1
|
Raatz M, Ward EC, Marshall J, Burns CL, Afoakwah C, Byrnes J. A time and cost analysis of speech pathology paediatric feeding services delivered in-person versus via telepractice. J Telemed Telecare 2023; 29:613-620. [PMID: 33966525 DOI: 10.1177/1357633x211012883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Telepractice models of care have the potential to reduce the time and financial burdens that consumers may experience accessing healthcare services. The current study aimed to conduct a time and financial cost analysis of paediatric feeding appointments accessed via telepractice (using videoconferencing) compared to an in-person model. METHODS Parents of 44 children with paediatric feeding disorders (PFDs) residing in a metropolitan area completed three questionnaires relating to (a) demographics, (b) time and cost for in-person care and (c) time and cost for telepractice. Both cost questionnaires collected data required for direct and indirect costs comparisons (e.g. out-of-pocket costs associated with the appointment (direct), time away from usual duties (indirect)). Average number of services accessed by each participant, and PFD appointments conducted annually by the service, were collected from service statistics. Analysis involved cost minimisation and cost modelling from a societal perspective. RESULTS The telepractice appointment resulted in significant time (p = 0.007) and cost (AUD$95.09 per appointment, SD = AUD$64.47, p = < 0.0001) savings per family. The health service cost was equivalent for both models (AUD$58.25). Cost modelling identified cost savings of up to AUD$475.45 per family if 50% of appointments in a 10-session block were converted to telepractice. Potential cost savings of AUD$68,750.07 per annum to society could be realised if 50% of feeding appointments within the service were provided via telepractice. DISCUSSION The telepractice model offered both time and cost benefits. Future service re-design incorporating hybrid services (in-person and telepractice) will help optimise benefits and minimise burden for families accessing services for PFDs.
Collapse
Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Australia
| | | | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Australia
| |
Collapse
|
2
|
Rationale, design, and methodology of a randomized pilot trial of an integrated intervention combining computerized behavioral therapy and recovery coaching for people with opioid use disorder: The OVERCOME study. Contemp Clin Trials Commun 2022; 28:100918. [PMID: 35573387 PMCID: PMC9097607 DOI: 10.1016/j.conctc.2022.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/25/2022] [Accepted: 04/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Opioid use disorder (OUD) has led to a staggering death toll in terms of drug-related overdoses. Despite the demonstrated benefits and effectiveness of buprenorphine, retention is suboptimal, and patients typically present with high rates of ongoing polysubstance use during treatment. A pilot trial provided preliminary support for the efficacy of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to buprenorphine in reducing substance use. Recovery coaching services provided by individuals with substance use experience and successful recovery have also shown to positively influence recovery outcomes for people with OUD by increasing buprenorphine initiation and reducing opioid use. Methods The OVERCOME study is a randomized clinical trial (RCT) aimed to tests an integrated intervention combining CBT4CBT and Recovery Coaching relative to treatment-as-usual (TAU) among individuals with OUD on buprenorphine. The primary outcome measure is the percentage of samples with any drug tested as positive at each research visit conducted during treatment (visits 1 to 8). Secondary outcomes include the percentage of samples with any drug tested as positive at 1- and 3- month follow-up and retention to buprenorphine at 3- month follow-up. Results We describe the rationale, design, and methodology of the OVERCOME Study. Conclusion This trial will provide evidence of the efficacy of an integrated intervention combining CBT4CBT and Recovery Coaching for reducing substance use and increasing buprenorphine adherence which has the potential to reduce mortality among people with OUD.
Collapse
|
3
|
Ahadzadeh AS, Wu SL, Ong FS, Deng R. The Mediating Influence of the Unified Theory of Acceptance and Use of Technology on the Relationship Between Internal Health Locus of Control and Mobile Health Adoption: Cross-sectional Study. J Med Internet Res 2021; 23:e28086. [PMID: 34964718 PMCID: PMC8756342 DOI: 10.2196/28086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022] Open
Abstract
Background Mobile health (mHealth) as an innovative form of information and communications technology can efficiently deliver high-quality health care by enhancing communication and health management, reducing costs, and increasing access to health services. An individual’s internal health locus of control (HLOC) is found to be associated with the behavioral intent to adopt mHealth. However, little is known about the underlying mechanism of this association. Objective The primary objective of this study was to test the mediation influence of the Unified Theory of Acceptance and Use of Technology (UTAUT) on the relationship between internal HLOC and the behavioral intention to use mHealth. Methods A total of 374 responses were collected from Malaysian adult users of mHealth, using convenience and snowball sampling methods. Partial least squares structural equation modeling was used to analyze the data. Data were collected for variables, including demographics, internal HLOC, and modified UTAUT constructs (ie, performance expectancy, effort expectancy, and social influence). Results The results showed that there was no direct relationship between internal HLOC and the behavioral intention to use mHealth (β=−0.039, P=.32). The indirect relationship between internal HLOC and the intent to adopt mHealth was supported, indicating that the UTAUT constructs performance expectancy (β=0.104, P<.001), effort expectancy (β=0.056, P=.02), and social influence (β=0.057, P=.002) mediated this relationship. The results showed full mediation, with total variance explained at 47.2%. Conclusions This study developed an integrative model, where a health-related disposition (internal HLOC), mHealth-related beliefs (performance expectancy and effort expectancy), and normative pressure (social influence) were combined to explain the underlying mechanism of the behavioral intent to adopt mHealth. The results showed that the intention to adopt mHealth is mediated by the influence of UTAUT factors, while HLOC has no direct effect on adoption intention. The findings provide insights into augmenting mHealth adoption among the public by enhancing the perceived benefits of mHealth, helping design more effective and user-friendly mHealth tools, and capitalizing on social normative influence to adopt mHealth. This study utilized the constructs of the UTAUT model to determine the intention to use mHealth. Future research should focus on other health- and technology-related theories to ascertain other possible factors influencing the behavioral intent of mHealth adoption.
Collapse
Affiliation(s)
| | - Shin Ling Wu
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Kuala Lumpur, Malaysia
| | - Fon Sim Ong
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Ruolan Deng
- Department of Communication, University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Verma R, Saldanha C, Ellis U, Sattar S, Haase KR. eHealth literacy among older adults living with cancer and their caregivers: A scoping review. J Geriatr Oncol 2021; 13:555-562. [PMID: 34810146 DOI: 10.1016/j.jgo.2021.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/20/2021] [Accepted: 11/05/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Over 90% of people living with cancer access information online to inform healthcare decisions. Older adults with cancer are also increasingly adopting electronic healthcare services, or eHealth, particularly with the rapid transition to virtual care amidst the pandemic. Therefore, the purpose of this review is to understand the level of eHealth literacy among older adults with cancer and their caregivers, as well as any barriers and facilitators in terms of accessing, comprehending, and implementing eHealth information. METHODS This scoping review was guided by Arksey and O'Malley methodology and PRISMA ScR guidelines. Comprehensive searches for the concepts of "eHealth Literacy" and "cancer" were performed in MEDLINE, Scopus, CINAHL, PsycINFO, AMED and EMBASE, from 2000 to 2021. We used descriptive quantitative and thematic analysis to analyze the literature. RESULTS Of the 6076 articles screened by two reviewers, eleven articles were included. Quantitative findings suggest older adults with cancer and their caregivers have low self-perceived eHealth literacy and less confidence evaluating online health information for cancer decision-making. Low socioeconomic status, lower education levels, rapid expansion of digital applications, broadband access, reduced familiarity, and frequency of use were cited as prominent barriers. eHealth literacy appears to be positively correlated with caregivers seeking a second opinion, awareness of treatment options, shared decision making, and trust in the health care system. CONCLUSION With the growing reliance on eHealth tools, developing credible digital health applications that require minimal internet navigation skills, patient education, and collaborative efforts to address access and affordability are urgently warranted.
Collapse
Affiliation(s)
- Ridhi Verma
- School of Healthcare Sciences, Cardiff University, 19 Brent Avenue, Didcot, Oxforshire, United Kingdom
| | - Conchita Saldanha
- School of Physical and Occupational Therapy, McGill University, 5385 rue de Bernieres, Saint Leonard H1R 1M9, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, Vancouver, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, 4400, 4th Avenue, Rm 108, Regina, Saskatchewan S4T 0H8, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
5
|
Evaluating the Use of Telepractice for Bottle-Feeding Assessments. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110989. [PMID: 34828701 PMCID: PMC8625576 DOI: 10.3390/children8110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month-2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.
Collapse
|
6
|
Raatz M, Ward EC, Marshall J, Burns CL. Evaluating the Use of Telepractice to Deliver Pediatric Feeding Assessments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1686-1699. [PMID: 34061575 DOI: 10.1044/2021_ajslp-20-00323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study aimed to investigate the interrater reliability of pediatric feeding assessments conducted via synchronous (real-time) telepractice. Secondary aims were to investigate parent and clinician satisfaction. Method The eating and/or cup drinking skills of 40 children (aged 4 months to 7 years) were simultaneously assessed by one speech-language pathologist (SLP) leading the appointment via telepractice and a second SLP present in the family home. A purpose-designed assessment form was used to assess (a) positioning, (b) development, (c) oral sensorimotor function, (d) prefeeding respiratory status, (e) observation of eating and drinking, (f) parent-child interaction, (g) overall feeding skills, and (h) feeding recommendations. The telepractice SLP completed a postappointment satisfaction questionnaire, and parents completed five questionnaires specifically investigating perceptions of and satisfaction with the telepractice feeding appointment. Results Agreement for all assessment components except intraoral examination (palate integrity and tonsils) was > 85%. All appointments were able to be conducted via telepractice, and for 90% of these (n = 36), clinicians agreed that telepractice was an effective service delivery method. Parents reported high levels of satisfaction with telepractice, with 76% reporting that the telepractice appointment was similar to a traditional in-person appointment. Conclusion Study results demonstrated that synchronous pediatric feeding assessments conducted in family homes via telepractice were feasible, reliable, and acceptable to both clinicians and parents. Supplemental Material https://doi.org/10.23641/asha.14700228.
Collapse
Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| |
Collapse
|
7
|
Kim H, Cho NB, Kim J, Kim KM, Kang M, Choi Y, Kim M, You H, Nam SI, Shin S. Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study. JMIR Mhealth Uhealth 2020; 8:e22080. [PMID: 33012704 PMCID: PMC7600016 DOI: 10.2196/22080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023] Open
Abstract
Background Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID) RR2-10.2196/19585
Collapse
Affiliation(s)
- HyangHee Kim
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam-Bin Cho
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinwon Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Kyung Min Kim
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minji Kang
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Younggeun Choi
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Minjae Kim
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Heecheon You
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Seok In Nam
- Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Soyeon Shin
- Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
8
|
Wall LR, Ward EC, Cartmill B, Hill AJ, Isenring E, Byrnes J, Porceddu SV. Prophylactic swallowing therapy for patients with head and neck cancer: A three-arm randomized parallel-group trial. Head Neck 2020; 42:873-885. [PMID: 31903689 DOI: 10.1002/hed.26060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intensive prophylactic swallowing therapy can mitigate dysphagia in patients with oropharyngeal (OP) SCC, however, presents service challenges. This trial investigated the clinical efficacy of three service models delivering prophylactic swallowing therapy during (chemo)radiotherapy ([C]RT). METHODS Patients (n = 79) with OPSCC receiving (C)RT were were randomized to: (a) clinician-directed face-to-face therapy (n = 26); (b) telepractice therapy via "SwallowIT" (n = 26); or (c) patient self-directed therapy (n = 27). Swallowing, nutritional, and functional status were compared at baseline, 6-weeks, and 3-months post-(C)RT. Patients' perceptions/preferences for service-delivery were collated posttreatment. RESULTS Service-delivery mode did not affect clinical outcomes, with no significant (P > .05) between-group differences or group-by-time interactions observed for swallowing, nutrition, or functional measures. Therapy adherence declined during (C)RT in all groups. SwallowIT and clinician-directed models were preferred by significantly (P = .002) more patients than patient-directed. CONCLUSIONS SwallowIT provided clinically equivalent outcomes to traditional service models. SwallowIT and clinician-directed therapy were preferred by patients, likely due to higher levels of therapy support.
Collapse
Affiliation(s)
- Laurelie R Wall
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Elizabeth Isenring
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sandro V Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia.,School of Medicine, The University of Queensland, Queensland, Australia
| |
Collapse
|
9
|
Kabeza CB, Harst L, Schwarz PE, Timpel P. A qualitative study of users' experiences after 3 months: the first Rwandan diabetes self-management Smartphone application "Kir'App". Ther Adv Endocrinol Metab 2020; 11:2042018820914510. [PMID: 32523670 PMCID: PMC7236575 DOI: 10.1177/2042018820914510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Owing to the increasing popularity of smartphones in Rwanda, almost 75% of the entire population currently has access to the internet. Although it has been shown that smartphone applications can support diabetes self-management, there was no diabetes self-management application available in Rwanda until April 2019. Based on the findings of a prior study assessing the needs and expectations of potential users, 'Kir'App' was developed to fill that void. The aim of this study was to evaluate users' experiences after 3 months of use of the first Kir'App prototype. METHODS The participants of the previous study were recruited to take part in the current study. Semi-structured, in-depth, face-to-face interviews were conducted. Findings were analysed thematically using Mayring's method of qualitative content analysis. Both deductive and inductive approaches were used to analyse transcripts according to the original categories and subcategories of the previous study. RESULTS A total of 14 people with either type 1 or type 2 diabetes participated in the study. Age of participants ranged from 19 to 70 years, with a mean age of 34.4 years. Seven of the eight original themes and one additional theme were subjoined: diabetes education and desired information provision; increased diabetes knowledge and awareness; monitoring and reminder functions; nutrition; physical activity; coping with burden of disease; app features; use behaviour and usability. Overall, participants stated that the app increased their diabetes knowledge and assisted them with their diabetes self-management. CONCLUSIONS We found that the first prototype of Kir'App meets the overall needs and expectations of participating Rwandan diabetics. Having followed a strict user-centred design process, their qualitative insights will help to further improve the app.
Collapse
Affiliation(s)
| | - Lorenz Harst
- Research Association Public Health Saxony, Centre for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Peter E.H. Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland Germany German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany Paul Langerhans Institute Dresden of the Helmholtz Centre Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland Germany
| |
Collapse
|
10
|
Timpel P, Harst L, Reifegerste D, Weihrauch-Blüher S, Schwarz PEH. What should governments be doing to prevent diabetes throughout the life course? Diabetologia 2019; 62:1842-1853. [PMID: 31451873 DOI: 10.1007/s00125-019-4941-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022]
Abstract
Health systems and governments are increasingly required to implement measures that target at-risk populations to prevent noncommunicable diseases. In this review we lay out what governments should be doing to prevent diabetes throughout the life course. The following four target groups were used to structure the specific recommendations: (1) pregnant women and young families, (2) children and adolescents, (3) working age population, and (4) the elderly. The evidence to date supports the effectiveness of some known government policy measures, such as sugar taxes and regulatory measures in the (pre-)school setting for children and adolescents. Many of these appear to be more effective if they are part of a bundle of strategies and if they are supplemented by communication strategies. Although there is a current focus on strategies that target the individual, governments can make use of evidence-based population-level prevention strategies. More research and continuous evaluation of the overall and subgroup-specific effectiveness of policy strategies using high-quality longitudinal studies are needed.
Collapse
Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Doreen Reifegerste
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Susann Weihrauch-Blüher
- Department of Pediatrics I, Pediatric Endocrinology and Diabetology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
| |
Collapse
|
11
|
Kristensen MB, Isenring E, Brown B. Nutrition and swallowing therapy strategies for patients with head and neck cancer. Nutrition 2019; 69:110548. [PMID: 31563019 DOI: 10.1016/j.nut.2019.06.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023]
Abstract
Patients with head and neck cancer experience many problems with eating which make them at high risk of malnutrition. Pre-habilitation swallowing exercises as overseen by a speech pathologist can improve swallowing function. A multidisciplinary approach to care, including effective nutritional screening, assessment and intervention has demonstrated improved outcomes in terms of meet nutritional requirements, improved nutritional status and quality of life. Nutritional recommendations are 1.2-1.5 g protein per kilogram per day and 125kJ/kg body weight per day but as these are guides close monitoring of intake and weight is important. Multidisciplinary teams and telehealth have shown better outcomes for nutrition and swallowing status for head and neck cancer patients and ongoing support is required for best patient care.
Collapse
Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark; Bond Institute of Health and Sport, Bond University, Gold Coast, Australia
| | - Elizabeth Isenring
- Bond Institute of Health and Sport, Bond University, Gold Coast, Australia.
| | - Bena Brown
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Queensland Health, Australia; Centre for Functioning and Health Research, Metro South Health, Queensland Health, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| |
Collapse
|
12
|
Collins A, Burns CL, Ward EC, Comans T, Blake C, Kenny L, Greenup P, Best D. Home-based telehealth service for swallowing and nutrition management following head and neck cancer treatment. J Telemed Telecare 2017; 23:866-872. [DOI: 10.1177/1357633x17733020] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Following (chemo)radiotherapy (C/RT) for head and neck cancer (HNC), patients return to hospital for regular outpatient reviews with speech pathology (SP) and nutrition and dietetics (ND) for acute symptom monitoring, nutritional management, and swallowing and communication rehabilitation. The aim of the current study was to determine the feasibility of a home-based telehealth model for delivering SP and ND reviews, to provide patients with more convenient access to these appointments. Methods Service outcomes, costs, and consumer satisfaction were examined across 30 matched participants: 15 supported via the standard model of care (SMOC), and 15 via the home-based telehealth model of care (TMOC). Results All patients were successfully managed via telehealth. The TMOC was more efficient, with a reduced number ( p < 0.003) and duration ( p < 0.01) of appointments required until discharge. Significant patient cost savings ( p = 0.002) were reported for the TMOC due to decreased travel requirements. While staff costs were reduced, additional telehealth equipment levies resulted in a lower but non-significant overall cost difference to the health service when using the TMOC. High satisfaction was reported by all participants attending the TMOC. Discussion The findings support the feasibility of a home-based telehealth model for conducting SP and ND reviews post C/RT for HNC.
Collapse
Affiliation(s)
- Annette Collins
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
| | - Clare L Burns
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Australia
| | - Tracy Comans
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Claire Blake
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
| | - Lizbeth Kenny
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
- Central Integrated Regional Cancer Services, Queensland Health, Australia
- School of Medicine, The University of Queensland, Australia
| | - Phil Greenup
- Telehealth Support Unit, Health Improvement Unit, Australia
| | - Daniel Best
- Telehealth Support Unit, Health Improvement Unit, Australia
| |
Collapse
|
13
|
Application of telepractice for head and neck cancer management: a review of speech language pathology service models. Curr Opin Otolaryngol Head Neck Surg 2017; 25:169-174. [DOI: 10.1097/moo.0000000000000357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Breen LJ, O'Connor M, Calder S, Tai V, Cartwright J, Beilby JM. The health professionals' perspectives of support needs of adult head and neck cancer survivors and their families: a Delphi study. Support Care Cancer 2017; 25:2413-2420. [PMID: 28258504 DOI: 10.1007/s00520-017-3647-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim was to identify the views of Australian and New Zealand health professionals regarding the support needs of people with head and neck cancer (HNC) and their families and current gaps in service delivery. METHODS A modified Delphi process assessed support needs of people with HNC following acute medical management. A systematic review of the literature was used to develop items relevant to seven key concepts underpinning the psychological experience of living with HNC. A panel of 105 health professionals was invited to participate in two questionnaire rounds. RESULTS Of the potential panellists, 50 (48%) completed round 1, and of these, 39 (78%) completed round 2. Following two rounds, there was consensus agreement on the concepts uncertainty and waiting, disruption to daily life and fear of recurrence. The concepts the diminished self, making sense of and managing the experience, sharing the burden and finding a path did not achieve consensus. There were no differences in responses according to gender, organization type or location. Medical professionals had significantly higher agreement for the concept uncertainty and waiting compared to allied health professionals, and professionals with five years' or more experience had significantly higher agreement than those with less experience. CONCLUSIONS Health professionals agreed that many psychosocial support needs of HNC survivors and families are not being met and that they experience difficulties in meeting these needs. Findings may inform evidence-based treatment programs for HNC survivors and their families to promote psychological resilience and quality of life in this vulnerable population.
Collapse
Affiliation(s)
- Lauren J Breen
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Samuel Calder
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Vivian Tai
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Jade Cartwright
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia
| | - Janet M Beilby
- School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| |
Collapse
|