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Dobson R, Whittaker R. What Do Health Service Users Think About the Use of Their Data for AI Development? Stud Health Technol Inform 2024; 310:1156-1160. [PMID: 38269996 DOI: 10.3233/shti231146] [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] [Indexed: 01/26/2024]
Abstract
AI tools are being introduced within health services around the globe. It is important that tools are developed and validated using the available health information of the population where it is intended to be used. We set out to determine what patients thought about the use of their health information for this purpose. In interviews we found that the patients of a health service in Auckland, Aotearoa New Zealand, are generally comfortable with their health information being used for these purposes but with conditions (around public good, governance, privacy, security, transparency, and restrictions on commercial gain) and with careful consideration of their perspectives. We suggest that health services should take the time to have these conversations with their communities and to provide open and clear communication around these developments in their services.
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Affiliation(s)
- Rosie Dobson
- National Institute for Health Information, University of Auckland
- Te Whatu Ora Waitematā
| | - Robyn Whittaker
- National Institute for Health Information, University of Auckland
- Te Whatu Ora Waitematā
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2
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Dobson R, Stowell M, Warren J, Tane T, Ni L, Gu Y, McCool J, Whittaker R. Use of Consumer Wearables in Health Research: Issues and Considerations. J Med Internet Res 2023; 25:e52444. [PMID: 37988147 DOI: 10.2196/52444] [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: 09/04/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
As wearable devices, which allow individuals to track and self-manage their health, become more ubiquitous, the opportunities are growing for researchers to use these sensors within interventions and for data collection. They offer access to data that are captured continuously, passively, and pragmatically with minimal user burden, providing huge advantages for health research. However, the growth in their use must be coupled with consideration of their potential limitations, in particular, digital inclusion, data availability, privacy, ethics of third-party involvement, data quality, and potential for adverse consequences. In this paper, we discuss these issues and strategies used to prevent or mitigate them and recommendations for researchers using wearables as part of interventions or for data collection.
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Affiliation(s)
- Rosie Dobson
- School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Melanie Stowell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lin Ni
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yulong Gu
- School of Health Sciences, Stockton University, Galloway, NJ, United States
| | - Judith McCool
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
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Whittaker R, Dobson R, Jin CK, Style R, Jayathissa P, Hiini K, Ross K, Kawamura K, Muir P. An example of governance for AI in health services from Aotearoa New Zealand. NPJ Digit Med 2023; 6:164. [PMID: 37658119 PMCID: PMC10474148 DOI: 10.1038/s41746-023-00882-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/21/2023] [Indexed: 09/03/2023] Open
Abstract
Artificial Intelligence (AI) is undergoing rapid development, meaning that potential risks in application are not able to be fully understood. Multiple international principles and guidance documents have been published to guide the implementation of AI tools in various industries, including healthcare practice. In Aotearoa New Zealand (NZ) we recognised that the challenge went beyond simply adapting existing risk frameworks and governance guidance to our specific health service context and population. We also deemed prioritising the voice of Māori (the indigenous people of Aotearoa NZ) a necessary aspect of honouring Te Tiriti (the Treaty of Waitangi), as well as prioritising the needs of healthcare service users and their families. Here we report on the development and establishment of comprehensive and effective governance over the development and implementation of AI tools within a health service in Aotearoa NZ. The implementation of the framework in practice includes testing with real-world proposals and ongoing iteration and refinement of our processes.
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Affiliation(s)
- R Whittaker
- Te Whatu Ora Waitematā, Auckland, New Zealand.
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
| | - R Dobson
- Te Whatu Ora Waitematā, Auckland, New Zealand
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - C K Jin
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | - R Style
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | | | - K Hiini
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | - K Ross
- Precision Driven Health, Auckland, New Zealand
| | - K Kawamura
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | - P Muir
- Te Whatu Ora Waitematā, Auckland, New Zealand
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Candy S, Reeve J, Dobson R, Whittaker R, Garrett J, Warren J, Calder A, Tane T, Robertson T, Rashid U, Taylor D. The Impact of Patient Preference on Attendance and Completion Rates at Centre-Based and mHealth Pulmonary Rehabilitation: A Non-Inferiority Pragmatic Clinical Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1419-1429. [PMID: 37465821 PMCID: PMC10350416 DOI: 10.2147/copd.s408423] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Pulmonary rehabilitation (PR) is vital in the management of chronic respiratory disorders (CRDs) although uptake, attendance and completion are poor. Differing models of delivering PR are emerging in an attempt to increase the uptake and completion of this intervention. This study aimed to evaluate participant rate of attendance and completion of PR when given a preference regarding model of delivery (centre-based and mPR). Secondary aims were to evaluate the factors affecting patient preference for model of delivery and determine whether mPR is non-inferior to centre-based PR in health outcomes. Methods A multi-centre non-inferiority preference based clinical trial in Auckland, New Zealand. Participants with a CRD referred for PR were offered the choice of centre-based or mHealth PR (mPR). The primary outcome was completion rate of chosen intervention. Results A total of 105 participants were recruited to the study with 67 (64%) preferring centre-based and 38 (36%) mPR. The odds of completing the PR programme were higher in the centre-based group compared to mPR (odds ratio 1.90 95% CI [0.83-4.35]). Participants opting for mPR were significantly younger (p = 0.002) and significantly more likely to be working (p = 0.0001). Results showed that mPR was not inferior to centre-based regarding changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ). When services were forced to transition to telehealth services during COVID-19 restrictions, the attendance and completion rates were higher with telephone calls and video conferencing compared to mPR - suggesting that synchronous interpersonal interactions with clinicians may facilitate the best attendance and completion rates. Conclusion When offered the choice of PR delivery method, the majority of participants preferred centre-based PR and this facilitated the best completion rates. mPR was the preferred choice for younger, working participants suggesting that mPR may offer a viable alternative to centre-based PR for some participants, especially younger, employed participants.
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Affiliation(s)
- Sarah Candy
- Te Whatu Ora Counties Manukau Health, Auckland, New Zealand
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Julie Reeve
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | | | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Amanda Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Usman Rashid
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Thaggard S, Reid S, Chan A, White C, Fraser L, Arroll BA, Best E, Whittaker R, Wells S, Thomas MG, Ritchie SR. Whānau Māori and Pacific peoples' knowledge, perceptions, expectations and solutions regarding antibiotic treatment of upper respiratory tract infections: a qualitative study. BMC Infect Dis 2023; 23:458. [PMID: 37430196 DOI: 10.1186/s12879-023-08431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION The rate of community antibiotic use is high in Aotearoa New Zealand (NZ) when compared to other nations, and in NZ, as in most other nations, antibiotics are very commonly prescribed for self-limiting upper respiratory tract infections (URTIs). Resources that build knowledge, perceptions and understanding can potentially reduce unnecessary antibiotic consumption. METHODS To inform the content of educational resources, we conducted an in-depth qualitative study with 47 participants via 6 focus groups of the knowledge, attitudes, and expectations of whānau Māori and Pacific peoples about antibiotics and URTIs. RESULTS Focus groups with 47 participants identified four themes: Knowledge that might influence expectations to receive antibiotics for URTIs; Perceptions - the factors that influence when and why to seek medical care for URTI; Expectations - the features of successful medical care for URTI; Solutions - how to build community knowledge about URTI and their treatment and prevention. Knowledge that might reduce expectations to receive antibiotics for URTI included confidence in the use of alternative remedies, knowledge that URTI are usually caused by viruses, and concerns about antibiotic adverse effects. Participants commonly reported that they would confidently accept their doctor's recommendation that an antibiotic was not necessary for an URTI, provided that a thorough assessment had been performed and that treatment decisions were clearly communicated. CONCLUSION These findings suggest that building patients' knowledge and skills about when antibiotics are necessary, and increasing doctors' confidence and willingness not to prescribe an antibiotic for patients with an URTI, could significantly reduce inappropriate antibiotic prescribing in NZ.
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Affiliation(s)
- S Thaggard
- Nursing Department, Auckland University of Technology, Auckland, New Zealand
| | - S Reid
- Health Literacy NZ, Auckland, New Zealand
| | - Ahy Chan
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - C White
- Health Literacy NZ, Auckland, New Zealand
| | - L Fraser
- Turuki Health Care, Auckland, New Zealand
| | - B A Arroll
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - E Best
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - R Whittaker
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Wells
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - M G Thomas
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S R Ritchie
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
- 502-301E Infection and Immunity, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag, 92019, New Zealand.
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Dobson R, Wihongi H, Whittaker R. Exploring patient perspectives on the secondary use of their personal health information: an interview study. BMC Med Inform Decis Mak 2023; 23:66. [PMID: 37041588 PMCID: PMC10088161 DOI: 10.1186/s12911-023-02143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/14/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The increased digitalisation of health records has resulted in increased opportunities for the secondary use of health information for advancing healthcare. Understanding how patients want their health information used is vital to ensure health services use it in an appropriate and patient-informed manner. The aim of this study was to explore patient perceptions of the use of their health information beyond their immediate care. METHODS Semi-structured in-depth interviews were conducted with current users of health services in Aotearoa New Zealand. Different scenarios formed the basis of the discussions in the interviews covering different types of information use (current practice, artificial intelligence and machine learning, clinical calculators, research, registries, and public health surveillance). Transcripts were analysed using thematic analysis. RESULTS Twelve interviews were conducted with individual's representative of key ethnicity groups and rural/urban populations, and at the time of recruitment, had been accessing a diverse range of health services. Participants ranged from high users of health care (e.g., weekly dialysis) through to low users (e.g., one-off presentation to the emergency department). Four interrelated overarching themes were identified from the transcripts describing the main issues for participants: helping others, sharing of data is important, trust, and respect. CONCLUSIONS People currently engaging with health services are supportive of their health information being used to help others, advance science, and contribute to the greater good but their support is conditional. People need to be able to trust the health service to protect, care for, and respect their health information and ensure no harm comes from its use. This study has identified key considerations for services and researchers to reflect on when using patient health information for secondary purposes to ensure they use it in a patient-informed way. TRIAL REGISTRATION NA.
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Affiliation(s)
- Rosie Dobson
- School of Population Health, University of Auckland, Auckland, New Zealand.
- Te Whatu Ora Waitematā, Auckland, New Zealand.
| | - Helen Wihongi
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Robyn Whittaker
- School of Population Health, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
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Perkes SJ, Bonevski B, Hall K, Mattes J, Chamberlain C, Bennett J, Whittaker R, Palazzi K, Lambkin D, Kennedy M. Aboriginal and Torres Strait Islander Women's Access to and Interest in mHealth: National Web-based Cross-sectional Survey. J Med Internet Res 2023; 25:e42660. [PMID: 36877565 PMCID: PMC10028504 DOI: 10.2196/42660] [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: 09/12/2022] [Revised: 01/22/2023] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. OBJECTIVE The objectives of this study were to investigate Aboriginal and Torres Strait Islander women's ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. METHODS A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. RESULTS In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. CONCLUSIONS Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions).
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Affiliation(s)
- Sarah Jane Perkes
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Kerry Hall
- First Peoples Health Unit, Griffith University, Southport, Australia
| | - Joerg Mattes
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jessica Bennett
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Robyn Whittaker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - David Lambkin
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Dobson R, Li LL, Garner K, Tane T, McCool J, Whittaker R. The Use of Sensors to Detect Anxiety for In-the-Moment Intervention: Scoping Review. JMIR Ment Health 2023; 10:e42611. [PMID: 36729590 PMCID: PMC9936367 DOI: 10.2196/42611] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND With anxiety a growing issue and barriers to accessing support services, there is a need for innovative solutions to provide early intervention. In-the-moment interventions support individuals to recognize early signs of distress and use coping mechanisms to prevent or manage this distress. There is potential for wearable sensors linked to an individual's mobile phone to provide in-the-moment support tailored to individual needs and physiological responses. OBJECTIVE The aim of this scoping review is to examine the role of sensors in detecting the physiological signs of anxiety to initiate and direct interventions for its management. METHODS Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, ProQuest, and Scopus. Studies were identified if they were conducted with people with stress or anxiety or at risk of anxiety and included a wearable sensor providing real-time data for in-the-moment management of anxiety. RESULTS Of the 1087 studies identified, 11 studies were included in the review, including 5 randomized controlled trials and 6 pilot or pretesting studies. The results showed that most studies successfully demonstrated improvements in their target variables. This included overall anxiety and stress levels, and the implementation of in-the-moment stress and anxiety management techniques such as diaphragmatic breathing. There was wide variation in the types of sensors used, physiological measures, and sensor-linked interventions. CONCLUSIONS This review indicates that sensors are potentially a useful tool in detecting anxiety and facilitating the implementation of a known control mechanism to reduce anxiety and improve mood, but further work is needed to understand the acceptability and effectiveness of this type of intervention.
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Affiliation(s)
- Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Linwei Lily Li
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Katie Garner
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Judith McCool
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
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Dobson R, Uri A, Whittaker R, Evison K, Umali E, McRobbie H. Is opt-out enrolment acceptable for low-risk digital health services? J Prim Health Care 2022; 14:368-371. [PMID: 36592779 DOI: 10.1071/hc22088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Digital health programmes not only complement existing services, but have the potential to reach populations that existing services are not reaching. Many of these services require people to opt-in to receive them, which presents significant barriers to access. An alternative is to make low-risk digital services opt-out, ensuring appropriate members of the target audience are signed up for a service unless they select to not receive it. Aim This study aimed to investigate how changing enrolment in a low-risk digital health programme from opt-in to opt-out would impact on enrolment and dropout rates. Methods This study involved the retrospective analysis of registration data from txtpēpi, a maternal and child health text-message programme. System-recorded data from enrolments during a 12-month period were obtained. In the first 6 months, users had to opt-in to the service (Period 1), but in the following 6 months, an opt-out process was implemented (Period 2). Results There was a 77% increase in enrolments in Period 2 (n = 113) compared to Period 1 (n = 64) and no significant change in the proportion of enrolments of Māori between time periods (P = 0.508). There was no significant difference in withdrawal rates between time periods at either 2 weeks (5% vs 6%, P = 0.676) or 1 month (9% vs 9%, P = 0.907). Discussion This study has shown switching from an opt-in to an opt-out option resulted in an increase in enrolments in an mHealth programme, but had no impact on withdrawals. This indicates that employing opt-out enrolment for low-risk evidence-based interventions is acceptable and a potential way to make these services more accessible.
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Affiliation(s)
- Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, Aotearoa New Zealand; and Te Whatu Ora - Waitemata, Auckland, Aotearoa New Zealand
| | - Amanda Uri
- National Institute for Health Innovation, University of Auckland, Auckland, Aotearoa New Zealand; and Te Arawa Whanau Ora, Rotorua, Aotearoa New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, Aotearoa New Zealand; and Te Whatu Ora - Waitemata, Auckland, Aotearoa New Zealand
| | - Karen Evison
- Te Whatu Ora - Lakes, Rotorua, Aotearoa New Zealand
| | - Elaine Umali
- National Institute for Health Innovation, University of Auckland, Auckland, Aotearoa New Zealand
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Abstract
Rapid, convenient, and full access to personal electronic health records is a key part of empowering patients to manage their health and collaborate with healthcare, argue Maria Hägglund and colleagues
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Affiliation(s)
- Maria Hägglund
- Healthcare Sciences and E-health, Department of Women's and Children's Health, Uppsala University, Sweden
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, New Zealand
- Waitemata District Health Board, New Zealand
| | - Charlotte Blease
- General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Whittaker R, Dobson R, Garner K. Chatbots for Smoking Cessation: Scoping Review. J Med Internet Res 2022; 24:e35556. [PMID: 36095295 PMCID: PMC9514452 DOI: 10.2196/35556] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/12/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite significant progress in reducing tobacco use over the past 2 decades, tobacco still kills over 8 million people every year. Digital interventions, such as text messaging, have been found to help people quit smoking. Chatbots, or conversational agents, are new digital tools that mimic instantaneous human conversation and therefore could extend the effectiveness of text messaging. OBJECTIVE This scoping review aims to assess the extent of research in the chatbot literature for smoking cessation and provide recommendations for future research in this area. METHODS Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, Google Scholar, and Scopus, as well as additional searches on JMIR, Cochrane Library, Lancet Digital Health, and Digital Medicine. Studies were considered if they were conducted with tobacco smokers, were conducted between 2000 and 2021, were available in English, and included a chatbot intervention. RESULTS Of 323 studies identified, 10 studies were included in the review (3 framework articles, 1 study protocol, 2 pilot studies, 2 trials, and 2 randomized controlled trials). Most studies noted some benefits related to smoking cessation and participant engagement; however, outcome measures varied considerably. The quality of the studies overall was low, with methodological issues and low follow-up rates. CONCLUSIONS More research is needed to make a firm conclusion about the efficacy of chatbots for smoking cessation. Researchers need to provide more in-depth descriptions of chatbot functionality, mode of delivery, and theoretical underpinnings. Consistency in language and terminology would also assist in reviews of what approaches work across the field.
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Affiliation(s)
- Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Katie Garner
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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12
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Whittaker R, Andrew P, Dobson R, Bramley D. Innovation in Aotearoa New Zealand's healthcare system-how to make it happen. N Z Med J 2022; 135:79-89. [PMID: 35834836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To date innovation in Aotearoa New Zealand healthcare services has varied around the country. As we move into a health system restructure, it is important to reflect on what has worked to date and how we can take these elements into the new system. In this paper we describe the approach at Waitematā District Health Board (DHB) including the establishment of an Institute for Innovation and Improvement. We highlight what we view as the key elements of an innovation enabling environment and suggest measures of success.
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Affiliation(s)
- Robyn Whittaker
- Associate Professor and Public Health Physician, i3, Waitematā DHB, Auckland, New Zealand; National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Penny Andrew
- Director, i3, Waitematā DHB, Auckland, New Zealand
| | - Rosie Dobson
- Psychologist and Senior Research Fellow, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. i3, Waitematā DHB, Auckland, New Zealand
| | - Dale Bramley
- Chief Executive Officer, Waitematā DHB, Auckland, New Zealand
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Dobson R, Baty C, Best G, Wells S, Wang K, Hallett K, Andrew P, Whittaker R. Digital solutions for providing patients access to hospital-held health information: what are the design issues that need to be addressed? N Z Med J 2022; 135:114-123. [PMID: 35728254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A patient and whānau centred healthcare system includes patients having easy access to their health records when and where they need it. Accessible digital solutions providing patients with access to their health information, including hospital-held healthcare records, will support patients and whānau to be active and informed participants in their health. A Northern Region proof-of-concept, providing patients with electronic access to their hospital-held health information, identified several challenges in the design of such "portals". The purpose of this paper is to present a discussion of these challenges, and to present a review of the literature on how other countries and health settings have managed them. The review has led to recommendations around how delegated access, auditing access, adding and correcting of information, the timing of test result availability, and retrospective records should be handled. However, more investigation is required into the challenges surrounding how various types of more sensitive information should be handled. There is still considerable work to be done on how to technically and operationally transform these "default design principles" into reality within the complexity of New Zealand hospitals' electronic health information systems.
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Affiliation(s)
- Rosie Dobson
- Health Psychologist and Senior Research Fellow, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand; i3, Waitematā District Health Board (DHB), Auckland, New Zealand
| | - Chris Baty
- Health Consumer. Waitematā DHB, Auckland, New Zealand
| | - Georgia Best
- Research Assistant, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Associate Professor, School of Population Health, University of Auckland, New Zealand; Associate Clinical Director, ProCare, Auckland, New Zealand
| | - Keming Wang
- Senior Business Analyst, healthAlliance, Auckland, New Zealand
| | - Karen Hallett
- Programme Manager, healthAlliance, Auckland, New Zealand
| | - Penny Andrew
- Director, i3, Waitematā DHB, Auckland, New Zealand
| | - Robyn Whittaker
- Associate Professor and Public Health Physician, i3, Waitematā DHB, Auckland, New Zealand; National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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14
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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15
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Dobson R, Whittaker R, Wihongi H, Andrew P, Armstrong D, Bartholomew K, Sporle A, Wells S. Patient perspectives on the use of health information. N Z Med J 2021; 134:48-62. [PMID: 35728109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM This survey aimed to investigate patient perspectives, including preferences, needs and concerns, on the use of, and access to, individual healthcare information. METHOD A mixed-methods cross-sectional survey of adult patients (n=1,377) in Waitematā District Health Board inpatient and outpatient services during November-December 2020. The survey was online and on paper and available in 10 languages. RESULTS Over 80% of participants were comfortable with their health information being used across the scenarios presented (range: 81-89%). Māori were significantly more likely than non-Māori to be comfortable with their health information being combined with the health information of others to better understand population needs (p=0.006). The level of comfort with the use of individual health information was related to assurances that its use was for public good, data were stored securely, individual privacy was maintained, the information was accurate and there was communication on how it was used. DISCUSSION This study has shown that most healthcare consumers are comfortable with the health service using their de-identified health information beyond their care if it benefits others.
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Affiliation(s)
- Rosie Dobson
- National Institute for Health Innovation, University of Auckland
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland; Waitematā District Health Board
| | - Helen Wihongi
- Waitematā District Health Board; Auckland District Health Board
| | | | | | | | - Andrew Sporle
- Department of Statistics, University of Auckland; iNZIght Analytics Ltd, Auckland
| | - Susan Wells
- ProCare Health Limited; Epidemiology and Biostatistics, School of Population Health, University of Auckland
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16
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Abstract
This article reflects on current trends and proposes new considerations for the future of mobile technologies for health (mHealth). Our focus is predominantly on the value of and concerns with regard to the application of digital health within low- and middle-income countries (LMICs). It is in LMICs and marginalized communities that mHealth (within the wider scope of digital health) could be most useful and valuable. Peer-reviewed literature on mHealth in LMICs provides reassurance of this potential, often reflecting on the ubiquity of mobile phones and ever-increasing connectivity globally, reaching remote or otherwise disengaged populations. Efforts to adapt successful programs for LMIC contexts and populations are only just starting to reap rewards. Private-sector investment in mHealth offers value through enhanced capacity and advances in technology as well as the ability to meet increasing consumer demand for real-time, accessible, convenient, and choice-driven health care options. We examine some of the potential considerations associated with a private-sector investment, questioning whether a core of transparency, local ownership, equity, and safety are likely to be upheld in the current environment of health entrepreneurship. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Judith McCool
- School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand;
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.,i3 Institute for Innovation and Improvement, Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Information Science, University of Otago, Dunedin, New Zealand
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17
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Ringi T, Aumea Herman J, Tairi M, Dobson R, Nosa V, Whittaker R, McCool J. Takore i te Kai Ava'ava (Quit smoking), a mCessation Program Adapted for the Cook Islands: Indicators of Potential for Tobacco Control. Asia Pac J Public Health 2021; 33:714-720. [PMID: 34486410 DOI: 10.1177/10105395211036267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022]
Abstract
Mobile phone-based smoking cessation interventions (mCessation) are an established evidence-based intervention designed to support smokers to quit. Evidence of impact to date is modestly positive but skewed in favor of high-resourced countries, with less evidence of value added to low-resourced settings. Takore i te Kai Ava'ava, a text message-based smoking cessation program, was delivered to smokers living on the island of Rarotonga in 2019. Eighty-eight smokers consented to take part. Participants completed a baseline questionnaire about current smoking behavior and previous quit attempts; follow-up measures at 2 months assess quit attempts feedback on the program. Thirty-two people completed the follow-up interviews; 10 (31%) had not smoked in the past 7 days, 23 (72%) reported a serious quit attempt, and 29 (91%) felt the program was effective for the Cook Islands. Takore i te Kai Ava'ava was deemed to be highly acceptable and potentially cost-effective.
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Affiliation(s)
- Teinatangi Ringi
- Te Marae Ora Ministry of Health Cook Islands, Rarotonga, Cook Islands
| | | | - Maina Tairi
- Te Marae Ora Ministry of Health Cook Islands, Rarotonga, Cook Islands
| | | | - Vili Nosa
- University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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18
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Maddison R, Jiang Y, Stewart R, Scott T, Kerr A, Whittaker R, Benatar J, Rolleston A, Estabrooks P, Dale L. An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e24952. [PMID: 34106081 PMCID: PMC8262599 DOI: 10.2196/24952] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/09/2020] [Accepted: 05/03/2021] [Indexed: 12/11/2022] Open
Abstract
Background Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records
were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2468-z
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Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Yannan Jiang
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Ralph Stewart
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Tony Scott
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - Andrew Kerr
- Section of Epidemiology and Biostatistics and School of Medicine, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Jocelyn Benatar
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | | | - Paul Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Centre, Nebraska, NE, United States
| | - Leila Dale
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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19
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Umali E, Tanielu H, Whittaker R, Sugden C, McCool J. I Keep Looking at What I'm Doing to My Organs: Samoans' Responses to Adapted Anti-Tobacco Television Advertisements. Asia Pac J Public Health 2021; 33:721-726. [PMID: 34075787 DOI: 10.1177/10105395211020920] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There has been an increase of adapted tobacco control media campaigns in low- and middle-income countries. Adapting existing material offers many benefits especially to countries with limited resources. We adapted 3 television advertisements for the Tu'u Nei Loa Le Ulaula Tapa'a (Stop Smoking Now) campaign in Samoa. Adaption included rigorous efforts to ensure advertisements were culturally appropriate. To determine audiences' perception of anti-tobacco television advertisements to promote smoking cessation, we conducted 8 talanoa, a Pacific Islands research methodology, among 54 smokers and nonsmokers in Apia, Samoa. The talanoa were transcribed, translated, and thematically coded. Results suggest that the advertisements raised awareness on the negative health impacts of tobacco use, especially to the internal organs. Graphic and emotionally evocative advertisements, especially those that have an impact on the family, have greater potential to motivate Samoans to quit.
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Affiliation(s)
| | | | | | - Cam Sugden
- The University of Sydney, Sydney, New South Wales, Australia
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20
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Whittaker R, Dobson R, Candy S, Tane T, Burrowes K, Reeve J, Tawhai M, Taylor D, Robertson T, Garrett J, Humphrey G, Brott T, Khan SR, Hu F, Warren J. Mobile Pulmonary Rehabilitation: Feasibility of Delivery by a Mobile Phone-Based Program. Front Comput Sci 2021. [DOI: 10.3389/fcomp.2021.546960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary rehabilitation (PR) has been proven effective but is not well accessed due to transport, time, cost, and physical limitations of patients. We have developed a mobile phone-based PR program (mPR) that could be offered as an alternative for those unable to attend in-person. This was developed following formative research with patients, their families and clinicians. mPR has a core text message program plus an app that includes an action plan, exercise videos, lung visualization, symptom score questionnaire and 1-min sit-to-stand test.Aims: To determine the feasibility of delivering pulmonary rehabilitation by mobile phone.Methods: A 9-week non-randomized (1-arm) pilot study was conducted. Participants were 26 adults with chronic obstructive pulmonary disease plus four family members, who were offered participation at first assessment or during group PR sessions. Outcomes included satisfaction, engagement with the program, and perceived impacts.Results: Eight people (31%) opted for text messages only, and 18 (69%) chose text messages plus the app. Three people stopped the program early, 20 said they would recommend it to others, 19 said it helped them to feel more supported, 17 said it helped them to change their behavior.Conclusion: It is feasible to deliver PR support via mobile phone, including exercise prescription and support. Our mPR program was appreciated by a small number of people with chronic respiratory disorders and family members. Suggestions for improvements are being used to inform the further development of the program, which will then be tested for effectiveness. Registered with the Australia New Zealand Clinical Trials Registry ACTRN12619000884101 (www.anzctr.org.au).
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21
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Matenga-Ikihele A, McCool J, Dobson R, Fa'alau F, Whittaker R. The characteristics of behaviour change interventions used among Pacific people: a systematic search and narrative synthesis. BMC Public Health 2021; 21:435. [PMID: 33663438 PMCID: PMC7931368 DOI: 10.1186/s12889-021-10420-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/06/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people. Methods Electronic searches were carried out on OVID Medline, PsycINFO, PubMed, Embase and SCOPUS databases (initial search January 2019 and updated in January 2020) for studies describing an intervention designed to change health behaviour(s) among Pacific people. Titles and abstracts of 5699 papers were screened; 201 papers were then independently assessed. A review of full text was carried out by three of the authors resulting in 208 being included in the final review. Twenty-seven studies were included, published in six countries between 1996 and 2020. Results Important characteristics in the interventions included meaningful partnerships with Pacific communities using community-based participatory research and ensuring interventions were culturally anchored and centred on collectivism using family or social support. Most interventions used social cognitive theory, followed by popular behaviour change techniques instruction on how to perform a behaviour and social support (unspecified). Negotiating the spaces between Eurocentric behaviour change constructs and Pacific worldviews was simplified using Pacific facilitators and talanoa. This relational approach provided an essential link between academia and Pacific communities. Conclusions This systematic search and narrative synthesis provides new and important insights into potential elements and components when designing behaviour change interventions for Pacific people. The paucity of literature available outside of the United States highlights further research is required to reflect Pacific communities living in New Zealand, Australia, and the Pacific region. Future research needs to invest in building research capacity within Pacific communities, centering self-determining research agendas and findings to be led and owned by Pacific communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10420-9.
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Affiliation(s)
- Amio Matenga-Ikihele
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. .,Moana Research, Nga Hau Māngere Birthing Centre, 14 Waddon Place, Auckland, Māngere, New Zealand.
| | - Judith McCool
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Fuafiva Fa'alau
- Pacific Health Section, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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22
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Whittaker R, Dobson R, Hopley L, Armstrong D, Corning-Davis B, Andrew P. Training clinicians to lead clinical IT projects. N Z Med J 2020; 133:116-122. [PMID: 33332334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Across New Zealand, a huge programme of work is being initiated to improve the health information systems of our sector. The goals of this plan are to address major risks and issues such as cybersecurity and our inability to securely share health data across organisations for clinical care. To fulfil the promise of planned health IT initiatives, we must involve clinicians of all disciplines to help lead, design and implement projects. However, there is currently little pragmatic training available for clinicians to learn how to do so. In 2019, Waitematā District Health Board and the National Institute for Health Innovation developed and delivered a 'hands-on' Clinical Digital Academy training programme for multidisciplinary clinicians. This paper describes the programme, the initial cohort's evaluation feedback and recommendations for the future.
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Affiliation(s)
- Robyn Whittaker
- Associate Professor and Public Health Physician, i3, Waitematā DHB, Auckland, New Zealand, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- Health Psychologist and Research Fellow, National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Lara Hopley
- Clinical Advisor Digital Innovations and Anaesthetist, Waitematā DHB, Auckland, New Zealand
| | | | | | - Penny Andrew
- Director, i3, Waitematā DHB, Auckland, New Zealand
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23
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McCool J, Dobson R, Muinga N, Paton C, Pagliari C, Agawal S, Labrique A, Tanielu H, Whittaker R. Factors influencing the sustainability of digital health interventions in low-resource settings: Lessons from five countries. J Glob Health 2020; 10:020396. [PMID: 33274059 PMCID: PMC7696238 DOI: 10.7189/jogh.10.020396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Judith McCool
- School of Population Health, University of Auckland, New Zealand
| | - Rosie Dobson
- National Institute of Health Innovation, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - Naomi Muinga
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, England
| | - Claudia Pagliari
- The Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Smisha Agawal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health / JHU Global mHealth Initiative, Baltimore, Maryland, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health / JHU Global mHealth Initiative, Baltimore, Maryland, USA
| | | | - Robyn Whittaker
- National Institute of Health Innovation, Faculty of Medical and Health Science, University of Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
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24
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Firestone R, Cheng S, Dalhousie S, Hughes E, Funaki T, Henry A, Vano M, Grey J, Schumacher J, Jull A, Whittaker R, Te Morenga L, Mhurchu CN. Exploring Pasifika wellbeing: findings from a large cluster randomised controlled trial of a mobile health intervention programme. N Z Med J 2020; 133:82-101. [PMID: 33119572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM The primary objective of this study was to determine the effect of a mobile health (mHealth) intervention on the wellbeing of Pasifika peoples, and to explore factors associated with Pasifika wellbeing. METHODS The OL@-OR@ mHealth programme was a co-designed smartphone app. Culturally relevant data was collected to examine holistic health and wellbeing status, at baseline, and at 12 weeks (end of the trial). The concept of wellbeing was examined as part of a two-arm, cluster randomised trial, using only the Pasifika data: 389 (of 726) Pasifika adults were randomised to receive the mHealth intervention, while 405 (of 725) Pasifika adults were randomised to receive a control version of the intervention. Culturally relevant data was collected to examine holistic health and wellbeing status, at baseline, and at 12 weeks (end of the trial). The intervention effects and the association of demographic and behavioural relationships with wellbeing, was examined using logistic regression analyses. RESULTS Relative to baseline, there were significant differences between the intervention and control groups for the 'family/community' wellbeing, at the end of the 12-week trial. There were no significant differences observed for all other wellbeing domains for both groups. Based on our multivariate regression analyses, education and acculturation (assimilation and marginalisation) were identified as positively strong factors associated to Pasifika 'family and community' wellbeing. CONCLUSION Our study provides new insights on how Pasifika peoples' characteristics and behaviours align to wellbeing. Our findings point to 'family and community' as being the most important wellbeing factor for Pasifika peoples.
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Affiliation(s)
- Ridvan Firestone
- Senior Research Officer/Co-Principal Investigator, Centre for Public Health Research, Massey University, Wellington
| | - Soo Cheng
- Biostatistician, Centre for Public Health Research, Massey University, Wellington
| | | | | | - Tevita Funaki
- Chief Executive, Community Partner, The Fono, Auckland
| | - Akarere Henry
- Chief Executive, Community Partner, South Waikato Pacific Islands Community Services, Tokoroa
| | - Mereaumate Vano
- Community Coordinator, South Waikato Pacific Islands Community Services, Tokoroa
| | - Jacqui Grey
- Project Manager, National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland
| | - Jodie Schumacher
- Project Coordinator, National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland
| | - Andrew Jull
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland; School of Nursing, University of Auckland, Auckland
| | - Robyn Whittaker
- Associate Professor, School of Nursing, University of Auckland, Auckland
| | - Lisa Te Morenga
- Senior Lecturer/Co-Principal Investigator, School of Health, Faculty of Health, Victoria University of Wellington, Wellington
| | - Cliona Ni Mhurchu
- Professor/Co-Principal Investigator, National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland
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25
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Chen J, Ho E, Jiang Y, Whittaker R, Yang T, Bullen C. Mobile Social Network-Based Smoking Cessation Intervention for Chinese Male Smokers: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17522. [PMID: 33095184 PMCID: PMC7647814 DOI: 10.2196/17522] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023] Open
Abstract
Background Around 2 million Chinese people, mostly men, die annually from tobacco-related diseases; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation support. Objective This study aimed to test the preliminary effectiveness and feasibility for a mobile social network (WeChat)–based smoking cessation intervention (SCAMPI program) among Chinese male smokers. Methods Chinese male smokers aged 25-44 years were recruited online from WeChat, the most widely used social media platform in China. Individuals using other smoking cessation interventions or who lacked capacity to provide online informed consent were excluded. Participants were randomly assigned (1:1) to intervention or control groups. Neither participants nor researchers were masked to assignment. The trial was fully online. All data were collected via WeChat. The intervention group received access to the full-version SCAMPI program, a Chinese-language smoking cessation program based on the Behaviour Change Wheel framework and relevant cessation guidelines. Specific intervention functions used in the program include: planning to help users make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, information about smoking harms, motivational messages to help users overcome urges, standardized tests for users to assess their levels of nicotine dependence and lung health, as well as a social platform to encourage social support between users. The control group had access to a static WeChat page of contacts for standard smoking cessation care. Both groups received incentive credit payments for participating. The primary outcome was 30-day biochemically verified smoking abstinence at 6 weeks after randomization, with missing data treated as not quitting. Secondary outcomes were other smoking status measures, reduction of cigarette consumption, study feasibility (recruitment and retention rate), and acceptability of and satisfaction with the program. Results The program recorded 5736 visitors over a 13-day recruitment period. We recruited 80 participants who were randomly allocated to two arms (n=40 per arm). At 6 weeks, 36 of 40 (90%) intervention participants and 35 of 40 (88%) control participants provided complete self-reported data on their daily smoking status via WeChat. Biochemically verified smoking abstinence at 6 weeks was determined for 10 of 40 (25%) intervention participants and 2 of 40 (5%) control participants (RR=5, 95% CI 1.2-21.4, P=.03). In the intervention group, the calculator function, motivational messages, and health tests were underused (less than once per week per users). Participants rated their satisfaction with the intervention program as 4.56 out of 5.00. Conclusions Our program is a novel, accessible, and acceptable smoking cessation intervention for Chinese male smokers. A future trial with a greater sample size and longer follow-up will identify if it is as effective as these preliminary data suggest. Trial Registration ANZCTR registry, ACTRN12618001089224; https://tinyurl.com/y536n7sx International Registered Report Identifier (IRRID) RR2-18071
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Affiliation(s)
- Jinsong Chen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Elsie Ho
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tingzhong Yang
- Centre for Tobacco Control Research, Zhejiang University, Hangzhou, China
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Chen J, Ho E, Jiang Y, Whittaker R, Yang T, Bullen C. A Mobile Social Network-Based Smoking Cessation Intervention for Chinese Male Smokers: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18071. [PMID: 32945261 PMCID: PMC7532454 DOI: 10.2196/18071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/29/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 2 million Chinese people die annually from tobacco-related diseases, mostly men; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation advice or support. A social network–based gamified smoking cessation intervention (SCAMPI: Smoking Cessation App for Chinese Male: Pilot Intervention) is designed to help Chinese male smokers to quit smoking. Objective This paper aims to present the protocol of a study examining the preliminary effectiveness of SCAMPI by comparing the prolonged abstinence rate of a group of users with a comparator group during a 6-week follow-up period. Methods A two-arm pilot randomized controlled trial was conducted to assess the preliminary effectiveness and acceptability of the SCAMPI program as a smoking cessation intervention. After initial web-based screening, the first 80 eligible individuals who had gone through the required registration process were registered as participants of the trial. Participants were randomly allocated to the intervention group (n=40) and the control group (n=40). Participants in the intervention group used the full version of the SCAMPI program, which is a Chinese smoking cessation program developed based on the Behavior Change Wheel framework and relevant smoking cessation and design guidelines with involvement of target users. The program delivers a range of smoking cessation approaches, including helping users to make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, providing information about smoking harms, motivational messages to help users overcome urges, providing standardized tests to users for assessing their levels of nicotine dependence and lung health, and providing a platform to encourage social support between users. Participants in the control group used the restricted version of the SCAMPI program (placebo app). Results Recruitment for this project commenced in January 2019 and proceeded until March 2019. Follow-up data collection was commenced and completed by June 2019. The primary outcome measure of the study was the 30-day bio-verified smoking abstinence at the 6-week follow-up (self-reported data verified by the Nicotine Cotinine Saliva Test). The secondary outcome measures of the study included participants’ cigarette consumption reduction (compared baseline daily cigarette consumption with end-of-trial daily cigarette consumption), participants’ 7-day smoking abstinence at 4-week and 6-week follow-up (self-reported), participants’ 30-day smoking abstinence at 6-week follow-up (self-reported data only), and participants’ acceptability and satisfaction levels of using the SCAMPI program (measured by the Mobile App Rating Scale questionnaire). Conclusions If the SCAMPI program is shown to be preliminary effective, the study will be rolled out to be a future trial with a larger sample size and longer follow-up (6 months) to identify if it is an effective social network–based tool to support Chinese male smokers to quit smoking. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618001089224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375381 International Registered Report Identifier (IRRID) RR1-10.2196/18071
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Affiliation(s)
- Jinsong Chen
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Elsie Ho
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Tingzhong Yang
- Centre for Tobacco Control Research, School of Medicine, The Zhejiang University, Hangzhou, China
| | - Christopher Bullen
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
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Graham AL, Papandonatos GD, Jacobs MA, Amato MS, Cha S, Cohn AM, Abroms LC, Whittaker R. Correction: Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment. J Med Internet Res 2020; 22:e21027. [PMID: 32721924 PMCID: PMC7420627 DOI: 10.2196/21027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | | | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Baig MM, Hua N, Zhang E, Robinson R, Armstrong D, Whittaker R, Robinson T, Mirza F, Ullah E. Machine Learning-based Risk of Hospital Readmissions: Predicting Acute Readmissions within 30 Days of Discharge. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2178-2181. [PMID: 31946333 DOI: 10.1109/embc.2019.8856646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this study was to design and develop a 30-day risk of hospital readmission predictive model using machine learning techniques. The proposed risk of readmission predictive model was then validated with the two most commonly used risk of readmission models - LACE index and patient at-risk of hospital readmission (PARR). The study cohort consisted of 180,118 admissions with 22565 (12.5%) of actual readmissions within 30-day of hospital discharge, from 01 Jan 2015 to 31 Dec 2016 from two Auckland-region hospitals. We developed a machine learning model to predict 30-day readmissions using the model types: XGBoost, Random Forests and Adaboost with decision stumps as a base learner with different feature combinations and preprocessing procedures. The proposed model achieved the F1-score (0.386 ± 0.006), sensitivity (0.598 ± 0.013), positive predictive value (PPV) (0.285 ± 0.004) and negative predictive value (NPV) (0.932 ± 0.002). When compared with LACE and PARR (NZ) models, the proposed model achieved better F1-score by 12.5% compared to LACE and 22.9% compared to PARR (NZ). The mean sensitivity of the proposed model was 6.0% higher than LACE and 42.4% higher than PARR (NZ). The mean PPV was 15.9% and 13.5% higher than LACE and PARR (NZ) respectively.
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Graham AL, Papandonatos GD, Jacobs MA, Amato MS, Cha S, Cohn AM, Abroms LC, Whittaker R. Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment. J Med Internet Res 2020; 22:e17734. [PMID: 32238338 PMCID: PMC7386536 DOI: 10.2196/17734] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. OBJECTIVE This study examined the impact of 4 experimental text message design factors on adult smokers' engagement with an internet smoking cessation program. METHODS We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were personalization (on/off), integration between the web and text message platforms (on/off), dynamic tailoring of intervention content based on user engagement (on/off), and message intensity (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. RESULTS Main effects were detected for integration and dynamic tailoring. Integration significantly increased interactive feature use by participants, whereas dynamic tailoring increased the number of features used and page views. No main effects were found for message intensity or personalization alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD >0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. CONCLUSIONS This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. TRIAL REGISTRATION ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2015-010687.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | | | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Direito A, Tooley M, Hinbarji M, Albatal R, Jiang Y, Whittaker R, Maddison R. Tailored Daily Activity: An Adaptive Physical Activity Smartphone Intervention. Telemed J E Health 2020; 26:426-437. [DOI: 10.1089/tmj.2019.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Artur Direito
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Tooley
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Moohamad Hinbarji
- The Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Rami Albatal
- The Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
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Dobson R, Whittaker R, Jiang Y, McNamara C, Shepherd M, Maddison R, Cutfield R, Khanolkar M, Murphy R. Long-term follow-up of a randomized controlled trial of a text-message diabetes self-management support programme, SMS4BG. Diabet Med 2020; 37:311-318. [PMID: 31722130 PMCID: PMC7004024 DOI: 10.1111/dme.14182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 01/03/2023]
Abstract
AIMS To determine the long-term effectiveness of an individually tailored text-message diabetes self-management support programme, SMS4BG, on glycaemic control at 2 years in adults with diabetes with an HbA1c concentration > 64 mmol/mol (8%). METHODS We conducted a 2-year follow-up of a two-arm, parallel, randomized controlled trial across health services in New Zealand. Participants were English-speaking adults with type 1 or 2 diabetes and with an HbA1c >64 mmol/mol (8%). In the main trial participants randomized to the intervention group (N=183) received up to 9 months of an automated tailored text-message programme in addition to usual care. Participants in the control group (N=183) received usual care for 9 months. In this follow-up study, 293 (80%) of 366 randomized participants in the main trial were included. The primary outcome measure was change in glycaemic control (HbA1c ) from baseline to 2 years. Mixed-effect models were used to compare the group differences at 3, 6, 9 and 24 months, adjusted for baseline HbA1c and stratification factors (health district category, diabetes type and ethnicity). RESULTS The decrease in HbA1c at 2 years was significantly greater in the intervention group [mean (sd) -10 (18) mmol/mol or -0.9 (1.6)%] compared with the control group [mean (sd) -1 (20) mmol/mol or -0.1 (1.8)%], with an adjusted mean difference of -9 mmol/mol (95% CI -14, -5) or -0.8% (95% CI -1.2, -0.4; P<0.0001). CONCLUSIONS Improvements in glycaemic control resulting from a text-message diabetes self-management support programme were sustained at 2 years after randomization. These findings support the implementation of SMS4BG in current practice.
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Affiliation(s)
- R. Dobson
- National Institute for Health InnovationSchool of Population HealthUniversity of AucklandAucklandNew Zealand
| | - R. Whittaker
- National Institute for Health InnovationSchool of Population HealthUniversity of AucklandAucklandNew Zealand
- Waitematā District Health BoardAucklandNew Zealand
| | - Y. Jiang
- National Institute for Health InnovationSchool of Population HealthUniversity of AucklandAucklandNew Zealand
| | - C. McNamara
- Waitematā District Health BoardAucklandNew Zealand
| | - M. Shepherd
- School of PsychologyMassey UniversityAucklandNew Zealand
| | - R. Maddison
- Institute for Physical Activity and NutritionDeakin UniversityBurwoodVic.Australia
| | - R. Cutfield
- Waitematā District Health BoardAucklandNew Zealand
| | - M. Khanolkar
- Auckland District Health BoardAucklandNew Zealand
| | - R. Murphy
- Auckland District Health BoardAucklandNew Zealand
- School of MedicineFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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Kool B, Dobson R, Sharpe S, Humphrey G, Whittaker R, Ameratunga S. A Web-Based Alcohol Risk Communication Tool: Development and Pretesting Study. JMIR Form Res 2020; 4:e13224. [PMID: 31895043 PMCID: PMC6966553 DOI: 10.2196/13224] [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: 12/21/2018] [Revised: 05/05/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background
Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI).
Objective
This study aimed to develop a prototype for a Web-based tool for use by primary care health professionals (eg, doctors and nurses) to communicate alcohol harm risk to their patients and to engage with them regarding ways this risk could be reduced.
Methods
Following conceptualization and development of prototype wireframes, formative work and pretesting were undertaken. For the formative work, focus groups and key informant interviews were conducted with potential end users of the risk communication tool, including health professionals and consumers. The focus groups and interviews explored perceptions of alcohol risk communication and obtained feedback on the initial prototype. For pretesting, participants (primary care doctors and nurses) completed a Web-based survey followed by a period of pretesting before completion of a follow-up survey. The study was designed to gain feedback on the tool’s performance in real-world settings as well as its relevance, ease of use, and any suggested refinements.
Results
In the formative work stage, 11 key informants and 7 consumers participated in either focus groups or individual interviews. Participants were very positive about the prototype and believed that it would be useful and acceptable in practice. Key informants identified that the key point of difference with the tool was that it provided all the pieces in 1 place (ie, assessment, interpretation, and resources to support change). Participants provided feedback on how the tool could be improved, and these suggestions were incorporated into the prototype where possible. In the pretesting stage, 7 people (5 doctors and 2 primary care nurses) completed the pretesting. Participants reported that the tool provided a useful framework for an intervention, that it would be acceptable to patients, that it was easy to use, that they would be likely to use it in practice, and that there were no technical issues.
Conclusions
The alcohol risk communication tool was found to be acceptable and has the potential to increase the confidence of health professionals in assessing risk and providing BI.
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Affiliation(s)
- Bridget Kool
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Gayl Humphrey
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Dobson R, Herbst P, Candy S, Brott T, Garrett J, Humphrey G, Reeve J, Tawhai M, Taylor D, Warren J, Whittaker R. Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews. JMIR Form Res 2019; 3:e15466. [PMID: 31859681 PMCID: PMC6942186 DOI: 10.2196/15466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. OBJECTIVE The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. METHODS A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. RESULTS Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. CONCLUSIONS These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population.
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Affiliation(s)
- Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Sarah Candy
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Tamzin Brott
- Waitemata District Health Board, Auckland, New Zealand
| | - Jeffrey Garrett
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Gayl Humphrey
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Julie Reeve
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Merryn Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Denise Taylor
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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Willcox JC, Dobson R, Whittaker R. Old-Fashioned Technology in the Era of "Bling": Is There a Future for Text Messaging in Health Care? J Med Internet Res 2019; 21:e16630. [PMID: 31859678 PMCID: PMC6942182 DOI: 10.2196/16630] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/20/2023] Open
Abstract
In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more "technologically advanced" systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model.
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Affiliation(s)
- Jane C Willcox
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
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Chu JTW, Wadham A, Jiang Y, Whittaker R, Stasiak K, Shepherd M, Bullen C. Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e15664. [PMID: 31746767 PMCID: PMC6893562 DOI: 10.2196/15664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/02/2022] Open
Abstract
Background Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen—an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). Objective The aim of this qualitative study was to explore parents and/or primary caregivers’ perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. Methods A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. Results Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. Conclusions Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents.
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Affiliation(s)
- Joanna Ting Wai Chu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Angela Wadham
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Christopher Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Sharpe S, Kool B, Whittaker R, Ameratunga S. Hawthorne effect in the YourCall trial suggested by participants’ qualitative responses. J Clin Epidemiol 2019; 115:177-179. [DOI: 10.1016/j.jclinepi.2019.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012. OBJECTIVES To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018. SELECTION CRITERIA Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up. DATA COLLECTION AND ANALYSIS We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only. MAIN RESULTS This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.
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Affiliation(s)
- Robyn Whittaker
- University of AucklandNational Institute for Health InnovationTamaki CampusPrivate Bag 92019AucklandNew Zealand1142
| | - Hayden McRobbie
- University of New South WalesNational Drug and Alcohol Research Centre22‐32 King Street,RandwickSydneyAustralia
| | - Chris Bullen
- University of AucklandNational Institute for Health InnovationTamaki CampusPrivate Bag 92019AucklandNew Zealand1142
| | - Anthony Rodgers
- The George Institute for Public Health321 Kent StreetSydneyAustraliaNSW 2000
| | - Yulong Gu
- Stockton UniversitySchool of Health SciencesGallowayNew JerseyUSA
| | - Rosie Dobson
- University of AucklandNational Institute for Health InnovationTamaki CampusPrivate Bag 92019AucklandNew Zealand1142
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Shariful Islam SM, Farmer AJ, Bobrow K, Maddison R, Whittaker R, Pfaeffli Dale LA, Lechner A, Lear S, Eapen Z, Niessen LW, Santo K, Stepien S, Redfern J, Rodgers A, Chow CK. Mobile phone text-messaging interventions aimed to prevent cardiovascular diseases (Text2PreventCVD): systematic review and individual patient data meta-analysis. Open Heart 2019; 6:e001017. [PMID: 31673381 PMCID: PMC6802999 DOI: 10.1136/openhrt-2019-001017] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background A variety of small mobile phone text-messaging interventions have indicated improvement in risk factors for cardiovascular disease (CVD). Yet the extent of this improvement and whether it impacts multiple risk factors together is uncertain. We aimed to conduct a systematic review and individual patient data (IPD) meta-analysis to investigate the effects of text-messaging interventions for CVD prevention. Methods Electronic databases were searched to identify trials investigating a text-messaging intervention focusing on CVD prevention with the potential to modify at least two CVD risk factors in adults. The main outcome was blood pressure (BP). We conducted standard and IPD meta-analysis on pooled data. We accounted for clustering of patients within studies and the primary analysis used random-effects models. Sensitivity and subgroup analyses were performed. Results Nine trials were included in the systematic review involving 3779 participants and 5 (n=2612) contributed data to the IPD meta-analysis. Standard meta-analysis showed that the weighted mean differences are as follows: systolic blood pressure (SBP), −4.13 mm Hg (95% CI −11.07 to 2.81, p<0.0001); diastolic blood pressure (DBP), −1.11 mm Hg (−1.91 to −0.31, p=0.002); and body mass index (BMI), −0.32 (−0.49 to −0.16, p=0.000). In the IPD meta-analysis, the mean difference are as follows: SBP, −1.3 mm Hg (−5.4 to 2.7, p=0.5236); DBP, −0.8 mm Hg (−2.5 to 1.0, p=0.3912); and BMI, −0.2 (−0.8 to 0.4, p=0.5200) in the random-effects model. The impact on other risk factors is described, but there were insufficient data to conduct meta-analyses. Conclusion Mobile phone text-messaging interventions have modest impacts on BP and BMI. Simultaneous but small impacts on multiple risk factors are likely to be clinically relevant and improve outcome, but there are currently insufficient data in pooled analyses to examine the extent to which simultaneous reduction in multiple risk factors occurs. PROSPERO registration number CRD42016033236.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Kirsten Bobrow
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Robyn Whittaker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | | | - Andreas Lechner
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximillian Universität, Munich, Germany
| | - Scott Lear
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Zubin Eapen
- Department of Medicine, Duke University, Durham, North California, United States
| | - Louis Wilhelmus Niessen
- Faculty of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Karla Santo
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandrine Stepien
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Julie Redfern
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- Professorial Unit, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Clara K Chow
- Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Affiliation(s)
- Ted Adams
- Southport and Ormskirk NHS Trust, Wigan Road, Ormskirk, Lancashire L39 2AZ UK
| | - Matthew Connor
- St Helens and Knowsley Health Informatics Service, Pavilion Building, Alexandra Business Park, St. Helens, WA10 3TP UK
| | - Robyn Whittaker
- Health Informatics & Technology, School of Population Health, The University of Auckland, Auckland, 1142 New Zealand
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Ni Mhurchu C, Te Morenga L, Tupai-Firestone R, Grey J, Jiang Y, Jull A, Whittaker R, Dobson R, Dalhousie S, Funaki T, Hughes E, Henry A, Lyndon-Tonga L, Pekepo C, Penetito-Hemara D, Tunks M, Verbiest M, Humphrey G, Schumacher J, Goodwin D. A co-designed mHealth programme to support healthy lifestyles in Māori and Pasifika peoples in New Zealand (OL@-OR@): a cluster-randomised controlled trial. The Lancet Digital Health 2019; 1:e298-e307. [DOI: 10.1016/s2589-7500(19)30130-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/23/2022]
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Tanielu H, McCool J, Umali E, Whittaker R. Samoan Smokers Talk About Smoking and Quitting: A Focus Group Study. Nicotine Tob Res 2019; 20:1132-1137. [PMID: 28673031 DOI: 10.1093/ntr/ntx152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/28/2017] [Indexed: 11/12/2022]
Abstract
Introduction Samoa, like other Pacific Island countries, faces a persistent challenge to reduce smoking use with relatively limited resources. As a signatory to the WHO FCTC, Samoa is obligated to introduce measures to reduce tobacco use and is currently trialing a text message smoking cessation programme (mCessation) to achieve this outcome. Cigarettes remain relatively cheap and are widely available, but little is known about how smoking is initiated or why and how people quit smoking in the Samoa. Methods Six focus groups with smokers and ex-smokers were conducted in Apia, Samoa. Groups were homogenous according to age, gender and smoking status. Focus groups were conducted in Samoan and transcribed and translated to English for analysis. Results Smoking is initiated most commonly in late teens and early twenties and most frequently in (non-family) social contexts. Smoking reflects a widely held (mis)perceptions of tangible benefits, including aiding feelings of strength and energy, relief from indigestion and as a means to accelerate the effects of alcohol. Smoking was deeply connected to social life in Samoa among friends and for some, with family members. Drivers to quit originate out of concern regarding health effects, concern for family and the costs of purchasing tobacco. Conclusions Smoking is well entrenched in Samoan society; efforts to reduce smoking need to be based on implicit understanding of Samoan cultural norms and priorities around family, social networks and culture. Efforts to support quitting are important, alongside other well validated measures to reverse the trajectory of smoking related disease. Implications This study offers an insight into smoking as a behavior and as cultural practice perceived by smokers and non-smokers in Samoa. A thorough understanding of smoking behaviors and cessation patterns is critical in efforts to reduce smoking especially in resource-limited settings. The results from this study was used to inform the development of a Samoan mHealth smoking cessation programme.
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Affiliation(s)
| | - Judith McCool
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Elaine Umali
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, University of Auckland, New Zealand
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Chu JTW, Wadham A, Jiang Y, Whittaker R, Stasiak K, Shepherd M, Bullen C. Effect of MyTeen SMS-Based Mobile Intervention for Parents of Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1911120. [PMID: 31509210 PMCID: PMC6739724 DOI: 10.1001/jamanetworkopen.2019.11120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022] Open
Abstract
Importance There is global pressure to respond to the burden posed by adolescent mental health problems. The National Mental Health Commission has made a call for investment in mobile health services directed at prevention and early intervention to relieve the demand on targeted mental health services that are costly to provide. Parents and primary caregivers play a significant role in the lives of adolescents and are important targets for such efforts. Currently, there is no evidence for the effectiveness of programs delivered solely via text message for parents of adolescents. Objective To evaluate the effects of a text-messaging program (MyTeen) on promoting parental competence and mental health literacy for parents of adolescents. Design, Setting, and Participants A parallel 2-group randomized clinical trial was conducted in New Zealand. A total of 221 parents and primary caregivers of adolescents aged 10 to 15 years were recruited from March 19 to August 17, 2018, via community outreach and social media and were randomly allocated 1:1 into the control or the intervention group. Statistical analysis was performed on the principle of intention to treat with adjustment for baseline factors and ethnicity. Intervention A text-messaging program for parents of adolescents (age 10-15 years) to promote parental competence and mental health literacy. Participants received 1 daily text message over 4 weeks. Main Outcomes and Measures Parental competence, assessed at 1 month after randomization by the Parenting Sense of Competence Scale. Results In total, 221 participants (214 [96.8%] female) were randomized, 109 to the intervention group and 112 to the control group; 201 participants (91%) completed the trial at 3 months. Significant group difference was observed on the primary outcome at the end of 1 month of intervention, with participants reporting a higher level of parental competence than those in the control group (estimated mean difference, 3.33 points; 95% CI, 1.37-5.29 points; P = .002). Except for knowledge about mental health, all secondary outcomes were significant, including continued improvement in parental competence at 3 months (estimated mean difference, 4.08 points; 95% CI, 1.96-6.20 points; P < .001), knowledge of help seeking (estimated mean difference, 0.99 points; 95% CI, 0.49-1.50 points; P < .001), parental distress (estimated mean difference, -2.39 points; 95% CI, -4.37 to -0.40 points; P = .02), and parent-adolescent communication (estimated mean difference, 2.21 points; 95% CI, 0.48-3.95 points; P = .01), with participants in the intervention group reporting better parenting-related outcomes than the control group at 1 and 3 months after the intervention. Conclusions and Relevance This text-messaging program for parents of adolescents appears to be an effective and feasible way to facilitate the implementation and delivery of evidence-based information to populations that are not easily reached with other intervention modalities. The program can be easily scaled up for delivery as an early preventive intervention and may represent a less expensive option for service delivery. Trial Registration anzctr.org.au Identifier: ACTRN12618000117213.
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Affiliation(s)
- Joanna Ting Wai Chu
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Angela Wadham
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Chris Bullen
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Baig M, Hua N, Zhang E, Robinson R, Armstrong D, Whittaker R, Robinson T, Mirza F, Ullah E. Predicting Patients at Risk of 30-Day Unplanned Hospital Readmission. Stud Health Technol Inform 2019; 266:20-24. [PMID: 31397296 DOI: 10.3233/shti190767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We developed a machine learning model to predict 30-day readmissions using the model types; XGBoost, Random Forests and Adaboost with decision stumps as a base learner with different feature combinations and preprocessing procedures. The proposed model achieved the F1-score (0.386 ± 0.006), sensitivity (0.598 ± 0.013), positive predictive value (PPV) (0.285 ± 0.004) and negative predictive value (NPV) (0.932 ± 0.002). When compared with LACE and PARR (NZ) models, the proposed model achieved better F1-score by 12.5% compared to LACE and 22.9% compared to PARR (NZ). The mean sensitivity of the proposed model was 6.0% higher than LACE and 42.4% higher than PARR (NZ). The mean PPV was 15.9% and 13.5% higher than LACE and PARR (NZ) respectively.
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Affiliation(s)
| | | | | | | | | | | | - Tom Robinson
- North Shore Hospital, Waitemata District Health Board
| | | | - Ehsan Ullah
- Clinical Quality & Safety Service, Auckland City, Auckland District Health Board
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Whittaker R, Umali E, Tanielu H, McCool J. TXTTaofiTapaa: pilot trial of a Samoan mobile phone smoking cessation programme. Journal of Global Health Reports 2019. [DOI: 10.29392/joghr.3.e2019035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Sharpe S, Kool B, Whittaker R, Lee AC, Reid P, Civil I, Ameratunga S. Effect of a text message intervention on alcohol-related harms and behaviours: secondary outcomes of a randomised controlled trial. BMC Res Notes 2019; 12:267. [PMID: 31088559 PMCID: PMC6518739 DOI: 10.1186/s13104-019-4308-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/08/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Mobile Health approaches show promise as a delivery mode for alcohol screening and brief intervention. The 'YourCall' trial evaluated the effect of a low-intensity mobile phone text message brief intervention compared with usual care on hazardous drinking and alcohol-related harms among injured adults. This paper extends our previously published primary outcome analysis which revealed a significant reduction in hazardous drinking associated with the intervention at 3 months, with the effect maintained across 12 months follow-up. The objective of the current study was to evaluate the effect of the intervention on alcohol-related harms and troubles and help-seeking behaviours (secondary outcomes) at 12-months follow-up. RESULTS A parallel two-group, single-blind, randomised controlled trial was conducted in 598 injured inpatients aged 16-69 years identified as having medium-risk hazardous drinking. Logistic regression models applied to 12-month follow-up data showed no significant differences between intervention and control groups in self-reported alcohol-related harms and troubles and help-seeking behaviours. Although this text message intervention led to a significant reduction in hazardous alcohol consumption (previously published primary outcome), changes in self-reported alcohol-related harms and troubles and help seeking behaviours at 12-months follow up (secondary outcomes) were small and non-significant. TRIAL REGISTRATION ACTRN12612001220853. Retrospectively registered 19 November 2012.
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Affiliation(s)
- Sarah Sharpe
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, and Waitemata District Health Board, Auckland, New Zealand
| | - Arier C. Lee
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
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Ricci-Cabello I, Bobrow K, Islam SMS, Chow CK, Maddison R, Whittaker R, Farmer AJ. Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review. JMIR Mhealth Uhealth 2019; 7:e12191. [PMID: 30924790 PMCID: PMC6460311 DOI: 10.2196/12191] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/27/2018] [Accepted: 01/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Balearic Islands Health Research Institute, Palma de Mallorca, Spain.,Atención Primaria Mallorca, IB-Salut, Palma de Mallorca, Spain.,Ciber de Epidemiologia y Salud Publica, Madrid, Spain
| | - Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, South Africa.,Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Radcliffe Observatory Quarter, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Andrew J Farmer
- Radcliffe Observatory Quarter, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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McCool J, Dobson R, Whittaker R. Moving beyond the individual: mHealth tools for social change in low-resource settings. BMJ Glob Health 2018; 3:e001098. [PMID: 30498591 PMCID: PMC6254750 DOI: 10.1136/bmjgh-2018-001098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Judith McCool
- School of Population Health, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Warren I, Meads A, Whittaker R, Dobson R, Ameratunga S. Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver). JMIR Form Res 2018; 2:e25. [PMID: 30684435 PMCID: PMC6334699 DOI: 10.2196/formative.9660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/11/2018] [Accepted: 10/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness.
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Affiliation(s)
- Ian Warren
- Department of Computer Science, University of Auckland, Auckland, New Zealand
| | - Andrew Meads
- Department of Computer Science, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- Waitemata District Health Board, Auckland, New Zealand.,National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology & Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Verbiest MEA, Corrigan C, Dalhousie S, Firestone R, Funaki T, Goodwin D, Grey J, Henry A, Humphrey G, Jull A, Vano M, Pekepo C, Morenga LT, Whittaker R, Mhurchu CN. Using codesign to develop a culturally tailored, behavior change mHealth intervention for indigenous and other priority communities: A case study in New Zealand. Transl Behav Med 2018; 9:720-736. [DOI: 10.1093/tbm/iby093] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The obesity rate in New Zealand is one of the highest worldwide (31%), with highest rates among Māori (47%) and Pasifika (67%). Codesign was used to develop a culturally tailored, behavior change mHealth intervention for Māori and Pasifika in New Zealand. The purpose of this article is to provide an overview of the codesign methods and processes and describe how these were used to inform and build a theory-driven approach to the selection of behavioral determinants and change techniques. The codesign approach in this study was based on a partnership between Māori and Pasifika partners and an academic research team. This involved working with communities on opportunity identification, elucidation of needs and desires, knowledge generation, envisaging the mHealth tool, and prototype testing. Models of Māori and Pasifika holistic well-being and health promotion were the basis for identifying key content modules and were applied to relevant determinants of behavior change and theoretically based behavior change techniques from the Theoretical Domains Framework and Behavior Change Taxonomy, respectively. Three key content modules were identified: physical activity, family/whānau [extended family], and healthy eating. Other important themes included mental well-being/stress, connecting, motivation/support, and health literacy. Relevant behavioral determinants were selected, and 17 change techniques were mapped to these determinants. Community partners established that a smartphone app was the optimal vehicle for the intervention. Both Māori and Pasifika versions of the app were developed to ensure features and functionalities were culturally tailored and appealing to users. Codesign enabled and empowered users to tailor the intervention to their cultural needs. By using codesign and applying both ethnic-specific and Western theoretical frameworks of health and behavior change, the mHealth intervention is both evidence based and culturally tailored.
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Affiliation(s)
- Marjolein E A Verbiest
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
- Tranzo Scientific Centre for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | - Ridvan Firestone
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | | | - Debbie Goodwin
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Jacqui Grey
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Akarere Henry
- South Waikato Pacific Islands Community Services, Tokoroa, New Zealand
| | - Gayl Humphrey
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Andrew Jull
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Mereaumate Vano
- South Waikato Pacific Islands Community Services, Tokoroa, New Zealand
| | | | - Lisa Te Morenga
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
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Chu JTW, Whittaker R, Jiang Y, Wadham A, Stasiak K, Shepherd M, Bullen C. Evaluation of MyTeen - a SMS-based mobile intervention for parents of adolescents: a randomised controlled trial protocol. BMC Public Health 2018; 18:1203. [PMID: 30367613 PMCID: PMC6204020 DOI: 10.1186/s12889-018-6132-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents play an important role in the lives of adolescents and efforts aimed at strengthening parenting skills and increasing knowledge on adolescent development hold much promise to prevent and mitigate adolescent mental health problems. Innovative interventions that make use of technology-based platforms might be an effective and efficient way to deliver such support to parents. This protocol presents the design of a randomised controlled trial to investigate the effectiveness of a SMS-based mobile intervention (MyTeen) for parents of adolescents on promoting parental competence and mental health literacy. METHODS A parallel two-arm randomised controlled trial will be conducted in New Zealand, aiming to recruit 214 parents or primary caregivers of adolescents aged 10-15 years via community outreach and social media. Eligible participants will be allocated 1:1 into the control or the intervention group, stratified by ethnicity. The intervention group will receive a tailored programme of text messages aimed at improving their parental competence and mental health literacy, over 4 weeks. The control group (care-as-usual) will receive no intervention from the research team, but can access alternative services if they wish, and will be offered the intervention programme upon completion of a 3-month post-randomisation follow-up assessment. Data will be obtained at baseline, post intervention (1-month), and 3-month follow up. The primary outcome is parental competence assessed by the Parental Sense of Competence Scale at 1-month follow up. Secondary outcomes include: mental health literacy; knowledge of help-seeking; parental distress; parent-adolescent communication; and programme satisfaction. DISCUSSION To our knowledge this is the first randomised controlled trial on the effectiveness of delivering a parenting support intervention for parents of adolescents solely via a SMS-based mobile intervention. If effective, it could have great potential to reach and support parents of adolescents. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ( ACTRN12618000117213 ) Registered on 29/01/2018.
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Affiliation(s)
- Joanna Ting Wai Chu
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Angela Wadham
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew Shepherd
- School of Counselling, Human Services & Social Work School of Counselling, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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