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Bernal-Jiménez MÁ, Calle G, Gutiérrez Barrios A, Gheorghe LL, Cruz-Cobo C, Trujillo-Garrido N, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e48756. [PMID: 38648103 DOI: 10.2196/48756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. OBJECTIVE This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. METHODS This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. RESULTS The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75% vs 11/61, 42%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). CONCLUSIONS The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. TRIAL REGISTRATION Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504.
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Affiliation(s)
- María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - German Calle
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Alejandro Gutiérrez Barrios
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Livia Luciana Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Celia Cruz-Cobo
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Nuria Trujillo-Garrido
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Biomedicine, Biotechnology and Public Health Department, University of Cádiz, Cádiz, Spain
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain
- Network Biomedical Research Center "Pathophysiology of Obesity and Nutrition", Carlos III Health Institute, Madrid, Spain
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
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Bernal-Jiménez MÁ, Calle-Pérez G, Gutiérrez-Barrios A, Gheorghe L, Solano-Mulero AM, Trujillo-Garrido N, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Design and Validation of a Scale of Knowledge of Cardiovascular Risk Factors and Lifestyle after Coronary Event. J Clin Med 2022; 11:jcm11102773. [PMID: 35628900 PMCID: PMC9147543 DOI: 10.3390/jcm11102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: It is important for health professionals to have tools available to assess patients’ knowledge of lifestyle and cardiovascular risk factors after they have suffered a coronary event and determine whether educational interventions are effective. This study aims to design and validate a scale to evaluate this knowledge. Methods: Four-phase instrument design: (A) Conceptual review. (B) Review by experts. (C) Pilot test–retest. (D) Psychometric validation of the final version of the questionnaire with 24 items. A panel of experts performed the content validity. The reliability of the scale was measured using Cronbach’s alpha score and criterion validity was evaluated by comparing the total scores for knowledge obtained by the participants among the three education level groups. The construct and dimensional structure validity were assessed using exploratory factor analysis. Results: A total of 143 people participated, 30 in the pilot study and 113 (68% male, 60.2 ± 9 years) in the psychometric validation of version 3 of the scale. A Cronbach’s alpha score of 0.887 was reached for this version. The factor analysis showed that the items were distributed into five factors that explained 57% of the variance. Significant differences were observed in the level of knowledge among the patients of the three levels of education (low, moderate and high) (99.20 ± 11.93, 105.92 ± 7.85, 109.78 ± 8.76 points, p = 0.003), as there was a negative correlation between age and knowledge level (r = −0.213, p = 0.024). Conclusions: The scale presents psychometric properties that are evidence of its reliability and validity. The relationship demonstrated between the level of knowledge and age, sex and level of education shows the importance of emphasizing educational interventions for elderly people and those with a lower level of education.
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Affiliation(s)
- María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11003 Cádiz, Spain
| | - Germán Calle-Pérez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | - Alejandro Gutiérrez-Barrios
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | - Livia Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | | | - Nuria Trujillo-Garrido
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11003 Cádiz, Spain
| | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Biomedicine, Biotechnology and Public Health Department, University of Cádiz, 11003 Cádiz, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS, IDISBA & CIBEROBN, 07122 Palma de Mallorca, Spain;
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Cardiology Unit, Puerta del Mar Hospital, 11009 Cádiz, Spain;
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11003 Cádiz, Spain; (M.Á.B.-J.); (N.T.-G.); (A.R.-M.)
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain; (G.C.-P.); (A.G.-B.); (L.G.); (R.V.-G.)
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11003 Cádiz, Spain
- Correspondence: ; Tel.: +34-956-019042; Fax: +34-956-015685
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Trujillo-Garrido N, Bernal-Jiménez MÁ, Santi-Cano MJ. Evaluation of Obesity Management Recorded in Electronic Clinical History: A Cohort Study. J Clin Med 2020; 9:E2345. [PMID: 32717839 PMCID: PMC7465947 DOI: 10.3390/jcm9082345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide. Because of their close proximity to the population, primary care physicians and nurses are in a unique position to motivate and advise patients with obesity on a healthy diet and increased physical activity. Drawing from information recorded in electronic clinical records, we evaluated how the general recommendations included in obesity guidelines are being implemented in routine clinical practice. METHODS This study drew from the following data from a cohort of 209 patients with obesity that attended primary care consultations: electronic clinical records, body mass index (BMI), waist circumference (WC), cardiovascular risk factors, comorbidities and whether their health professional documented compliance with the recommendations of the evidence-based obesity guidelines in their electronic history. RESULTS Only 25.4% of the clinical records met all the criteria established in the therapeutic guidelines regarding diet prescription, 1.4% for physical activity and 1.5% for behavioral change activities. The patients whose records mentioned diet prescription and physical activity and who received follow-up consultations for both factors had lower average BMI and WC, although this relationship was not significant after adjusting for baseline. CONCLUSIONS We found that only a small number of records in the electronic clinical histories followed the evidence-based obesity guidelines. Recording dietetic prescription and physical exercise in the patient's clinical record is associated with better control of obesity.
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Affiliation(s)
- Nuria Trujillo-Garrido
- Faculty of Nursing, University of Cádiz, 11207 Cádiz, Spain;
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
| | - María Ángeles Bernal-Jiménez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
| | - María J. Santi-Cano
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11003 Cádiz, Spain;
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
- Research Group on Nutrition: Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
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