interventions for the management of GDM. METHODS We conducted a thorough systematic search across Web of Science, Scopus, and PubMed, following PRISMA guidelines, and supplemented it with a manual search. Our results included both qualitative and quantitative research. We rigorously assessed quantitative studies for bias using ROBINS-I and RoB 2 tools, ensuring the reliability of our findings. RESULTS We incorporated a total of 22 studies, which were comprised of ten qualitative and twelve quantitative studies. Online support interventions were found to have a positive impact on promoting self-care and improving healthcare outcomes for women with GDM. Individualized diet and exercise interventions resulted in lower odds of weight gain and GDM diagnosis, while online prenatal education increased breastfeeding rates. In addition, telemedicine options reduced the need for in-person clinical visits and improved patient satisfaction. CONCLUSIONS Online support interventions show potential to improve outcomes in patients with GDM in this small literature review. Future research is also necessary to determine the effectiveness of different types of online interventions and identify strategies to improve engagement and the quality of the information provided through online resources.
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Affiliation(s)
- Zilin Cheng
- Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Haijing Hao
- Department of Computer Information Systems, Bentley University, Waltham, MA, USA.
| | - Fotini Tsofliou
- Department of Rehabilitation & Sport Sciences, Bournemouth University, Bournemouth, UK.
| | - Melissa D Katz
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Yiye Zhang
- Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
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Poulter SE, Meloncelli N, Mack M. Use of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus: A pilot study. Diabetes Res Clin Pract 2022; 185:109224. [PMID: 35122904 DOI: 10.1016/j.diabres.2022.109224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
AIMS To determine patient satisfaction, impact on maternal and neonatal outcomes and resource utilisation of a smartphone-based, remote blood glucose level (BGL) monitoring platform with software surveillance inwomen with gestational diabetes (GDM) compared with historical controls. METHODS This intervention study prospectively enrolled 98 women with GDM to the NET-Health smartphone-based application and compared them to 94 historical controls. The application allows automatic, real-time BGL upload to a central server for software monitoring, with automatic alerts generated for out-of-range results. Data recorded included demographics, outcomes and occasions of service (OOS). A validated satisfaction questionnaire was completed post-delivery. RESULTS The groups had comparable baseline characteristics and no significant difference in maternal and neonatal outcomes. The NET-Health application intervention reduced resource utilisation, with 1.9 fewer OOS and 37 min less clinician time - equivalent to AUD$68 saved per woman (based on clinician time only) or AUD$23 after taking into account the cost of the application. Patient satisfaction was high. CONCLUSIONS Use of this smartphone-based application with software surveillance in women with GDM has high patient satisfaction and no differences in maternal or neonatal outcomes despite reduced resource utilisation. It is the first to demonstrate a financial benefit. Larger studies are needed.
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Affiliation(s)
- Sophie E Poulter
- Endocrinology, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Australia.
| | - Nina Meloncelli
- Nutrition and Dietetics, Allied Health, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Australia
| | - Michele Mack
- Endocrinology, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Australia
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Blair RA, Horn CE, Dias JM, McDonnell ME, Seely EW. Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study. JMIR Hum Factors 2022; 9:e32815. [PMID: 35191851 PMCID: PMC8905478 DOI: 10.2196/32815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/29/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed.
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Affiliation(s)
- Rachel A Blair
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christine E Horn
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer M Dias
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Marie E McDonnell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Abasi S, Yazdani A, Kiani S, Mahmoudzadeh‐Sagheb Z. Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review. Health Sci Rep 2021; 4:e434. [PMID: 34869915 PMCID: PMC8596943 DOI: 10.1002/hsr2.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Patients after transplantation need medical management for the rest of their lives, and self-management seems to lead to greater adherence to medical standards, improve early physical changes, and increase patient empowerment. The main objective of this article is to systematic review of the consideration to mobile health applications (m-Health apps) used in transplantation. METHODS A systematic search was conducted MEDLINE (through PubMed), Web of Science, Scopus, and Science Direct from inception to November 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used in this study. Comprehensive research was carried out using a combination of keywords and MeSH terms associated with m-Health, empowerment, self-management, and transplantation. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included posttransplant care and mobile phone-based applications to support self-management and self-care. Also, thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, systematic reviews, or meta-analysis were excluded. RESULTS We divided all the reviewed articles into four categories, self-management (medication adherence, adherence to medical regimen, and remote monitoring), evaluation, interaction, and interface; 37.5% of the studies were focused on lung transplantation. In 56.25% of the studies, medication adherence was considered because one of the main reasons for the rejection and graft loss is stated medication nonadherence. Also, 62.5% of the studies demonstrated that the use of m-health improved medication adherence and self-management in transplantation. CONCLUSIONS The use of m-Health apps interventions to self-management after transplantation has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. We found that m-Health solutions can help the patient in self-management in many ways after transplantation.
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Affiliation(s)
- Sanaz Abasi
- Department of Health Information ManagementSchool of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
| | - Azita Yazdani
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
| | - Shamim Kiani
- Department of Health Information ManagementSchool of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
| | - Zahra Mahmoudzadeh‐Sagheb
- Department of Health Information ManagementHealth Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
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Zakerabasali S, Ayyoubzadeh SM, Baniasadi T, Yazdani A, Abhari S. Mobile Health Technology and Healthcare Providers: Systemic Barriers to Adoption. Healthc Inform Res 2021; 27:267-278. [PMID: 34788907 PMCID: PMC8654335 DOI: 10.4258/hir.2021.27.4.267] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Despite the growing use of mobile health (mHealth), certain barriers seem to be hindering the use of mHealth applications in healthcare. This article presents a systematic review of the literature on barriers associated with mHealth reported by healthcare professionals. Methods This systematic review was carried out to identify studies published from January 2015 to December 2019 by searching four electronic databases (PubMed/MEDLINE, Web of Science, Embase, and Google Scholar). Studies were included if they reported perceived barriers to the adoption of mHealth from healthcare providers’ perspectives. Content analysis and categorization of barriers were performed based on a focus group discussion that explored researchers’ knowledge and experiences. Results Among the 273 papers retrieved through the search strategy, 18 works were selected and 18 barriers were identified. The relevant barriers were categorized into three main groups: technical, individual, and healthcare system. Security and privacy concerns from the category of technical barriers, knowledge and limited literacy from the category of individual barriers, and economic and financial factors from the category of healthcare system barriers were chosen as three of the most important challenges related to the adoption of mHealth described in the included publications. Conclusions mHealth adoption is a complex and multi-dimensional process that is widely implemented to increase access to healthcare services. However, it is influenced by various factors and barriers. Understanding the barriers to adoption of mHealth applications among providers, and engaging them in the adoption process will be important for the successful deployment of these applications.
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Affiliation(s)
- Somayyeh Zakerabasali
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azita Yazdani
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahabeddin Abhari
- Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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