A P5 Approach to m-Health: Design Suggestions for Advanced Mobile Health Technology

Technology-based self-management interventions for women with breast cancer: a systematic review

PURPOSE

Since technology-based interventions can facilitate convenient access to healthcare for women with breast cancer, it is crucial to understand innovative approaches to maintaining the effectiveness of these interventions. Therefore, we conducted a systematic review of technology-based self-management interventions for women with breast cancer in six countries. We analyzed the characteristics of these interventions and examined their diverse health outcomes.

METHODS

Six databases were systematically searched to extract research articles using the keywords "breast cancer," "technology," and "self-management." The search was carried out up until June 12, 2023. From the 1,288 studies retrieved from the database search, 10 eligible papers were identified based on inclusion/exclusion criteria. Two authors independently extracted and compared the data from these articles, resolving any discrepancies through discussion.

RESULTS

Most of the 10 studies utilized web- or mobile-based technology, and one used artificial intelligence-based technology. Among the 12 health-related outcome variables, quality of life and symptom distress were the most frequently mentioned, appearing in six articles. Furthermore, an analysis of the intervention programs revealed a variety of common constructs and the involvement of managers in the self-management intervention.

CONCLUSION

Incorporating key components such as self-management planning, diary keeping, and communication support in technology-based interventions could significantly improve the self-management process for breast cancer survivors. The practical application of technology has the potential to empower women diagnosed with breast cancer and improve their overall quality of life, by providing timely and sustainable interventions, and by leveraging available resources and tools.

A Systematic Review of the Use of mHealth in Oral Health Education among Older Adults

Oral diseases are largely preventable. However, as the number of older adults is expected to increase, along with the high cost and various barriers to seeking continuous professional care, a sustainable approach is needed to assist older adults in maintaining their oral health. Mobile health (mHealth) technologies may facilitate oral disease prevention and management through oral health education. This review aims to provide an overview of existing evidence on using mHealth to promote oral health through education among older adults. A literature search was performed across five electronic databases. A total of five studies were identified, which provided low to moderate evidence to support using mHealth among older adults. The selected studies showed that mHealth could improve oral health management, oral health behavior, and oral health knowledge among older adults. However, more quality studies regarding using mHealth technologies in oral health management, oral health behavior, and oral health knowledge among older adults are needed.

Effectiveness of Digital Health on the Quality of Life of Long-Term Breast Cancer Survivors: A Systematic Review

OBJECTIVES

To identify, critically appraise, and synthesize the available evidence on the effectiveness of digital health interventions to improve the quality of life or any of its four dimensions (physical, psychological, social, and spiritual) in women survivors of breast cancer who are in the extended or permanent survival stage.

DATA SOURCES

Systematic review-Four databases were searched: PubMed, CINAHL, PsycINFO, and Web of Science.

CONCLUSION

The clinical evidence shows a positive relationship or association between eHealth use and improved quality of life in breast cancer survivors at extended or permanent survival stage. However, the findings point to a deficit in the assessment of the social and spiritual domains that play a fundamental role in the quality of life of survivors.

IMPLICATION FOR NURSING PRACTICE

The findings found reflect implications of great value for nursing practice because these professionals are the main users of digital health tools to provide them to patients. Using these digital tools contributes to improving evidence-based practice and providing greater efficiency and effectiveness in the care of long-term cancer survivors.

Capacity Building, Knowledge Enhancement, and Consultative Processes for Development of a Digital Tool (Ni-kshay SETU) to Support the Management of Patients with Tuberculosis: Exploratory Qualitative Study

BACKGROUND

Achieving the target for eliminating tuberculosis (TB) in India by 2025, 5 years ahead of the global target, critically depends on strengthening the capacity of human resources as one of the key components of the health system. Due to the rapid updates of standards and protocols, the human resources for TB health care suffer from a lack of understanding of recent updates and acquiring necessary knowledge.

OBJECTIVE

Despite an increasing focus on the digital revolution in health care, there is no such platform available to deliver the key updates in national TB control programs with easy access. Thus, the aim of this study was to explore the development and evolution of a mobile health tool for capacity building of the Indian health system's workforce to better manage patients with TB.

METHODS

This study involved two phases. The first phase was based on a qualitative investigation, including personal interviews to understand the basic requirements of staff working in the management of patients with TB, followed by participatory consultative meetings with stakeholders to validate and develop the content for the mobile health app. Qualitative information was collected from the Purbi Singhbhum and Ranchi districts of Jharkhand and Gandhinagar, and from the Surat districts of Gujarat State. In the second phase, a participatory design process was undertaken as part of the content creation and validation exercises.

RESULTS

The first phase collected information from 126 health care staff, with a mean age of 38.4 (SD 8.9) years and average work experience of 8.9 years. The assessment revealed that more than two-thirds of participants needed further training and lacked knowledge of the most current updates to TB program guidelines. The consultative process determined the need for a digital solution in easily accessible formats and ready reckoner content to deliver practical solutions to address operational issues for implementation of the program. Ultimately, the digital platform named Ni-kshay SETU (Support to End Tuberculosis) was developed to support the knowledge enhancement of health care workers.

CONCLUSIONS

The development of staff capacity is vital to the success or failure of any program or intervention. Having up-to-date information provides confidence to health care staff when interacting with patients in the community and aids in making quick judgments when handling case scenarios. Ni-kshay SETU represents a novel digital capacity-building platform for enhancing human resource skills in achieving the goal of TB elimination.

Value attributed to text-based archives generated by artificial intelligence

Openly available natural language generation (NLG) algorithms can generate human-like texts across domains. Given their potential, ethical challenges arise such as being used as a tool for misinformation. It is necessary to understand both how these texts are generated from an algorithmic point of view, and how they are evaluated by a general audience. In this study, our aim was to investigate how people react to texts generated algorithmically, whether they are indistinguishable from original/human-generated texts, and the value people assign these texts. Using original text-based archives, and text-based archives generated by artificial intelligence (AI), findings from our preregistered study (N = 228) revealed that people were more likely to preserve original archives compared with AI-generated archives. Although participants were unable to accurately distinguish between AI-generated and original archives, participants assigned lower value to archives they categorized as AI-generated compared with those they categorized as original. People's judgements of value were also influenced by their attitudes toward AI. These findings provide a richer understanding of how the emergent practice of automated text creation alters the practices of readers and writers, and have implications for how readers' attitudes toward AI affect the use and value of AI-based applications and creations.

Understanding the Antecedents and Effects of mHealth App Use in Pandemics: A Sequential Mixed-Method Investigation

Pandemics such as COVID-19 pose serious threats to public health and disrupt the established systems for obtaining healthcare services. Mobile health (mHealth) apps serve the general public as a potential method for coping with these exogenous challenges. However, prior research has rarely discussed the antecedents and effects of mHealth apps and their use as a coping method during pandemics. Based on the technology acceptance model, empowerment theory, and event theory, we developed a research model to examine the antecedents (technology characteristics and event strength) and effects (psychological empowerment) of mHealth apps and their use. We tested this research model through a sequential mixed-method investigation. First, a quantitative study based on 402 Chinese mHealth users who used the apps during the COVID-19 pandemic was conducted to validate the theoretical model. A follow-up qualitative study of 191 online articles and reviews on mHealth during the COVID-19 pandemic was conducted to cross-validate the results and explain the unsupported findings of the quantitative study. The results show that (1) the mHealth app characteristics (perceived usefulness and perceived ease of use) positively affect mHealth app use; (2) mHealth app use positively affects the psychological empowerment of mHealth users; and (3) the characteristics of pandemic events (event criticality and event disruption) have positive moderating effects on the relationship between mHealth app characteristics and mHealth app use. This study explains the role of mHealth apps in the COVID-19 pandemic on the micro-level, which has implications for the ways in which mHealth apps are used in response to public pandemics.

A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review

Objective

This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases.

Methods

Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members.

Results

A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively.

Conclusion

This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.

mHealth Applications to Monitor Lifestyle Behaviors and Circadian Rhythm in Clinical Settings: Current Perspective and Future Directions

Metabolic diseases are a global rising health burden, mainly due to the deleterious interaction of current lifestyles with the underlying biology of these diseases. Daily habits and behaviors, such as diet, sleep, and physical exercise impact the whole-body circadian system through the synchronization of the peripheral body clocks that contribute to metabolic homeostasis. The disruption of this system may promote the development of metabolic diseases, including obesity and diabetes, emphasizing the importance of assessing and monitoring variables that affect circadian rhythms. Advances in technology are generating innovative resources and tools for health care management and patient monitoring, particularly important for chronic conditions. The use of mobile health technologies, known as mHealth, is increasing and these approaches are contributing to aiding both patients and healthcare professionals in disease management and education. The mHealth solutions allow continuous monitoring of patients, sharing relevant information and data with physicians and other healthcare professionals and accessing education resources to support informed decisions. Thus, if properly used, these tools empower patients and help them to adopt healthier lifestyles. This article aims to give an overview of the influence of circadian rhythms disruption and lifestyle habits in the progression of metabolic diseases while also reviewing some of the mobile applications available to monitor lifestyle behaviors and individual chronobiology. Herein is also described the design and development of the NutriClock system, an mHealth solution developed by our team to monitor these variables.

Electronic Health Interventions for Patients With Breast Cancer: Systematic Review and Meta-Analyses

PURPOSE

Ongoing supportive care using electronic health (eHealth) interventions has the potential to provide remote support and improve health outcomes for patients with breast cancer. This study aimed to evaluate the effectiveness of eHealth interventions on patient-reported outcomes (quality of life [QOL], self-efficacy, and mental or physical health) for patients during and after breast cancer treatment and patient-reported experience measures (acceptability and engagement).

METHODS

Systematic review with meta-analyses (random-effects model) of randomized controlled trials was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nine databases were searched using a prespecified search strategy. Patient-directed eHealth interventions for adult patients during or after active breast cancer treatment measuring QOL, self-efficacy, and mental (depressive, anxiety, and distress symptoms) or physical (physical activity, nutrition, and fatigue) health outcomes were included. Data from eligible full-text articles were independently extracted by six observers.

RESULTS

Thirty-two unique studies (4,790 patients) were included. All were health self-management interventions, and most were multicomponent (videos, forums, and electronic reminder systems) websites. Meta-analyses revealed a significant effect of eHealth interventions on QOL (standardized mean difference [SMD], 0.20 [95% CI, 0.03 to 0.36]), self-efficacy (SMD, 0.45 [95% CI, 0.24 to 0.65]), distress (SMD, -0.41 [95% CI,-0.63 to -0.20]), and fatigue (SMD, -0.37 [95% CI, -0.61 to -0.13]). Twenty-five studies (78.1%) measured patient-reported experience measures. Acceptability (n = 9) was high, with high ratings for satisfaction (range, 71%-100%), usefulness (range, 71%-95%), and ease-of-use (range, 73%-92%). Engagement (n = 25) decreased over time, but disease-focused information and interactive support were most engaging.

CONCLUSION

eHealth interventions may provide an acceptable and effective strategy for improving QOL, distress, self-efficacy, and fatigue among patients with breast cancer.

Barriers and Supports in eHealth Implementation among People with Chronic Cardiovascular Ailments: Integrative Review

eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities.

OBJECTIVE

Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions.

METHOD

An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified.

RESULTS

Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users' age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others.

CONCLUSIONS

eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed.

Understanding the Antecedents of the Routine Use of Mobile Health Services: A Person–Technology–Health Framework

Although numerous studies have been conducted to understand the antecedents of usage of mobile health (mHealth) services, most of them solely focus on characteristics of mHealth services themselves but neglect taking users’ psychological and health-related factors into consideration. Besides, the comprehensive understanding of what influences users’ routine use intentions regarding mHealth services is lacking. Therefore, this study proposes a person–technology–health framework that underlines how personal factors (e.g., personal innovativeness in IT), technological factors (e.g., trust), and health factors (e.g., perceived health severity) jointly influence individuals’ routine use intentions regarding mHealth services. The proposed research model and related hypotheses were tested based on survey data from 270 respondents. The results indicate that personal innovativeness in IT, trust, and perceived health severity are important for enhancing routine use intention of mHealth services. Specifically, in situations of high perceived health severity, trust relates less positively to routine use intention than personal innovativeness in IT. In contrast, in situations of low perceived health severity, trust relates more positively to routine use intention than personal innovativeness in IT. The research findings extend the existing literature on routine use intention related to mHealth services and provide significant implications for practitioners.

E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews

Background

Human immunodeficiency virus/sexually transmitted infections, sexual risk, substance (alcohol and other legal and illegal drugs) use and mental ill health constitute a ‘syndemic’ of mutually reinforcing epidemics among men who have sex with men. Electronic health (e-health) interventions addressing these epidemics among men who have sex with men might have multiplicative effects. To our knowledge, no systematic review has examined the effectiveness of such interventions on these epidemics among men who have sex with men.

Objective

The objective was to synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective?

Data sources

A total of 24 information sources were searched initially (October–November 2018) [the following sources were searched: ProQuest Applied Social Sciences Index and Abstracts; Campbell Library; EBSCO Cumulative Index to Nursing and Allied Health Literature Plus, Wiley Online Library The Cochrane Library; Centre for Reviews and Dissemination databases (the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database); the Health Technology Assessment database; Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) database of health promotion research (Bibliomap); ProQuest Dissertations & Theses Global; OvidSP EconLit; OvidSP EMBASE; OvidSP Global Health; OvidSP Health Management Information Consortium; ProQuest International Bibliography of the Social Sciences; Ovid MEDLINE ALL; OvidSP PsycINFO; Web of Science Science Citation Index Expanded; Elsevier Scopus; OvidSP Social Policy & Practice; Web of Science Social Sciences Citation Index Expanded; ProQuest Sociological Abstracts; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform; EPPI-Centre Trials Register of Promoting Health Interventions; and the OpenGrey database], and an updated search of 19 of these was conducted in April 2020. Reference lists of included reports were searched and experts were contacted.

Review methods

Eligible reports presented theories of change and/or process, outcome and/or economic evaluations of e-health interventions offering ongoing support to men who have sex with men to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk behaviour, alcohol/drug use and/or common mental illnesses. References were screened by title/abstract, then by full text. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised using qualitative methods. Outcome and economic data were synthesised narratively; outcome data were meta-analysed.

Results

Original searches retrieved 27 eligible reports. Updated searches retrieved 10 eligible reports. Thirty-seven reports on 28 studies of 23 interventions were included: 33 on theories of change, 12 on process evaluations, 16 on outcome evaluations and one on an economic evaluation. Research question 1: five intervention types were identified – ‘online modular’, ‘computer games’ and ‘non-interactive’ time-limited/modular interventions, and open-ended interventions with ‘content organised by assessment’ and ‘general content’. Three broad types of intervention theories of change were identified, focusing on ‘cognitive/skills’, ‘self-monitoring’ and ‘cognitive therapy’. Research question 2: individual tailoring based on participant characteristics was particularly acceptable, and participants valued intervention content reflecting their experiences. Research question 3: little evidence was available of effects on human immunodeficiency virus or sexually transmitted infections. The analysis did not suggest that interventions were effective in reducing instances of human immunodeficiency virus or sexually transmitted infections. The overall meta-analysis for sexually transmitted infections reported a small non-significant increase in sexually transmitted infections in the intervention group, compared with the control group. Meta-analyses found a significant impact on sexual risk behaviour. The findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health. Research question 4: evidence on cost-effectiveness was limited.

Limitations

The quality of the eligible reports was variable and the economic synthesis was limited to one eligible study.

Conclusions

There is commonality in intervention theories of change and factors affecting receipt of e-health interventions. Evidence on effectiveness is limited.

Future work

Future trials should assess the impact of interventions on multiple syndemic factors, among them sexual risk, substance use and mental health; incorporate sufficient follow-up and sample sizes to detect the impact on human immunodeficiency virus/sexually transmitted infections; and incorporate rigorous process and economic evaluations.

Study registration

This study is registered as PROSPERO CRD42018110317.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.

Adapting an evidence-based e-learning CBT program into a mobile app for people experiencing gambling-related problems: A Formative Study

Background

Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support.

Objective

This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions.

Methods

Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Māori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention.

Results

Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users’ stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Māori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Māori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed.

Conclusions

Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention’s mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness.

eHealth Interventions to Address Sexual Health, Substance Use, and Mental Health Among Men Who Have Sex With Men: Systematic Review and Synthesis of Process Evaluations

Background

Men who have sex with men (MSM) face disproportionate risks concerning HIV and other sexually transmitted infections, substance use, and mental health. These outcomes constitute an interacting syndemic among MSM; interventions addressing all 3 together could have multiplicative effects. eHealth interventions can be accessed privately, and evidence from general populations suggests these can effectively address all 3 health outcomes. However, it is unclear how useable, accessible, or acceptable eHealth interventions are for MSM and what factors affect this.

Objective

We undertook a systematic review of eHealth interventions addressing sexual risk, substance use, and common mental illnesses among MSM and synthesized evidence from process evaluations.

Methods

We searched 19 databases, 3 trials registers, OpenGrey, and Google, and supplemented this by reference checks and requests to experts. Eligible reports were those that discussed eHealth interventions offering ongoing support to MSM aiming to prevent sexual risk, substance use, anxiety or depression; and assessed how intervention delivery or receipt varied with characteristics of interventions, providers, participants, or context. Reviewers screened citations on titles, abstracts, and then full text. Reviewers assessed quality of eligible studies, and extracted data on intervention, study characteristics, and process evaluation findings. The analysis used thematic synthesis.

Results

A total of 12 reports, addressing 10 studies of 8 interventions, were eligible for process synthesis. Most addressed sexual risk alone or with other outcomes. Studies were assessed as medium and high reliability (reflecting the trustworthiness of overall findings) but tended to lack depth and breadth in terms of the process issues explored. Intervention acceptability was enhanced by ease of use; privacy protection; use of diverse media; opportunities for self-reflection and to gain knowledge and skills; and content that was clear, interactive, tailored, reflective of MSM’s experiences, and affirming of sexual-minority identity. Technical issues and interventions that were too long detracted from acceptability. Some evidence suggested that acceptability varied by race or ethnicity and educational level; findings on variation by socioeconomic status were mixed. No studies explored how intervention delivery or receipt varied by provider characteristics.

Conclusions

Findings suggest that eHealth interventions targeting sexual risk, substance use, and mental health are acceptable for MSM across sociodemographic groups. We identified the factors shaping MSM’s receipt of such interventions, highlighting the importance of tailored content reflecting MSM’s experiences and of language affirming sexual-minority identities. Intervention developers can draw on these findings to increase the usability and acceptability of integrated eHealth interventions to address the syndemic of sexual risk, substance use, and mental ill health among MSM. Evaluators of these interventions can draw on our findings to plan evaluations that explore the factors shaping usability and acceptability.

In the eye of a quiet storm: A critical incident study on the quarantine experience during the coronavirus pandemic

OBJECTIVE

In 2020, the COVID-19 appeared in Italy with an exponential transmission capacity and serious consequences for the whole population. To counter the spread of the virus, the Italian government has adopted an extensive lockdown, forcing citizens to stay at home and avoid social contact. The COVID-19 quarantine represents a unique phenomenon in the recent centuries, and its long-term consequences on people's lives and mental health are still to be understood. This study aimed to explore significant experiences of people who did not contract the virus, yet experienced the quarantine as a potentially stressful condition.

METHODS

Italians who did not contract the COVID-19 were invited to participate in semi-structured interviews employing the Critical Incident Technique. Interviews were designed to capture the significant experiences related to the lockdown period in Italy. Participants were asked to describe the most significant (1) negative and (2) positive critical events that they personally experienced during the ongoing quarantine. Such events were meant to provide information on their experience of the quarantine as a whole. The audio-taped interviews were transcribed verbatim and analyzed following Critical Incident Technique's indications.

RESULTS

Twenty two participants described a total of 43 critical events, including 22 negative episodes and 21 positive events experienced during the COVID-19 quarantine. Three categories emerged from the negative episodes and four categories emerged from the positive events described by the participants. Relevant themes both positive and negative concerned mostly relationships (with partners, family, and friends), and the alteration of everyday activities, Also a specific "sensation of emergency" that the participants felt during the pandemic emerged, as an emotionally-charged response to quarantine-related external stimuli.

CONCLUSIONS

To our knowledge this is the first in-depth qualitative study investigating the significant negative and positive events that people experienced during the COVID-19 quarantine. Future research could employ analogous event recollection methods but focus on other populations (e.g., fragile subjects or on other national contests), in order to extend the information on the quarantine experience and its possible long-lasting effects.

[Acceptability of the use of mobile phones for HIV management in Togo]

OBJECTIVE

To describe the acceptability and factors associated with the use of mobile telephones in the care of people living with HIV (PLHIV) in Lomé, Togo.

METHOD

A cross-sectional study was conducted from January 5th to March 31st, 2018 in Lomé. PLHIV were recruited from the Department of Infectious and Tropical Diseases of the teaching hospital “CHU Sylvanus Olympio” and the NGO “Espoir Vie Togo”. Socio-demographic and clinical data, mobile phone possession and acceptability of communication with health professionals using a mobile phone were collected with a standardized questionnaire during a face-to-face interview.

RESULTS

A total of 259 PLHIV (79.6% women) were recruited. The mean age (± standard deviation) of PLHIV was 43.7 ± 9.8 years and the majority (95.4%) had a mobile phone. Almost all (98.1%) of respondents declared that mobile phone could be a means to maintain contact with a health professional. Phone calls (43.0%), text messages (SMS) (35.1%), and voice messages (20.0%) were the preferred means of communication with health professionals. Factors associated with the acceptability of receiving SMS from a health professional were age < 44 years and having at least a secondary level of education.

CONCLUSION

PLHIV are receptive to the integration of mobile technology into the management of their condition. M-health could be an opportunity to improve the management of HIV infection in Togo.

Construal beliefs moderate the usability and effectiveness of a novel healthy eating mobile app

Reduced self-control is a strong predictor of overeating and obesity. Priming a high construal level mind-set has been shown to enhance self-control and reduce snack consumption in the lab but the long-term and real-world effects are not known. The use of digital technology is an efficient way to deliver priming cues in real-world settings. Many mobile apps claim to support healthy eating but few are grounded in psychological theories of self-control. The aim of this study was to test the feasibility and effectiveness of a novel, construal-theory-based mobile app to promote self-control and healthy eating. In an exploratory analysis, the moderating influence of user characteristics was also examined. Using an iterative process involving users at every stage of the process, a prototype mobile app was developed. The final version included a high construal, self-control priming task, sent personalised reminder cues before each eating occasion, provided a just-in time 'crave-buster' for unanticipated eating opportunities and an optional food log. In a longitudinal trial the app was used over an eight-week period (N=71; 51 females; M (SD) Age = 33.34 (11.68) years; M (SD) BMI = 26.22 (4.94)) with pre-post measures of weight, percent body fat and dietary intake. The app received high usability ratings on the System Usability Scale (M=76.55; SD=11.35), however food intake, per cent body fat and weight pre- and post- app use showed no significant change (p>.05). Exploratory analyses showed that baseline construal belief moderated the extent to which engagement with the app predicted dietary changes (p<.05). These findings indicate that this novel app was user-friendly and effective but that this was dependent on the user's characteristics. Future development in this area should consider tailoring apps to the specific characteristics of the user for improved support and effectiveness.

How to Train Your Health: Sports as a Resource to Improve Cognitive Abilities in Cancer Patients

From a cognitive-psychological perspective, physical exercise (PE) and sports are an interesting tool for improving people's cognitive abilities. One field of application for such a tool is decision making (DM) support in chronic patients, cancer patients, and survivors in particular. On the one hand, cancer patients and survivors have to continually take important decisions about their own care (e.g., treatment choice; changes in lifestyle), in collaboration with caregivers and health providers; on the other hand, side effects of treatment may be detrimental to cognitive abilities, such as attention, which make the health DM tasks even more demanding, complex, and emotionally disruptive for patients. Since cancer patients have to engage in healthy activities both for improving their own quality of life and for sustaining the effects of medications, clinical advice to engage in sport and PE is becoming more and more widespread within interventions. However, while sports are usually seen as healthy physical activities, their impact on cognitive abilities is mostly overlooked in the literature. The hypothesis of the present work is that sports could be fully exploited in their potential as focused exercises for cognitive ability training, in the field of cognitive training for chronic patients specifically. Indeed, literature shows that different sports (e.g., individual or team-based) influence and possibly augment cognitive abilities such as focused and divided attention, working memory, and DM under time constraints. Moreover, besides providing training for cognitive abilities, the experience of sports may represent an opportunity to explore, train and sharpen DM abilities directly: we identify five ways in which sport experiences may influence DM processes, and provide indications for future research on the topic.

ERS Presidential Summit 2018: multimorbidities and the ageing population

As the average age of the population increases, so will the prevalence of chronic respiratory diseases and associated multimorbidity. This will result in a more complex clinical environment. Part of the solution will be to allow patients to be co-creators in the design of their care. It will also require clinicians to shift in their current approaches to care, step out of the disease- or pathology-oriented approach and embrace new ideas. In an effort to prepare the respiratory community for the challenge, we reflect on concepts to empower patients via multidisciplinary systems, new technologies and transition from end-of-life care to advanced care planning.

The role of emotions in cancer patients' decision-making

Introduction

Despite the attempt to make decisions based on evidence, doctors still have to consider patients' choices which often involve other factors. In particular, emotions seem to influence the way that options and the surrounding information are interpreted and used.

Objective

The objective of the present review is to provide a brief overview of research on decision making and cancer with a specific focus on the role of emotions.

Method

Thirty-nine studies were identified and analysed. Most of the studies investigated anxiety and fear. Worry was the other psychological factor that, together with anxiety, played a crucial role in cancer-related decision-making.

Results

The roles of fear, anxiety and worry were described for detection behaviour, diagnosis, choice about prevention and curative treatments and help-seeking behaviour. Results were inconsistent among the studies. Results stressed that cognitive appraisal and emotional arousal (emotion's intensity level) interact in shaping the decision. Moderate levels of anxiety and worry improved decision-making, while low and high levels tended to have no effect or a hindering effect on decision making. Moderating factors played an under-investigated role.

Conclusions

Decision making is a complex non-linear process that is affected by several factors, such as, for example, personal knowledge, past experiences, individual differences and certainly emotions. Research studies should investigate further potential moderators of the effect of emotions on cancer-related choice. Big data and machine learning could be a good opportunity to test the interaction between a large amount of factors that is not feasible in traditional research. New technologies such as eHealth and virtual reality can offer support for the regulation of emotions and decision making.

eHealth for improving quality of life in breast cancer patients: A systematic review

Breast cancer patients (and survivors) use to deal with important challenges daily, such as coping with stress and depression, and adopting healthy lifestyles in order to improve treatment effectiveness; moreover, some experiential issues are quite specific of this disease, such as sexuality and fertility disfunctions after hormonal therapy, and distortions in body image after breast surgery. Recent literature highlighted the utility of eHealth or the use of new technologies to promote health management and quality of life in chronic diseases generally. The present contribution aims at (1) exploring usage and effectiveness of eHealth resources to improve breast cancer patients/survivors' quality of life, and (2) describing whether existing eHealth interventions addressed specific characteristics of breast cancer, or employed a generic approach only. A systematic literature search according to PRISMA guidelines was performed. Twenty-four studies met inclusion criteria and were included. Discussion highlights a majority of encouraging results about eHealth in breast cancer patients' health management, especially in those interventions featuring eHealth tools for improving patients' abilities (e.g., coping) and complex eHealth systems with multiple resources. However, generic use of eHealth is still predominant over disease-focused solutions. Guidelines for future eHealth research and development are listed in order to promote technology design centered on the lived experience of specific illness.