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Hennebelle A, Ismail L, Materwala H, Al Kaabi J, Ranjan P, Janardhanan R. Secure and privacy-preserving automated machine learning operations into end-to-end integrated IoT-edge-artificial intelligence-blockchain monitoring system for diabetes mellitus prediction. Comput Struct Biotechnol J 2024; 23:212-233. [PMID: 38169966 PMCID: PMC10758733 DOI: 10.1016/j.csbj.2023.11.038] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Diabetes Mellitus, one of the leading causes of death worldwide, has no cure to date and can lead to severe health complications, such as retinopathy, limb amputation, cardiovascular diseases, and neuronal disease, if left untreated. Consequently, it becomes crucial to be able to monitor and predict the incidence of diabetes. Machine learning approaches have been proposed and evaluated in the literature for diabetes prediction. This paper proposes an IoT-edge-Artificial Intelligence (AI)-blockchain system for diabetes prediction based on risk factors. The proposed system is underpinned by blockchain to obtain a cohesive view of the risk factors data from patients across different hospitals and ensure security and privacy of the user's data. We provide a comparative analysis of different medical sensors, devices, and methods to measure and collect the risk factors values in the system. Numerical experiments and comparative analysis were carried out within our proposed system, using the most accurate random forest (RF) model, and the two most used state-of-the-art machine learning approaches, Logistic Regression (LR) and Support Vector Machine (SVM), using three real-life diabetes datasets. The results show that the proposed system predicts diabetes using RF with 4.57% more accuracy on average in comparison with the other models LR and SVM, with 2.87 times more execution time. Data balancing without feature selection does not show significant improvement. When using feature selection, the performance is improved by 1.14% for PIMA Indian and 0.02% for Sylhet datasets, while it is reduced by 0.89% for MIMIC III.
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Affiliation(s)
- Alain Hennebelle
- School of Computing and Information Systems, The University of Melbourne, Australia
| | - Leila Ismail
- School of Computing and Information Systems, The University of Melbourne, Australia
- Intelligent Distributed Computing and Systems Lab, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, United Arab Emirates
- National Water and Energy Center, United Arab Emirates University, United Arab Emirates
| | - Huned Materwala
- Intelligent Distributed Computing and Systems Lab, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, United Arab Emirates
- National Water and Energy Center, United Arab Emirates University, United Arab Emirates
| | - Juma Al Kaabi
- College of Medicine and Health Sciences, Department of Internal Medicine, United Arab Emirates University, United Arab Emirates
- Tawam and Mediclinic Hospitals, Al Ain, Abu Dhabi, United Arab Emirates
| | - Priya Ranjan
- School of Computer Science, Internet of Things Center of Excellence, University of Petroleum and Energy Studies, India
| | - Rajiv Janardhanan
- Faculty of Medical & Health Sciences, SRM Institute of Science & Technology, India
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Wu R, Calligan M, Son T, Rakhra H, de Lara E, Mariakakis A, Gershon AS. Impressions and Perceptions of a Smartphone and Smartwatch Self-Management Tool for Patients With COPD: A Qualitative Study. COPD 2024; 21:2277158. [PMID: 38348964 DOI: 10.1080/15412555.2023.2277158] [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: 06/19/2023] [Accepted: 10/25/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often do not seek care until they experience an exacerbation. Improving self-management for these patients may increase health-related quality of life and reduce hospitalizations. Patients are willing to use wearable technology for real-time data reporting and perceive mobile technology as potentially helpful in COPD management, but there are many barriers to the uptake of these technologies. OBJECTIVE We aimed to understand patients' experiences using a wearable and mobile app and identify areas for improvement. METHODS We conducted semi-structured interviews as part of a larger prospective cohort study wherein patients used a wearable and app for 6 months. We asked which features patients found accessible, acceptable and useful. RESULTS We completed 26 interviews. We summarized our research findings into four main themes: (1) information, support and reassurance, (2) barriers to adoption, (3) impact on communication with health care providers, and (4) opportunities for improvement. Most patients found the feedback received through the app to be reassuring and useful. Some patients experienced technical difficulties with the app and found the wearable to be uncomfortable. CONCLUSIONS Patients found a wearable device and mobile application to be acceptable and useful for the management of COPD. We identified barriers to adoption and opportunities for improvement to the design of our app. Further research is needed to understand what people with COPD and their healthcare providers want and will use in a mobile app and wearable for COPD management.
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Affiliation(s)
- Robert Wu
- Division of General Internal Medicine, University Health Network, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maryann Calligan
- Division of General Internal Medicine, University Health Network, Toronto, Canada
| | - Tanya Son
- Division of General Internal Medicine, University Health Network, Toronto, Canada
| | - Harshmeet Rakhra
- Division of General Internal Medicine, University Health Network, Toronto, Canada
| | - Eyal de Lara
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Alex Mariakakis
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Andrea S Gershon
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
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Werther L, Thorén E, Brännström J, Andersson G, Öberg M. Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program: A feasibility study. Internet Interv 2024; 36:100734. [PMID: 38524894 PMCID: PMC10958056 DOI: 10.1016/j.invent.2024.100734] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.
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Affiliation(s)
- Louise Werther
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Thorén
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology Clinic, Skåne University Hospital, Lund, Sweden
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Jonas Brännström
- Department of Clinical Science, Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden
| | - Gerhard Andersson
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Marie Öberg
- Department of Otorhinolaryngology in Östergötland, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Poolman EY, Vorstermans L, Donker MH, Bijker L, Coppieters MW, Cuijpers P, Scholten-Peeters GGM, de Wit LM. How people with persistent pain experience in-person physiotherapy blended with biopsychosocial digital health - A qualitative study on participants' experiences with Back2Action. Internet Interv 2024; 36:100731. [PMID: 38465202 PMCID: PMC10924200 DOI: 10.1016/j.invent.2024.100731] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
Background A blended intervention consisting of in-person physiotherapy and psychologically-informed digital health, called Back2Action, was developed to optimise the management of people with persistent spinal pain who also have psychosocial risk factors associated with the development or maintenance of persistent pain. This study aimed to gain insights in how participants experienced this blended intervention. Methods A qualitative study using semi-structured interviews was conducted. Eleven people with persistent non-specific spinal pain who received the blended intervention within a randomised clinical trial were included. All interviews were recorded, transcribed verbatim and analysed independently by two researchers. Data were analysed using a thematic analysis. Results The analysis identified four themes: (1) Experiencing a better understanding of the relationship between own physical and mental health; (2) Importance of the physiotherapist's active involvement in biopsychosocial blended care, which describes the crucial role of physiotherapists in supporting participants in this; (3) Appreciation of digital health, to better understand persistent pain and make meaningful lifestyle changes; and (4) Trials and triumphs, revealing gains such as better coping, but also challenges with implementation of changes into long-term routines. Conclusion Participants of the blended intervention experienced positive changes in thoughts and behaviours, which highlights the feasibility and acceptability of the blended intervention as a more holistic treatment within pain management. The differences in personal preferences for receiving psychologically-informed digital health poses challenges for implementation of blended biopsychosocial care in evidence-based practice.
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Affiliation(s)
- E Y Poolman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - L Vorstermans
- Master Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - M H Donker
- Department of Health Sciences, Faculty of Beta Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - L Bijker
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - M W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
- School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - P Cuijpers
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
| | - L M de Wit
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Staykov E, Helmer-Smith M, Fung C, Tanuseputro P, Liddy C. Development of the electronic consultation long-term care utilization and savings estimator tool to model the potential impact of electronic consultation for residents living in long-term care. J Telemed Telecare 2024; 30:597-603. [PMID: 35073207 DOI: 10.1177/1357633x221074500] [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: 02/21/2024]
Abstract
Ageing populations have resulted in more patients living in long-term care or nursing homes, where they face challenges to accessing prompt specialist care exacerbated in many cases by physical or cognitive decline. Electronic consultation has demonstrated an ability to improve access to specialist care for vulnerable groups and offers a potential solution to this gap in care. To support electronic consultation's uptake among long-term care homes, we created the electronic consultation long-term care utilization and savings estimator, an Excel-based tool that estimates the number of off-site appointments that patients in a long-term care home could avoid through electronic consultation, along with the consequent time and cost savings. In this brief report, we discuss the electronic consultation long-term care utilization and savings estimator's creation and function, and provide a case study using long-term care data to demonstrate its potential impact. We anticipate the electronic consultation long-term care utilization and savings estimator will be a highly impactful tool and intend to test it in real-world conditions following the relaxation of COVID-19 restrictions.
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Affiliation(s)
- Emiliyan Staykov
- Department of Biology, University of Ottawa, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Canada
- Ottawa Hospital Research Institute, Canada
| | - Mary Helmer-Smith
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Canada
- Department of Family Medicine, University of Ottawa, Canada
| | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Canada
- St Patrick's Home of Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Canada
- Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Canada
- Department of Family Medicine, University of Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Canada
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Man JP, Klopotowska J, Asselbergs FW, Handoko ML, Chamuleau SAJ, Schuuring MJ. Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions. Curr Heart Fail Rep 2024; 21:147-161. [PMID: 38363516 PMCID: PMC10924030 DOI: 10.1007/s11897-024-00649-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
PURPOSEOF REVIEW Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. RECENT FINDINGS We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.
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Affiliation(s)
- Jelle P Man
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Joanna Klopotowska
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
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Van Biesen D, Van Damme T, Morgulec-Adamowicz N, Buchholz A, Anjum M, Healy S. A Systematic Review of Digital Interventions to Promote Physical Activity in People With Intellectual Disabilities and/or Autism. Adapt Phys Activ Q 2024; 41:330-350. [PMID: 37793654 DOI: 10.1123/apaq.2023-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
This systematic review synthesized the literature on digital health interventions for the promotion of physical activity (PA) among people with intellectual disabilities and/or autism. From an initial screening of 553 records, 10 studies underwent full-text review. Data were extracted relating to study, intervention, and sample characteristics and PA-related findings. Methodological quality was evaluated using the Crowe Critical Appraisal Tool. There were mixed findings pertaining to the effectiveness of digital health interventions for promoting PA among these populations. Positive results were reported for three of five active-video-game interventions, two of three social-media-based interventions, and one of two e-learning/multicomponent interventions. Digital health interventions can potentially be effective for promoting PA among people with intellectual disabilities and/or autism. However, the large variation in the samples and intervention types and a reliance on pre- and quasi-experimental research designs suggest that inferences should be made with caution and additional research is needed.
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Affiliation(s)
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | | | | | - Momna Anjum
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Séan Healy
- Physical Education and Sports Science, University of Limerick, Limerick, Ireland
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Smith A'B, Bamgboje-Ayodele A, Jegathees S, Butow P, Klein B, Salter M, Turner J, Fardell J, Thewes B, Sharpe L, Beatty L, Pearce A, Beith J, Costa D, Rincones O, Wu VS, Garden FL, Kiely BE, Lim K, Morstyn L, Hanley B, Hodgkin R, Beattie A, Girgis A. Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence. J Cancer Surviv 2024; 18:425-438. [PMID: 35876964 PMCID: PMC9309991 DOI: 10.1007/s11764-022-01233-9] [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: 06/02/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Approximately 50% of cancer survivors experience moderate-severe fear of cancer recurrence (FCR). Self-guided digital interventions have potential to address the high level of FCR-related unmet needs at scale, but existing digital interventions have demonstrated variable engagement and efficacy. This study aimed to evaluate the feasibility and preliminary efficacy of iConquerFear, a five-module self-guided digital FCR intervention. METHODS Eligible curatively treated breast cancer survivors were recruited. Participants reporting clinically significant FCR (≥ 13 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were given access to iConquerFear. Feasibility was indicated by > 50% of eligible participants enrolling in iConquerFear and recording moderate (≥ 120 min) or greater usage. Preliminary efficacy was evaluated via changes in self-reported FCR severity, anxiety, depression, intrusions and metacognitions from baseline to immediately and 3 months post-intervention. RESULTS Fifty-four (83%) of 65 eligible participants enrolled in iConquerFear; six subsequently withdrew. Thirty-nine (83%) participants recorded moderate (n = 24; 120-599 min) or high (n = 15; ≥ 600 min) usage. Engagement levels increased with participant age (p = 0.043), but were lower in participants with higher baseline FCR (p = 0.028). Qualitative feedback indicated engagement was sometimes limited by difficulties with navigation and relating to featured survivors. Participants reported significantly improved FCR (mean reduction (95%CI): baseline to post-intervention - 3.44 (- 5.18, - 1.71), baseline to 3-month follow-up - 4.52 (- 6.25, - 2.78), p = < 0.001). CONCLUSION iConquerFear is a feasible and potentially efficacious intervention for reducing FCR in breast cancer survivors. Easier navigation and more relatable examples may enhance engagement. IMPLICATIONS FOR CANCER SURVIVORS iConquerFear may help address moderate but burdensome FCR levels in cancer survivors.
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Affiliation(s)
- Allan 'Ben' Smith
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia.
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia.
| | - Adeola Bamgboje-Ayodele
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharuja Jegathees
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia
| | - Britt Klein
- Health Innovation & Transformation Centre (HITC) & Biopsychosocial and eHealth Research & Innovation (BeRI), DVC-R&I Portfolio, Federation University Australia, Churchill, Australia
| | - Marj Salter
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Jane Turner
- Department of Psychiatry, University of Queensland, Brisbane, Australia
| | - Joanna Fardell
- School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia
- Western Sydney Youth Cancer Service, Westmead Hospital, Westmead, Australia
| | - Belinda Thewes
- School of Psychology, University of Sydney NSW, Sydney, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney NSW, Sydney, Australia
| | - Lisa Beatty
- College of Education, Psychology & Social Work, Flinders University, Adelaide, Australia
| | - Alison Pearce
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Daniel Costa
- School of Psychology, University of Sydney NSW, Sydney, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Verena S Wu
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Frances L Garden
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
| | - Belinda E Kiely
- South Western Sydney Local Health District, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Karen Lim
- South Western Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Lisa Morstyn
- Breast Cancer Network Australia (BCNA), Camberwell, Australia
| | - Brigid Hanley
- Cancer Council Queensland, Fortitude Valley, Australia
| | | | | | - Afaf Girgis
- Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia
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Lopez-Alcalde J, Susan Wieland L, Barth J, Grainger R, Baxter N, Heron N, Triantafyllidis A, Carrion C, Trecca EMC, Holl F, Maria Wägner A, Edney S, Yan Y, Campos-Asensio C, Villanueva G, Ramsey RR, Witt CM. Methodological challenges in systematic reviews of mHealth interventions: Survey and consensus-based recommendations. Int J Med Inform 2024; 184:105345. [PMID: 38309237 DOI: 10.1016/j.ijmedinf.2024.105345] [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: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Mobile Health (mHealth) refers to using mobile devices to support health. This study aimed to identify specific methodological challenges in systematic reviews (SRs) of mHealth interventions and to develop guidance for addressing selected challenges. STUDY DESIGN AND SETTING Two-phase participatory research project. First, we sent an online survey to corresponding authors of SRs of mHealth interventions. On a five-category scale, survey respondents rated how challenging they found 24 methodological aspects in SRs of mHealth interventions compared to non-mHealth intervention SRs. Second, a subset of survey respondents participated in an online workshop to discuss recommendations to address the most challenging methodological aspects identified in the survey. Finally, consensus-based recommendations were developed based on the workshop discussion and subsequent interaction via email with the workshop participants and two external mHealth SR authors. RESULTS We contacted 953 corresponding authors of mHealth intervention SRs, of whom 50 (5 %) completed the survey. All the respondents identified at least one methodological aspect as more or much more challenging in mHealth intervention SRs than in non-mHealth SRs. A median of 11 (IQR 7.25-15) out of 24 aspects (46 %) were rated as more or much more challenging. Those most frequently reported were: defining intervention intensity and components (85 %), extracting mHealth intervention details (71 %), dealing with dynamic research with evolving interventions (70 %), assessing intervention integrity (69 %), defining the intervention (66 %) and maintaining an updated review (65 %). Eleven survey respondents participated in the workshop (five had authored more than three mHealth SRs). Eighteen consensus-based recommendations were developed to address issues related to mHealth intervention integrity and to keep mHealth SRs up to date. CONCLUSION mHealth SRs present specific methodological challenges compared to non-mHealth interventions, particularly related to intervention integrity and keeping SRs current. Our recommendations for addressing these challenges can improve mHealth SRs.
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Affiliation(s)
- Jesus Lopez-Alcalde
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Faculty of Medicine, Universidad Francisco de Vitoria (UFV), Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Unidad de bioestadística clínica, Hospital Universitario Ramón y Cajal, (CIBERESP), Madrid, Spain.
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Nancy Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Heron
- Centre for Public Health, Queen's University Belfast, Northern Ireland, School of Medicine, Keele University, Staffordshire, England, United Kingdom
| | - Andreas Triantafyllidis
- Information Technologies Institute, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Carme Carrion
- eHealth Lab Research Group, Universitat Oberta de Catalunya (UOC), Spain
| | - Eleonora M C Trecca
- Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy; Department of Otorhinolaryngology, University Hospital of Foggia, Foggia, Italy
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ana Maria Wägner
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Instituto de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sarah Edney
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yuqian Yan
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Marco-Ruiz L, Hernández MÁT, Ngo PD, Makhlysheva A, Svenning TO, Dyb K, Chomutare T, Llatas CF, Muñoz-Gama J, Tayefi M. A multinational study on artificial intelligence adoption: Clinical implementers' perspectives. Int J Med Inform 2024; 184:105377. [PMID: 38377725 DOI: 10.1016/j.ijmedinf.2024.105377] [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: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Despite substantial progress in AI research for healthcare, translating research achievements to AI systems in clinical settings is challenging and, in many cases, unsatisfactory. As a result, many AI investments have stalled at the prototype level, never reaching clinical settings. OBJECTIVE To improve the chances of future AI implementation projects succeeding, we analyzed the experiences of clinical AI system implementers to better understand the challenges and success factors in their implementations. METHODS Thirty-seven implementers of clinical AI from European and North and South American countries were interviewed. Semi-structured interviews were transcribed and analyzed qualitatively with the framework method, identifying the success factors and the reasons for challenges as well as documenting proposals from implementers to improve AI adoption in clinical settings. RESULTS We gathered the implementers' requirements for facilitating AI adoption in the clinical setting. The main findings include 1) the lesser importance of AI explainability in favor of proper clinical validation studies, 2) the need to actively involve clinical practitioners, and not only clinical researchers, in the inception of AI research projects, 3) the need for better information structures and processes to manage data access and the ethical approval of AI projects, 4) the need for better support for regulatory compliance and avoidance of duplications in data management approval bodies, 5) the need to increase both clinicians' and citizens' literacy as respects the benefits and limitations of AI, and 6) the need for better funding schemes to support the implementation, embedding, and validation of AI in the clinical workflow, beyond pilots. CONCLUSION Participants in the interviews are positive about the future of AI in clinical settings. At the same time, they proposenumerous measures to transfer research advancesinto implementations that will benefit healthcare personnel. Transferring AI research into benefits for healthcare workers and patients requires adjustments in regulations, data access procedures, education, funding schemes, and validation of AI systems.
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Affiliation(s)
- Luis Marco-Ruiz
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway.
| | | | - Phuong Dinh Ngo
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Alexandra Makhlysheva
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Therese Olsen Svenning
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Kari Dyb
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Taridzo Chomutare
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Carlos Fernández Llatas
- Instituto de las Tecnologías de la Información y las Comunicaciones (ITACA), Universitat Politècnica de València (UPV), Valencia, Spain
| | - Jorge Muñoz-Gama
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maryam Tayefi
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
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11
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Nees J, Struewe F, Schott S. Medical students' knowledge on cancer predisposition syndromes and attitude toward eHealth. Arch Gynecol Obstet 2024; 309:1535-1541. [PMID: 37934269 PMCID: PMC10894105 DOI: 10.1007/s00404-023-07266-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Individuals with cancer predisposition syndromes (CPS) inherit elevated cancer risks. Medical supply gaps for people at risk of CPS cause insufficient outreach and miss potential benefits of individualized care strategies. Increased awareness of CPS and progress in the eHealth sector are untapped sources of health care improvement for affected individuals. METHODS AND RESULTS This study addressed German-speaking medical students with an online questionnaire in respect to their knowledge of CPS, their medical education, and perspectives. The study population (n = 404) reported interest in and knowledge of CPS, supported by a satisfactory and sustainable education for their prospective patient care. The next generation of doctors would implement eHealth to improve medical services. Skepticism about digitization was claimed by students. They were especially concerned about deterioration in the physician-patient relationship, data abuse, dependence on technology, and incorrect diagnoses. CONCLUSION Due to increasing diagnosing of CPS and deeper knowledge, this topic is essential for the curriculum in medical schools. In particular, care providers need know-how on identifying patients at risk for a CPS, certain diagnostic and therapeutic steps, surveillance and prophylactic strategies to improve patients' outcomes. Education in medical school as well as implemented eHealth seems to have potential to meet this demand in an upcoming era of personalized medicine. What does this study add to the clinical work. Medical teaching on cancer predisposition syndromes should be expanded to improve knowledge and individualized and personalized healthcare.
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Affiliation(s)
- Juliane Nees
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Farina Struewe
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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12
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Boy K, von Rohr S, May S, Kuhn S, Schett G, Labinsky H, Knitza J, Muehlensiepen F. Pre-assessment of patients with suspected axial spondyloarthritis combining student-led clinics and telemedicine: a qualitative study. Rheumatol Int 2024; 44:663-673. [PMID: 38289350 PMCID: PMC10914903 DOI: 10.1007/s00296-023-05522-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Patients referred to rheumatologists are currently facing months of inefficient waiting time due to the increasing demand and rising workforce shortage. We piloted a pre-assessment of patients with suspected axial spondyloarthritis (axSpA) combining student-led clinics and telemedicine (symptom assessment, symptom monitoring and at-home capillary self-sampling) to improve access to rheumatology care. The aim of this study was to explore (1) current challenges accessing axSpA care and (2) patients' first-hand experiences. METHODS Embedded within a clinical trial, this study was based on qualitative interviews with patients with suspected axSpA (n = 20). Data was analysed via qualitative content analysis. RESULTS Student-led clinics were perceived as high-quality care, comparable to conventional rheumatologist-led visits. Patients expressed that their interactions with the students instilled a sense of trust. History-taking and examinations were perceived as comprehensive and meticulous. Telehealth tools were seen as empowering, offering immediate and continuous access to symptom assessment at home. Patients reported a lack of specificity of the electronic questionnaires, impeding accurate responses. Patients requested a comments area to supplement questionnaire responses. Some patients reported receiving help to complete the blood collection. CONCLUSION Patients' access to rheumatology care is becoming increasingly burdensome. Pre-assessment including student-led clinics and telemedicine was highly accepted by patients. Patient interviews provided valuable in-depth feedback to improve the piloted patient pathway.
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Affiliation(s)
- Katharina Boy
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany.
| | - Sophie von Rohr
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany
| | - Sebastian Kuhn
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hannah Labinsky
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
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13
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Clement A, Ravet M, Stanger C, Gabrielli J. Feasibility, usability, and acceptability of MobileCoach-Teen: A smartphone app-based preventative intervention for risky adolescent drinking behavior. J Subst Use Addict Treat 2024; 159:209275. [PMID: 38110119 DOI: 10.1016/j.josat.2023.209275] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Older adolescence (ages 15-18) is a critical period for experimentation with substance use, especially alcohol. Adolescent drinking poses hazards to physical and mental health, amplifies risk associated with other activities typically initiated during this life stage (e.g., driving, sexual activity), and is associated with adverse outcomes in adolescence and adulthood. Existing preventative interventions are expensive and have questionable long-term efficacy. Digital interventions may represent an accessible and personalized approach to providing preventative intervention content to youth. METHODS This study recruited 29 adolescents aged 16-18 (M = 17.24, SD = 0.74) for a pilot feasibility trial of the MobileCoach-Teen (MC-Teen) smartphone app-based intervention. The study team randomized participants to receive either the alcohol intervention (MC-Teen) or attention control pseudo-intervention (MC-Fit). MC-Teen participants received 12 weeks of content adapted from a prior Swiss-based trial of a preventative alcohol intervention. Participants provided qualitative and quantitative feedback at baseline, via six biweekly surveys during and post-intervention. RESULTS Both groups rated the application as easy to download (M = 4.31, SD = 0.93; 5-point Likert). All participants completed the baseline survey in less than the estimated time of 10 min (M = 7:42, SD = 2:15) and rated the survey as easy to complete (M = 4.69, SD = 0.60; 5-point Likert). MC-Teen participants favorably assessed application user experience, message user experience, and digital working alliance with application. Qualitative themes included a desire for increased rate/amount and diversity of content, greater representation via coach options, user interface/user experience improvements, and additional features. CONCLUSION The MC-Teen intervention is feasible and acceptable based on a pilot feasibility trial with a sample of U.S. adolescents.
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Affiliation(s)
- Alex Clement
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, United States of America.
| | - Mariah Ravet
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America
| | - Catherine Stanger
- Geisel School of Medicine, Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, United States of America
| | - Joy Gabrielli
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States of America
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Ballmaier J, Hölzer S, Geitner M, Kuttenreich AM, Erfurth C, Guntinas-Lichius O, Volk GF. [Telemedicine for patients with facial palsy : Current developments and options in otorhinolaryngologic treatment]. HNO 2024:10.1007/s00106-024-01449-4. [PMID: 38530382 DOI: 10.1007/s00106-024-01449-4] [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] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
Digitalization is also becoming increasingly important in medicine. The COVID-19 pandemic has further accelerated this process and politicians are trying to create a framework for successful knowledge transfer and better digital medical care. This article describes the role of telemedicine in the treatment of patients suffering from facial nerve palsy. Facial nerve palsy has a wide range of effects, from limitations in facial mobility to psychological sequelae. While many of the acute, idiopathic facial nerve palsies improve after a few weeks, around a third of those affected develop synkinesis, involuntary movements that have lifelong functional and psychological consequences. Treatment includes various modalities, from medication and surgery to movement training. Telemedicine offers innovative solutions in cases of regional underuse, but also in the treatment of chronic facial nerve palsies. The article defines the term "telemedicine" in the current context and presents different types of application. A detailed analysis of the application scenarios of telemedicine in facial nerve palsy patients shows that despite a lack of evidence, many potentially useful concepts exist.
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Affiliation(s)
- Jonas Ballmaier
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Sabrina Hölzer
- Fachbereich Wirtschaftsingenieurswesen, Ernst-Abbe-Hochschule Jena, Jena, Deutschland
| | - Maren Geitner
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Anna-Maria Kuttenreich
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Christian Erfurth
- Fachbereich Wirtschaftsingenieurswesen, Ernst-Abbe-Hochschule Jena, Jena, Deutschland
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Gerd Fabian Volk
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland.
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland.
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland.
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15
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O'Kane KMK, Otamendi T, Silverberg ND, Choi E, Sicard V, Zemek R, Healey K, Brown O, Butterfield L, Smith A, Goldfield G, Kardish R, Saab B, Ledoux AA, Cairncross M. Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study. JMIR Form Res 2024; 8:e49133. [PMID: 38517472 DOI: 10.2196/49133] [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: 06/27/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. OBJECTIVE This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents' development of therapeutic alliance and social presence with the intervention. METHODS Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. RESULTS Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by "developing a genuine connection" with their mindfulness guides and "sensing real people." Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides' "personal backgrounds and voices," such that participants felt more connected to the guides by knowing information about them and through the guides' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. CONCLUSIONS Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.
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Affiliation(s)
- Kiarah M K O'Kane
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Thalia Otamendi
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Esther Choi
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Healey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Olivier Brown
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, BC, Canada
| | - Lauren Butterfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Andra Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, BC, Canada
| | - Gary Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Rachel Kardish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, BC, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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16
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Alibhai SMH, Puts M, Jin R, Godhwani K, Antonio M, Abdallah S, Feng G, Krzyzanowska MK, Soto-Perez-de-Celis E, Papadopoulos E, Mach C, Nasiri F, Sridhar SS, Glicksman R, Moody L, Bender J, Clarke H, Matthew A, McIntosh D, Klass W, Emmenegger U. TOward a comPrehensive supportive Care intervention for Older men with metastatic Prostate cancer (TOPCOP3): A pilot randomized controlled trial and process evaluation. J Geriatr Oncol 2024:101750. [PMID: 38521641 DOI: 10.1016/j.jgo.2024.101750] [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: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Current management of metastatic prostate cancer (mPC) includes androgen receptor axis-targeted therapy (ARATs), which is associated with substantial toxicity in older adults. Geriatric assessment and management and remote symptom monitoring have been shown to reduce toxicity and improve quality of life in patients undergoing chemotherapy, but their efficacy in patients being treated with ARATs has not been explored. The purpose of this study is to examine whether these interventions, alone or in combination, can improve treatment tolerability and quality of life (QOL) for older adults with metastatic prostate cancer on ARATs. MATERIALS AND METHODS TOPCOP3 is a multi-centre, factorial pilot clinical trial coupled with an embedded process evaluation. The study includes four treatment arms: geriatric assessment and management (GA + M); remote symptom monitoring (RSM); geriatric assessment and management plus remote symptom monitoring; and usual care and will be followed for six months. The aim is to recruit 168 patients between two cancer centres in Toronto, Canada. Eligible participants will be randomized equally via REDCap. Participants in all arms will complete a comprehensive baseline assessment upon enrollment following the Geriatric Core dataset, as well as follow-up assessments at 1.5, 3, 4.5, and 6 months. The co-primary outcomes will be grade 3-5 toxicity and QOL. Toxicities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. QOL will be measured by patient self-reporting using the EuroQol 5 dimensions of health questionnaire. Secondary outcomes include fatigue, insomnia, and depression. Finally, four process evaluation outcomes will also be observed, namely feasibility, fidelity, and acceptability, along with implementation barriers and facilitators. DISCUSSION Data will be collected to observe the effects of GA + M and RSM on QOL and toxicities experienced by older adults receiving ARATs for metastatic prostate cancer. Data will also be collected to help the design and conduct of a definitive multicentre phase III randomized controlled trial. This study will extend supportive care interventions for older adults with cancer into new areas and inform the design of larger trials. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (registration number: NCT05582772).
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Affiliation(s)
- Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rana Jin
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kian Godhwani
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Maryjo Antonio
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Soha Abdallah
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Gregory Feng
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Calvin Mach
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ferozah Nasiri
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rachel Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto, Canada
| | - Lesley Moody
- Varian Medical Systems, Winnipeg, Manitoba, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Urban Emmenegger
- Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Dege T, Glatzel B, Borst V, Grän F, Goller S, Glatzel C, Goebeler M, Schmieder A. Patient-Centered Chronic Wound Care Mobile Apps: Systematic Identification, Analysis, and Assessment. JMIR Mhealth Uhealth 2024; 12:e51592. [PMID: 38533818 DOI: 10.2196/51592] [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: 08/04/2023] [Revised: 12/17/2023] [Accepted: 01/25/2024] [Indexed: 03/28/2024] Open
Abstract
Background The prevalence of chronic wounds is predicted to increase within the aging populations in industrialized countries. Patients experience significant distress due to pain, wound secretions, and the resulting immobilization. As the number of wounds continues to rise, their adequate care becomes increasingly costly in terms of health care resources worldwide. eHealth support systems are being increasingly integrated into patient care. However, to date, no systematic analysis of such apps for chronic wounds has been published. Objective The aims of this study were to systematically identify and subjectively assess publicly available German- or English-language mobile apps for patients with chronic wounds, with quality assessments performed by both patients and physicians. Methods Two reviewers independently conducted a systematic search and assessment of German- or English-language mobile apps for patients with chronic wounds that were available in the Google Play Store and Apple App Store from April 2022 to May 2022. In total, 3 apps met the inclusion and exclusion criteria and were reviewed independently by 10 physicians using the German Mobile App Rating Scale (MARS) and the System Usability Scale (SUS). The app with the highest mean MARS score was subsequently reviewed by 11 patients with chronic wounds using the German user version of the MARS (uMARS) and the SUS. Additionally, Affinity for Technology Interaction (ATI) scale scores were collected from both patients and physicians. Results This study assessed mobile apps for patients with chronic wounds that were selected from a pool of 118 identified apps. Of the 73 apps available in both app stores, 10 were patient oriented. After excluding apps with advertisements or costs, 3 apps were evaluated by 10 physicians. Mean MARS scores ranged from 2.64 (SD 0.65) to 3.88 (SD 0.65) out of 5, and mean SUS scores ranged from 50.75 (SD 27) to 80.5 (SD 17.7) out of 100. WUND APP received the highest mean MARS score (mean 3.88, SD 0.65 out of 5) among physicians. Hence, it was subsequently assessed by 11 patients and achieved a similar rating (uMARS score: mean 3.89, SD 0.4 out of 5). Technical affinity, as measured with the ATI scale, was slightly lower in patients (score: mean 3.62, SD 1.35 out of 6) compared to physicians (score: mean 3.88, SD 1.03 out 6). Conclusions The quality ratings from physicians and patients were comparable and indicated mediocre app quality. Technical affinity, as assessed by using the ATI scale, was slightly lower for patients. Adequate apps for patients with chronic wounds remain limited, emphasizing the need for improved app development to meet patient needs. The ATI scale proved valuable for assessing technical affinity among different user groups.
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Affiliation(s)
- Tassilo Dege
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Bernadette Glatzel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Vanessa Borst
- Department of Computer Science, University of Würzburg, Würzburg, Germany
| | - Franziska Grän
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Simon Goller
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Glatzel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Astrid Schmieder
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Liu AW, Brown Iii W, Madu NE, Maiorano AR, Bigazzi O, Medina E, Sorric C, Hays SR, Odisho AY. Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e51236. [PMID: 38506896 DOI: 10.2196/51236] [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: 07/26/2023] [Revised: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Patient engagement attrition in mobile health (mHealth) remote patient monitoring (RPM) programs decreases program benefits. Systemic disparities lead to inequities in RPM adoption and use. There is an urgent need to understand patients' experiences with RPM in the real world, especially for patients who have stopped using the programs, as addressing issues faced by patients can increase the value of mHealth for patients and subsequently decrease attrition. OBJECTIVE This study sought to understand patient engagement and experiences in an RPM mHealth intervention in lung transplant recipients. METHODS Between May 4, 2020, and November 1, 2022, a total of 601 lung transplant recipients were enrolled in an mHealth RPM intervention to monitor lung function. The predictors of patient engagement were evaluated using multivariable logistic and linear regression. Semistructured interviews were conducted with 6 of 39 patients who had engaged in the first month but stopped using the program, and common themes were identified. RESULTS Patients who underwent transplant more than 1 year before enrollment in the program had 84% lower odds of engaging (odds ratio [OR] 0.16, 95% CI 0.07-0.35), 82% lower odds of submitting pulmonary function measurements (OR 0.18, 95% CI 0.09-0.33), and 78% lower odds of completing symptom checklists (OR 0.22, 95% CI 0.10-0.43). Patients whose primary language was not English had 78% lower odds of engaging compared to English speakers (OR 0.22, 95% CI 0.07-0.67). Interviews revealed 4 prominent themes: challenges with devices, communication breakdowns, a desire for more personal interactions and specific feedback with the care team about their results, understanding the purpose of the chat, and understanding how their data are used. CONCLUSIONS Care delivery and patient experiences with RPM in lung transplant mHealth can be improved and made more equitable by tailoring outreach and enhancements toward non-English speakers and patients with a longer time between transplant and enrollment. Attention to designing programs to provide personalization through supplementary provider contact, education, and information transparency may decrease attrition rates.
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Affiliation(s)
- Andrew W Liu
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - William Brown Iii
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, United States
| | - Ndubuisi E Madu
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Ali R Maiorano
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Olivia Bigazzi
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Eli Medina
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Christopher Sorric
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
| | - Steven R Hays
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Anobel Y Odisho
- Center for Digital Health Innovation, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Department of Urology, University of California, San Francisco, CA, United States
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19
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Li DH, Macapagal K, Mongrella M, Saber R, Mustanski B. "Your Package Could Not Be Delivered": The State of Digital HIV Intervention Implementation in the US. Curr HIV/AIDS Rep 2024:10.1007/s11904-024-00693-1. [PMID: 38502421 DOI: 10.1007/s11904-024-00693-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE OF REVIEW Despite continuous innovations and federal investment to create digital interventions addressing the HIV prevention and care continua, these interventions have not reached people in the U.S. at scale. This article reviews what is known about U.S. implementation of digital HIV interventions and presents a strategy to cross the research-to-practice chasm for these types of interventions. RECENT FINDINGS We conducted a narrative review of U.S.-based original research on implementation of digital HIV interventions and identified few studies reporting on implementation determinants, strategies, processes, or outcomes, particularly outside the context of effectiveness trials. To supplement the literature, in 2023, we surveyed 47 investigators representing 64 unique interventions about their experiences with implementation after their research trials. Respondents placed high importance on intervention implementation, but major barriers included lack of funding and clear implementation models, technology costs, and difficulty identifying partners equipped to deliver digital interventions. They felt that responsibility for implementation should be shared between intervention developers, deliverers (e.g., clinics), and a government entity. If an implementation center were to exist, most respondents wanted to be available for guidance or technical assistance but largely wanted less involvement. Numerous evidence-based, effective digital interventions exist to address HIV prevention and care. However, they remain "on the shelf" absent a concrete and sustainable model for real-world dissemination and implementation. Based on our findings, we call for the creation of national implementation centers, analogous to those in other health systems, to facilitate digital HIV intervention delivery and accelerate progress toward ending the U.S. epidemic.
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Affiliation(s)
- Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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20
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Stapleton JL, Manne SL, Pagoto SL, Leip A, Greene K, Hillhouse JJ, Merritt AS, Shelton BJ. A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56562. [PMID: 38502173 DOI: 10.2196/56562] [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: 02/07/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability. OBJECTIVE This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning. METHODS Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up. RESULTS This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up. CONCLUSIONS This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines. TRIAL REGISTRATION ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56562.
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Affiliation(s)
- Jerod L Stapleton
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Sherry L Pagoto
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, United States
| | - Allison Leip
- Department of Family Sciences, University of Kentucky, Lexington, KY, United States
| | - Kathryn Greene
- Department of Communication, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, United States
| | - Allison S Merritt
- Markey Cancer Center, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Brent J Shelton
- Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, KY, United States
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Bishop FL, Cross N, Dewar-Haggart R, Teasdale E, Herbert A, Robinson ME, Ridd MJ, Mallen C, Clarson L, Bostock J, Becque T, Stuart B, Garfield K, Morrison L, Pollet S, Vennik J, Atherton H, Howick J, Leydon GM, Nuttall J, Islam N, Lee PH, Little P, Everitt HA. Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement. BMJ Open 2024; 14:e081932. [PMID: 38508652 PMCID: PMC10953007 DOI: 10.1136/bmjopen-2023-081932] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. METHODS AND ANALYSIS A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. ETHICS APPROVAL AND DISSEMINATION Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. TRIAL REGISTRATION NUMBER ISRCTN18010240.
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Affiliation(s)
| | - Nadia Cross
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Rachel Dewar-Haggart
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Amy Herbert
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Christian Mallen
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lorna Clarson
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Jennifer Bostock
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
| | - Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Sebastien Pollet
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Jeremy Howick
- Leicester Medical School, University of Leicester, Leicester, UK
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Geraldine M Leydon
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Hazel A Everitt
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
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22
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Dang TTH, Carnahan E, Nguyen L, Mvundura M, Dao S, Duong TH, Nguyen T, Nguyen D, Nguyen T, Werner L, Ryman TK, Nguyen N. Outcomes and Costs of the Transition From a Paper-Based Immunization System to a Digital Immunization System in Vietnam: Mixed Methods Study. J Med Internet Res 2024; 26:e45070. [PMID: 38498020 DOI: 10.2196/45070] [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: 12/14/2022] [Revised: 07/28/2023] [Accepted: 01/26/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits. OBJECTIVE This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system. METHODS This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective. RESULTS NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8% (202/580) in Hanoi and 29.4% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS. CONCLUSIONS The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs.
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Affiliation(s)
- Thi Thanh Huyen Dang
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | - Thi Hong Duong
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Trung Nguyen
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Doan Nguyen
- National Expanded Program on Immunization, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Tove K Ryman
- Bill & Melinda Gates Foundation, Seattle, WA, United States
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Holl F, Kircher J, Hertelendy AJ, Sukums F, Swoboda W. Tanzania's and Germany's Digital Health Strategies and Their Consistency With the World Health Organization's Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis. J Med Internet Res 2024; 26:e52150. [PMID: 38498021 DOI: 10.2196/52150] [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: 08/26/2023] [Revised: 11/28/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. OBJECTIVE This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. METHODS A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. RESULTS Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. CONCLUSIONS This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation.
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Affiliation(s)
- Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Jennifer Kircher
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Attila J Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
| | - Felix Sukums
- MUHAS Digital Health and Innovation Research Group, Muhimbili University of Health & Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
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24
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Bühne D, Elling JM, Hetzel C, Alles T. Promoting Return to Work After Vocational Rehabilitation Using a Work-Related Fitness App: Protocol for a Cluster-Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e50200. [PMID: 38498051 DOI: 10.2196/50200] [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: 06/22/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Retraining programs in vocational rehabilitation are often characterized by a low level of physical activity, even when targeting jobs with primarily physical demands. They might therefore be accompanied by a decline in functional capacity if the lack of physical activity is not compensated by increased activity during leisure time. The implementation of a work-related exercise app might be a promising approach to promoting a return to work in vocational rehabilitation. We developed the "WORKout-app" which provides exercise plans based on a comparison of the physical demands of the retraining profession and the current functional capacity. OBJECTIVE The aim of this study is to examine the effects of app-based exercise during vocational rehabilitation on perceived work ability (primary outcome), occupational self-efficacy, days of sick leave, and return to work (secondary outcomes). METHODS We conducted a cluster-randomized controlled trial with 2 arms (intervention: WORKout-app vs control: treatment as usual) in 4 cohorts of 5 vocational rehabilitation centers in Germany. Participants are nested within retraining classes per vocational rehabilitation center and per cohort assigned to either the intervention condition or the control condition. The target sample size at the participant level is 598. Measurement time points include baseline, the end of rehabilitation, 3 months after the end of rehabilitation, and 6 months after the end of rehabilitation. Linear and generalized linear mixed-effects models are performed to test for treatment differences in outcomes. RESULTS This study is funded by the German Federal Pension Insurance. The trial is registered with the German Clinical Trials Register (DRKS00030775) and approved by the Ethics Committee of the German Sport University Cologne (145/2022). CONCLUSIONS The findings of the study will inform researchers and practitioners about the effectiveness of an exercise app developed to counteract the effects of physical inactivity during vocational rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50200.
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Affiliation(s)
- David Bühne
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR), German Sport University Cologne, Köln, Germany
| | - Jan Mathis Elling
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR), German Sport University Cologne, Köln, Germany
| | - Christian Hetzel
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR), German Sport University Cologne, Köln, Germany
| | - Torsten Alles
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR), German Sport University Cologne, Köln, Germany
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 DOI: 10.2196/49647] [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: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Firet L, Teunissen TAM, Kool RB, Akkermans RP, Lagro-Janssen ALM, van der Vaart H, Assendelft WJJ. The relation between usage of an eHealth intervention for stress urinary incontinence and treatment outcomes: an observational study. BMC Prim Care 2024; 25:89. [PMID: 38493288 PMCID: PMC10943843 DOI: 10.1186/s12875-024-02325-4] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Stress urinary incontinence (SUI), though a prevalent condition among women, is undertreated in primary care. EHealth with pelvic floor muscle training is an evidence-based alternative to care-as-usual. It is unknown, however, how eHealth usage is related to treatment outcome, and this knowledge is required for general practitioners to implement eHealth in their practice. This study examines the relation between usage of eHealth for SUI and treatment outcomes by examining log data. Baseline factors were also explored for associations with treatment success. METHOD In this pre-post study, women with SUI participated in "Baasoverjeblaas.nl", a web-based intervention translated from the Swedish internet intervention "Tät®-treatment of stress urinary incontinence". Usage was based on log data and divided into three user groups (low, intermediate and high). Online questionnaires were sent before, after treatment and at six-months follow-up. The relation between usage and the primary outcome - treatment success (PGI-) - was studied with a binomial logistic regression analysis. Changes in the secondary outcomes - symptom severity (ICIQ-UI SF) and quality of life (ICIQ-LUTSqol) - were studied per user group with linear mixed model analysis. RESULTS Included were 515 users with a mean age of 50.5 years (12.0 SD). The majority were low users (n = 295, 57.3%). Treatment success (PGI-I) was reached by one in four women and was more likely in high and intermediate users than in low users (OR 13.2, 95% CI 6.1-28.5, p < 0.001 and OR 2.92, 95% CI 1.35-6.34, p = 0.007, respectively). Symptom severity decreased and quality of life improved significantly over time, especially among high users. The women's expected ability to train their pelvic floor muscles and the frequency of pelvic floor muscle exercises at baseline were associated with treatment success. CONCLUSION This study shows that usage of eHealth for SUI is related to all treatment outcomes. High users are more likely to have treatment success. Treatment success is more likely in women with higher expectations and pelvic floor muscle training at baseline. These findings indicate that general practitioners can select patients that would be more likely to benefit from eHealth treatment, and they can enhance treatment effect by stimulating eHealth usage. TRIAL REGISTRATION Landelijk Trial Register NL6570; https://onderzoekmetmensen.nl/nl/trial/25463 .
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Affiliation(s)
- Lotte Firet
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands.
| | - Theodora Alberta Maria Teunissen
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
| | - Rudolf Bertijn Kool
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands
| | - Reinier Peter Akkermans
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
- Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands
| | - Antoinette Leonarda Maria Lagro-Janssen
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
| | - Huub van der Vaart
- Department of Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willem Jan Jozef Assendelft
- Radboud University Medical Center, Department of Primary and Community Care, Research Institute for Medical Innovation, Postbox 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, the Netherlands
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Raggi A, Bernard RM, Toppo C, Sabariego C, Salvador Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Olaya B, Antunes Lima R, Gutiérrez-Marín D, Vorstenbosch E, Curatoli C, Cacciatore M. The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study. J Med Internet Res 2024; 26:e48504. [PMID: 38488846 DOI: 10.2196/48504] [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: 04/26/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. OBJECTIVE The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. METHODS Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. RESULTS In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. CONCLUSIONS Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
| | - Luis Salvador Carulla
- Health Research Institute, University of Canberra, Canberra, Australia
- Healthcare Information Systems (CTS553), University of Cadiz, Cadiz, Spain
| | - Sue Lukersmith
- Health Research Institute, University of Canberra, Canberra, Australia
| | | | | | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rodrigo Antunes Lima
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Desirée Gutiérrez-Marín
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ellen Vorstenbosch
- Swiss Paraplegic Research, Nottwil, Switzerland
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Chiara Curatoli
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Martina Cacciatore
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Veneman T, Koopman FS, Oorschot S, Koomen PG, Nollet F, Voorn EL. A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study. JMIR Hum Factors 2024; 11:e49808. [PMID: 38488838 DOI: 10.2196/49808] [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: 06/12/2023] [Revised: 09/21/2023] [Accepted: 01/20/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). OBJECTIVE We aimed to determine the usability of the ReVi app. METHODS Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. RESULTS Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. CONCLUSIONS The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice.
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Affiliation(s)
- Tim Veneman
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Fieke Sophia Koopman
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Sander Oorschot
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Pien G Koomen
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Frans Nollet
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Eric L Voorn
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
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Hofner M, Hurnaus P, DiStefano D, Philip S, Kim S, Shaw J, Waring AC. Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study. JMIR Diabetes 2024; 9:e53835. [PMID: 38363585 DOI: 10.2196/53835] [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: 10/20/2023] [Revised: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. OBJECTIVE We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. METHODS We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. RESULTS Among all 95 patients, the average HbA1c decreased by -1.0 (from 8.2% to 7.2%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8%, the average HbA1c decreased by -2.1 (from 10.2% to 8.1%; P<.001), and in those with a baseline HbA1c >9%, the average HbA1c decreased by -2.8 (from 11% to 8.2%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by -1.2 (from 8.6% to 7.4%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). CONCLUSIONS A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible.
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Affiliation(s)
| | | | | | - Shaji Philip
- Washington Permanente Medical Group, Seattle, WA, United States
| | - Sarah Kim
- Zuckerberg San Francisco General Hospital, Division of Endocrinology, Diabetes and Metabolism, University of California, San Francisco, San Francisco, CA, United States
| | - Julie Shaw
- The Ottawa Hospital and EORLA, University of Ottawa, Ottowa, ON, Canada
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Xie H, Cong S, Wang R, Sun X, Han J, Ni S, Zhang A. Effect of eHealth interventions on perinatal depression: A meta-analysis. J Affect Disord 2024; 354:160-172. [PMID: 38490593 DOI: 10.1016/j.jad.2024.03.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND. AIM This meta-analysis aimed to determine the effect of eHealth interventions on PND. METHODS Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model. RESULTS A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy. CONCLUSIONS The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.
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Affiliation(s)
- Hongyan Xie
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Shengnan Cong
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Jiangsu, China
| | - Rui Wang
- Central South University Xiangya School of Nursing, Hunan, China
| | - Xiaoqing Sun
- Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jingjing Han
- School of Nursing, Suzhou University, Jiangsu, China
| | - Shiqian Ni
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Aixia Zhang
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Jiangsu, China.
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Ramos N, Besoain F, Cancino N, Gallardo I, Albornoz P, Fresno A, Spencer R, Schott S, Núñez D, Salgado C, Campos S. Development of a Multiplatform Tool for the Prevention of Prevalent Mental Health Pathologies in Adults: Protocol for a Randomized Control Trial. JMIR Res Protoc 2024; 13:e52324. [PMID: 38466982 DOI: 10.2196/52324] [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: 08/31/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The prevalence of depression and anxiety has increased in recent years, with many individuals having trouble accessing mental health support. Smartphones have become an integral part of modern life, with apps offering new ways to deliver evidence-based self-help strategies to cope with common mental health symptoms. However, most of them do not have empirical evidence of their overall effectiveness or the effectiveness of their components, which could pose a risk for users. OBJECTIVE The aim of this study is to evaluate the effectiveness of the modules of evaluation, psychoeducation, and emotional regulation strategies in a multiplatform self-help mental health mobile app in the Maule region of Chile. METHODS A sample of 196 adults will be selected, who will be randomly assigned to different components of the app for a fixed period to assess its ability to reduce symptomatology. RESULTS The trial is not yet recruiting and is expected to end in October 2024. The first results are expected in April 2024. CONCLUSIONS This is the first study in Chile to develop and test the effectiveness of a mobile app to manage anxiety and depression symptoms in adults. The intervention proposed is based on evidence suggesting that the internet or remote intervention tools and self-management of prevalent symptomatology could be the future of mental health care systems in the digital era. If the effects of the intervention are positive, wide implementation in Chile and other Spanish-speaking countries could be possible in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52324.
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Affiliation(s)
- Nadia Ramos
- Faculty of Psychology, University of Talca, Talca, Chile
- Center of Applied Psychology, Faculty of Psychology, University of Talca, Talca, Chile
| | - Felipe Besoain
- Faculty of Engineering, University of Talca, Talca, Chile
| | - Natalia Cancino
- Center of Applied Psychology, Faculty of Psychology, University of Talca, Talca, Chile
- Doctorate in Psychology, Faculty of Psychology, University of Talca, Talca, Chile
| | | | - Paula Albornoz
- Center of Applied Psychology, Faculty of Psychology, University of Talca, Talca, Chile
| | - Andres Fresno
- Faculty of Psychology, University of Talca, Talca, Chile
| | | | | | - Daniel Núñez
- Faculty of Psychology, University of Talca, Talca, Chile
| | - Carolina Salgado
- Center of Applied Psychology, Faculty of Psychology, University of Talca, Talca, Chile
- Medical School, Universidad Catolica del Maule, Talca, Chile
| | - Susana Campos
- Center of Applied Psychology, Faculty of Psychology, University of Talca, Talca, Chile
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Christie HL, Atefi G, Craven MP, Orrell M, de Vugt ME. EmpRess: an eHealth implementation readiness checklist for dementia developed through an interview study of stakeholder needs. Aging Ment Health 2024:1-9. [PMID: 38468471 DOI: 10.1080/13607863.2024.2323951] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE This study aimed to create a tool to assess eHealth interventions for dementia by adapting an existing implementation readiness (ImpRess) checklist that assessed manualised interventions. METHODS In Part 1, online semi-structured interviews with individual stakeholders (N = 9) with expertise in eHealth and dementia were conducted (response rate 83%). The Nonadoption, Abandonment, and challenges to the Scale-Up, Spread, and Sustainability of Health and care technologies (NASSS) framework was applied, both to guide the construction of the interview guide, as well as to use its subdomains as codes in the deductive qualitative thematic analysis. Respondents were industry professionals (n = 3), researchers (n = 3), policy officers (n = 2), and a clinician (n = 1). In Part 2, the items of the original ImpRess checklist were supplemented by items that covered determinants discussed in the interviews, that were not included in the original checklist. RESULTS The main findings from the interviews included: Participants' preference for a non-dementia-specific, more general approach to the checklist; the importance of searching for shared values with implementers; and the need for more systematic monitoring of implementation. CONCLUSIONS The EmpRess checklist applies an inclusive design approach. The checklist will help evaluate the implementation determinants of eHealth interventions for dementia and provide up-to-date information on what is, and is not, working in eHealth for dementia care.
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Affiliation(s)
- Hannah L Christie
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Golnaz Atefi
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Michael P Craven
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Marjolein E de Vugt
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Canfell OJ, Woods L, Meshkat Y, Krivit J, Gunashanhar B, Slade C, Burton-Jones A, Sullivan C. The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis. J Med Internet Res 2024; 26:e47715. [PMID: 38466978 DOI: 10.2196/47715] [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: 03/29/2023] [Revised: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. OBJECTIVE This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. RESULTS A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. CONCLUSIONS Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.
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Affiliation(s)
- Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yasaman Meshkat
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jenna Krivit
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brinda Gunashanhar
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia
| | - Andrew Burton-Jones
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia
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Savolainen K, Kujala S. Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services. JMIR Hum Factors 2024; 11:e45275. [PMID: 38457214 PMCID: PMC10960212 DOI: 10.2196/45275] [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: 12/22/2022] [Revised: 03/08/2023] [Accepted: 02/03/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The popularity of eHealth services has surged significantly, underscoring the importance of ensuring their usability and accessibility for users with diverse needs, characteristics, and capabilities. These services can pose cognitive demands, especially for individuals who are unwell, fatigued, or experiencing distress. Additionally, numerous potentially vulnerable groups, including older adults, are susceptible to digital exclusion and may encounter cognitive limitations related to perception, attention, memory, and language comprehension. Regrettably, many studies overlook the preferences and needs of user groups likely to encounter challenges associated with these cognitive aspects. OBJECTIVE This study primarily aims to gain a deeper understanding of cognitive accessibility in the practical context of eHealth services. Additionally, we aimed to identify the specific challenges that vulnerable groups encounter when using eHealth services and determine key considerations for testing these services with such groups. METHODS As a case study of eHealth services, we conducted qualitative usability testing on 2 online symptom checkers used in Finnish public primary care. A total of 13 participants from 3 distinct groups participated in the study: older adults, individuals with mild intellectual disabilities, and nonnative Finnish speakers. The primary research methods used were the thinking-aloud method, questionnaires, and semistructured interviews. RESULTS We found that potentially vulnerable groups encountered numerous issues with the tested services, with similar problems observed across all 3 groups. Specifically, clarity and the use of terminology posed significant challenges. The services overwhelmed users with excessive information and choices, while the terminology consisted of numerous complex medical terms that were difficult to understand. When conducting tests with vulnerable groups, it is crucial to carefully plan the sessions to avoid being overly lengthy, as these users often require more time to complete tasks. Additionally, testing with vulnerable groups proved to be quite efficient, with results likely to benefit a wider audience as well. CONCLUSIONS Based on the findings of this study, it is evident that older adults, individuals with mild intellectual disability, and nonnative speakers may encounter cognitive challenges when using eHealth services, which can impede or slow down their use and make the services more difficult to navigate. In the worst-case scenario, these challenges may lead to errors in using the services. We recommend expanding the scope of testing to include a broader range of eHealth services with vulnerable groups, incorporating users with diverse characteristics and capabilities who are likely to encounter difficulties in cognitive accessibility.
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Affiliation(s)
- Kaisa Savolainen
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Sari Kujala
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
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Bente BE, Van Dongen A, Verdaasdonk R, van Gemert-Pijnen L. eHealth implementation in Europe: a scoping review on legal, ethical, financial, and technological aspects. Front Digit Health 2024; 6:1332707. [PMID: 38524249 PMCID: PMC10957613 DOI: 10.3389/fdgth.2024.1332707] [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: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Background The evolution of eHealth development has shifted from standalone tools to comprehensive digital health environments, fostering data exchange among diverse stakeholders and systems. Nevertheless, existing research and implementation frameworks have primarily emphasized technological and organizational aspects of eHealth implementation, overlooking the intricate legal, ethical, and financial considerations. It is essential to discover what legal, ethical, financial, and technological challenges should be considered to ensure successful and sustainable implementation of eHealth. Objective This review aims to provide insights into barriers and facilitators of legal, ethical, financial, and technological aspects for successful implementation of complex eHealth technologies, which impacts multiple levels and multiple stakeholders. Methods A scoping review was conducted by querying PubMed, Scopus, Web of Science, and ACM Digital Library (2018-2023) for studies describing the implementation process of eHealth technologies that facilitate data exchange. Studies solely reporting clinical outcomes or conducted outside Europe were excluded. Two independent reviewers selected the studies. A conceptual framework was constructed through axial and inductive coding, extracting data from literature on legal, ethical, financial, and technological aspects of eHealth implementation. This framework guided systematic extraction and interpretation. Results The search resulted in 7.308 studies that were screened for eligibility, of which 35 (0.48%) were included. Legal barriers revolve around data confidentiality and security, necessitating clear regulatory guidelines. Ethical barriers span consent, responsibility, liability, and validation complexities, necessitating robust frameworks. Financial barriers stem from inadequate funding, requiring (commercial) partnerships and business models. Technological issues include interoperability, integration, and malfunctioning, necessitating strategies for enhancing data reliability, improving accessibility, and aligning eHealth technology with existing systems for smoother integration. Conclusions This research highlights the multifaceted nature of eHealth implementation, encompassing legal, ethical, financial, and technological considerations. Collaborative stakeholder engagement is paramount for effective decision-making and aligns with the transition from standalone eHealth tools to integrated digital health environments. Identifying suitable stakeholders and recognizing their stakes and values enriches implementation strategies with expertise and guidance across all aspects. Future research should explore the timing of these considerations and practical solutions for regulatory compliance, funding, navigation of responsibility and liability, and business models for reimbursement strategies.
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Affiliation(s)
- Britt E. Bente
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Esnchede, Netherlands
| | - Anne Van Dongen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Esnchede, Netherlands
| | - Ruud Verdaasdonk
- Section of Health, Technology and Implementation, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Esnchede, Netherlands
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Main A, McCartney H, Ibrar M, Rai HK, Muirhead F, Mavroeidi A, Maguire R. Patients' Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Protocol for a Systematic Review and Thematic Synthesis. JMIR Res Protoc 2024; 13:e52469. [PMID: 38451694 PMCID: PMC10958340 DOI: 10.2196/52469] [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: 09/04/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent condition that requires multidisciplinary treatment. However, in the United Kingdom, access to specialist pain clinics where patients can receive medical multidisciplinary treatment is limited, and provision varies between health boards. As such, self-management of chronic pain using digital tools has been gaining traction recently, but evidence of its effectiveness from clinical-based trials focuses mainly on quantitative outcomes. OBJECTIVE This systematic review aims to identify, appraise, and synthesize qualitative evidence on patients' experiences with digital health interventions (DHIs) for the management of chronic pain. METHODS This systematic review will consider qualitative and mixed methods studies that explore the experience of patients (aged 18 years and older) with chronic pain engaging in DHIs to manage their pain. MEDLINE Ovid, PubMed, Embase, CINAHL, PsycINFO, and Scopus databases will be searched for published studies. The systematic review will be conducted in accordance with the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Following the 3-step thematic synthesis methodology of Thomas and Harden, titles and abstracts will be screened by 2 independent reviewers (AM and HM), and a third reviewer (MI or FM) will resolve any conflict that arises before the full-text screening. The Critical Appraisal Skills Programme checklist tool will be used to critically appraise the included studies. The extracted data will be imported to NVivo (QSR International), where thematic synthesis will be used to derive analytical themes from the included studies. RESULTS Themes that encapsulate the patient experience will be identified from qualitative evidence, and these themes will shed light on the perceived benefits and disadvantages, usability, acceptability, and the overall impact digital tools can have on the lives of those with chronic pain. CONCLUSIONS This systematic review will identify, appraise, and synthesize the overall experience of patients engaging in DHI to manage a diverse range of chronic pain conditions. By elaborating the patient experience through qualitative analysis, the findings from this review will enhance our current understanding of the experiences of patients with chronic pain using digital tools for the self-management of their pain and highlight what person-centered elements are essential for future DHI development. TRIAL REGISTRATION PROSPERO CRD42023445100; http://tinyurl.com/4z77khfs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52469.
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Affiliation(s)
- Ashleigh Main
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Haruno McCartney
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Maryam Ibrar
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Harleen Kaur Rai
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Fiona Muirhead
- Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Alexandra Mavroeidi
- Department of Occupational Therapy and Human Nutrition and Dietetics, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Haslbeck J, Casanova F, Cascais D, Staudacher S. [Chat-based cancer counseling in Switzerland: A reflexive thematic analysis of chat protocols focused on cancer survivors' needs]. Pflege 2024. [PMID: 38450628 DOI: 10.1024/1012-5302/a000986] [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: 03/08/2024]
Abstract
Chat-based cancer counseling in Switzerland: A reflexive thematic analysis of chat protocols focused on cancer survivors' needs Abstract: Background: The number of people diagnosed with cancer and continue to live as cancer survivors is growing. Together with their relatives, they have information and counseling needs during the illness trajectory. With Cancerline, the Swiss Cancer League offers a chat-based counseling service for cancer survivors. Research question/objective: For the first time, the qualitative study investigated which needs cancer survivors express in Cancerline to gain insights for the further development and quality assurance of chat-based cancer counseling. Methods: Based on the principles of Interpretive Description, 669 chat counseling transcripts were analyzed using Braun et al. (2018) reflexive thematic analysis in an iterative process in six analysis steps. Results: Cancer survivorship needs in Cancerline are multifaceted, and we have identified nine themes: need anonymous chat to communicate, get informed, weigh ethical dilemmas and make decisions, seek meaning and hope, find ways to manage burdensome emotions, resolve social conflict and not burden others, feel understood and give space to own needs, clarify role as significant other acting correctly and seeking security. Conclusions: Chat-based counseling may contribute to supporting cancer survivors with information needs about cancer in a flexible way that is close to everyday life. Professionals can sensitize survivors to chat-based counseling, which makes low-threshold counseling accessible.
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Affiliation(s)
| | | | - Diana Cascais
- Gynäkologisches Tumorzentrum, Universitätsspital Basel, Schweiz
| | - Sandra Staudacher
- Institut für Pflegewissenschaft, Universität Basel, Schweiz
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Niederlande
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Panadés Zafra R, Amorós Parramon N, Albiol-Perarnau M, Yuguero Torres O. [Analysis of the challenges and dilemmas that bioethics of the 21st century will face in the digital health era]. Aten Primaria 2024; 56:102901. [PMID: 38452658 PMCID: PMC10926291 DOI: 10.1016/j.aprim.2024.102901] [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: 11/10/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
The medical history underscores the significance of ethics in each advancement, with bioethics playing a pivotal role in addressing emerging ethical challenges in digital health (DH). This article examines the ethical dilemmas of innovations in DH, focusing on the healthcare system, professionals, and patients. Artificial Intelligence (AI) raises concerns such as confidentiality and algorithmic biases. Mobile applications (Apps) empower but pose challenges of access and digital literacy. Telemedicine (TM) democratizes and reduces healthcare costs but requires addressing the digital divide and interconsultation dilemmas; it necessitates high-quality standards with patient information protection and attention to equity in access. Wearables and the Internet of Things (IoT) transform healthcare but face ethical challenges like privacy and equity. 21st-century bioethics must be adaptable as DH tools demand constant review and consensus, necessitating health science faculties' preparedness for the forthcoming changes.
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Affiliation(s)
- Robert Panadés Zafra
- Grup de Recerca Promoció de la Salut en l'Àmbit Rural, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, España; Grup de Salut Digital CAMFIC, Barcelona, España; Equip d'Atenció Primària d'Anoia Rural, Gerència d'Atenció Primària i a la Comunitat de Catalunya Central, Institut Català de la Salut, Jorba i Copons, Barcelona, España
| | - Noemí Amorós Parramon
- Equip d'Atenció Primària Guineueta, Gerència d'Atenció Primària i a la Comunitat de Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | - Marc Albiol-Perarnau
- Grup de Salut Digital CAMFIC, Barcelona, España; Equip d'Atenció Primària Can Moritz-Mossèn Jaume Soler, UDMAFiC Metropolitana Sud, Institut Català de la Salut, Cornellà de Llobregat, Barcelona, España.
| | - Oriol Yuguero Torres
- Grup de Salut Digital CAMFIC, Barcelona, España; Ehealth Center, Universitat Oberta de Catalunya (UOC), Barcelona, España; ErLab, Instituto de Investigación Biomédica de Lleida, IRBLLEIDA, Lleida, España
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McCartney H, Main A, Ibrar M, Rai HK, Weir NM, Maguire R. Professional-Facing Digital Health Solutions for the Care of Patients With Chronic Pain: Protocol for a Systematic Scoping Review. JMIR Res Protoc 2024; 13:e51311. [PMID: 38441946 PMCID: PMC10951835 DOI: 10.2196/51311] [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: 07/27/2023] [Revised: 12/22/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent condition and one of the most common reasons why people seek health care. As a result, chronic pain has a significant personal and economic burden. The COVID-19 pandemic has aggravated the situation for patients with chronic pain through increased risk factors (eg, anxiety or depression) as well as decreased access to health care. Digital health solutions to support people with chronic pain are becoming increasingly popular. Most of the research has focused on patient-facing digital health solutions, although it is clear that the involvement of health and care professionals is crucial in chronic pain care. Certainly, digital health solutions intended for the use of health and care professionals in the care of patients with chronic pain (ie, professional facing) exist, for example, for clinical decision support; however, no review has investigated the studies reporting these interventions. OBJECTIVE The overall aim of this scoping review is to identify the available professional-facing digital health solutions for the purpose of chronic pain management. The objectives of this review are to investigate the components, target populations, and user settings of the available professional-facing digital solutions; health and care professionals' perspectives on using digital health solutions (if reported); the methods in which the digital health solutions are developed; and the outcomes of using professional-facing digital health solutions. METHODS Databases including MEDLINE, Embase, CINAHL, PsycInfo, and Inspec will be searched for studies reporting professional-facing digital health solutions for chronic pain care, using a comprehensive search strategy developed for each of the specific databases. A total of 2 independent reviewers will screen the titles and abstracts for review inclusion and then conduct full-text screening. Any conflicts in study inclusion will be resolved by a third reviewer at each stage of the screening process. Following data extraction and quality assessment, a qualitative content analysis of the results will be conducted. This review will identify the available professional-facing digital health solutions for chronic pain management. The results of this review are likely to be heterogeneous in terms of content (ie, the digital solutions will serve a variety of purposes, settings, target populations, etc) and methods (ie, experimental and nonexperimental designs). RESULTS The review is expected to finish in March 2024 and published in the summer of 2024. CONCLUSIONS This protocol outlines the need for a scoping review to identify professional-facing digital health solutions for the management of chronic pain. Results from this review will contribute to the growing field of research into the utility of digital health for chronic pain management. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51311.
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Affiliation(s)
- Haruno McCartney
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Ashleigh Main
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Maryam Ibrar
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Harleen Kaur Rai
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Natalie McFayden Weir
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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van Dijk W, Oosterman M, de Vente W, Jansen I, Blankers M, Huizink AC. Smoking cessation in pregnant women: A randomized controlled trial investigating the effectiveness of an eHealth intervention including heart rate variability-biofeedback training. Addict Behav 2024; 154:108005. [PMID: 38513327 DOI: 10.1016/j.addbeh.2024.108005] [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: 11/16/2023] [Revised: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Prenatal smoking and stress are associated with adverse health effects for women themselves and are risk factors for adverse outcomes of the child. Effective interventions are needed to support women with smoking cessation and reducing stress. The aims were (1) to test the effectiveness of an 8-week eHealth intervention targeting stress reduction and smoking cessation; (2) to examine whether stress reduction mediated the intervention effect on smoking behavior; (3) to test motivation to quit as a moderator; and (4) to investigate a dose-response effect of program usage. METHODS Pregnant women were included if they were >18 years of age, < 28 weeks pregnant at recruitment, and currently smoking. In total, 156 consenting participants were randomly assigned to the intervention or active control condition. Study outcomes on smoking (yes/no, frequency, and quantity) were collected via online questionnaires at pre-intervention (baseline; t0), post-intervention (8 weeks after t0; t1), and follow up at two weeks (t2) and three months (t3) after birth. RESULTS Smoking and stress reduced over the 8-week period in both conditions. The intervention effect on smoking was not mediated by stress reduction. Motivation to quit was found to moderate the intervention effect (smoking frequency and quantity) and a dose-response effect was found for program usage in the intervention for the reduction on smoking frequency and quantity. CONCLUSION Program usage and motivation to quit are important for smoking reduction in pregnant women. Further research is needed to examine how the intervention could be improved to increase treatment effectiveness.
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Affiliation(s)
- Willeke van Dijk
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
| | - Mirjam Oosterman
- Department of Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
| | - Wieke de Vente
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam Roeterseilandcampus, Building D, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands.
| | - Imke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Institute for Brain and Behavior Amsterdam (IBBA), Van der Boechorststraat 1, Transitorium Room 1B-78, 1081 BT Amsterdam, the Netherlands.
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, the Netherlands; Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Anja C Huizink
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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Dratva J, Schaeffer D, Zeeb H. [Digital health literacy in Germany: current status, concepts, and challenges]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:277-284. [PMID: 38315221 DOI: 10.1007/s00103-024-03841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
A key prerequisite for the successful digital transformation of the healthcare system is a well-developed level of digital health literacy (DHL) among the population. DHL is the ability to deal with health-relevant digital information and information options with the aim of promoting and maintaining health and well-being for oneself and one's environment. This article examines the discussions about digital health literacy, the existing studies and measurement tools used in them, the data situation in Germany, and current challenges.DHL consists of various sub-competencies that reflect current digital information behavior, opportunities, and risks. The data situation is very heterogeneous due to different study designs and instruments, which limits the informative value. Two representative studies, HLS-Ger‑2 by Bielefeld University and the study by AOK Rheinland/Hamburg and the Leibniz-WissenschaftsCampus, both indicate a high proportion of people with low DHL despite different methods. Both nationally and internationally, DHL is subject to a social gradient and is associated with educational level, social status, financial deprivation, and age.According to the current empirical data, the acquisition of DHL in Germany is still insufficient, so there is a great need for action. The necessary legal framework conditions have been established, but there is still a lack of reliable and financial resources, as well as a solid data basis on DHL at population level. This is essential to identify vulnerability factors and to prepare and evaluate the implementation of measures. In addition, there is a need for an in-depth conceptual discussion on DHL that builds on the established health literacy concept and addresses the emerging health-related infodemic and its consequences for DHL.
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Affiliation(s)
- Julia Dratva
- Institut für Public Health, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Katharina-Sulzer-Platz 9, 8400, Winterthur, Schweiz.
- Fakultät Medizin, Universität Basel, Basel, Schweiz.
| | - Doris Schaeffer
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Hajo Zeeb
- Leibniz ScienceCampus Digital Public Health, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland
- Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
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42
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Jonassaint CR, Parchuri E, O'Brien JA, Lalama CM, Lin J, Badawy SM, Hamm ME, Stinson J, Lalloo C, Carroll CP, Saraf SL, Gordeuk VR, Cronin R, Shah N, Lanzkron SM, Liles D, Trimnell C, Bailey L, Lawrence RH, Abebe KZ. Mental health, pain and likelihood of opioid misuse among adults with sickle cell disease. Br J Haematol 2024; 204:1029-1038. [PMID: 38171495 PMCID: PMC10939903 DOI: 10.1111/bjh.19243] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Depressive symptoms are prevalent in individuals living with sickle cell disease (SCD) and may exacerbate pain. This study examines whether higher depressive symptoms are associated with pain outcomes, pain catastrophizing, interference and potential opioid misuse in a large cohort of adults with SCD. The study utilized baseline data from the 'CaRISMA' trial, which involved 357 SCD adults with chronic pain. Baseline assessments included pain intensity, daily mood, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorders scale, PROMIS Pain Interference, Pain Catastrophizing Scale, the Adult Sickle Cell Quality of Life Measurement Information System and the Current Opioid Misuse Measure. Participants were categorized into 'high' or 'low' depression groups based on PHQ scores. Higher depressive symptoms were significantly associated with increased daily pain intensity, negative daily mood, higher pain interference and catastrophizing, poorer quality of life and a higher likelihood of opioid misuse (all p < 0.01). SCD patients with more severe depressive symptoms experienced poorer pain outcomes, lower quality of life and increased risk of opioid misuse. Longitudinal data from this trial will determine whether addressing depressive symptoms may potentially reduce pain frequency and severity in SCD.
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Affiliation(s)
| | - Ektha Parchuri
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julia A O'Brien
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christina M Lalama
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan Lin
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Megan E Hamm
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Stinson
- Child Health Evaluative Sciences in Research Institute, Hospital for Sick Children and Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Chitra Lalloo
- Child Health Evaluation Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Santosh L Saraf
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Department of Medicine, Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Cronin
- Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Nirmish Shah
- Division of Hematology, Division of Pediatric Hematology/Oncology, Sickle Cell Transition Program, Duke University, Durham, North Carolina, USA
| | - Sophie M Lanzkron
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darla Liles
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Lakiea Bailey
- Sickle Cell Community Consortium, Atlanta, Georgia, USA
| | - Raymona H Lawrence
- The Jiann-Ping Hsu College of Public Health, Georgia Southern University in Statesboro, Statesboro, Georgia, USA
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Cohen Rodrigues TR, de Buisonjé DR, Reijnders T, Santhanam P, Kowatsch T, Breeman LD, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW. Human cues in eHealth to promote lifestyle change: An experimental field study to examine adherence to self-help interventions. Internet Interv 2024; 35:100726. [PMID: 38370288 PMCID: PMC10869898 DOI: 10.1016/j.invent.2024.100726] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024] Open
Abstract
eHealth lifestyle interventions without human support (self-help interventions) are generally less effective, as they suffer from lower adherence levels. To solve this, we investigated whether (1) using a text-based conversational agent (TCA) and applying human cues contribute to a working alliance with the TCA, and whether (2) adding human cues and establishing a positive working alliance increase intervention adherence. Participants (N = 121) followed a TCA-supported app-based physical activity intervention. We manipulated two types of human cues: visual (ie, message appearance) and relational (ie, message content). We employed a 2 (visual cues: yes, no) x 2 (relational cues: yes, no) between-subjects design, resulting in four experimental groups: (1) visual and relational cues, (2) visual cues only, (3) relational cues only, or (4) no human cues. We measured the working alliance with the Working Alliance Inventory Short Revised form and intervention adherence as the number of days participants responded to the TCA's messages. Contrary to expectations, the working alliance was unaffected by using human cues. Working alliance was positively related to adherence (t(78) = 3.606, p = .001). Furthermore, groups who received visual cues showed lower adherence levels compared to those who received relational cues only or no cues (U = 1140.5, z = -3.520, p < .001). We replicated the finding that establishing a working alliance contributes to intervention adherence, independently of the use of human cues in a TCA. However, we were unable to show that adding human cues impacted the working alliance and increased adherence. The results indicate that adding visual cues to a TCA may even negatively affect adherence, possibly because it may create confusion concerning the true nature of the coach, which may prompt unrealistic expectations.
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Affiliation(s)
| | | | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Instiute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
| | - Linda D. Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
| | - Veronica R. Janssen
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Roderik A. Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
- Vital10, Amsterdam, the Netherlands
| | - Douwe E. Atsma
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, the Netherlands
| | - the BENEFIT consortium
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Instiute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Department of Cardiology, Leiden University Medical Center, the Netherlands
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
- Vital10, Amsterdam, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, the Netherlands
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Kukka AJ, Sundelin HEK, Basnet O, Paudel P, Upadhyay Subedi K, Svensson K, Brown N, Litorp H, Gurung R, Bhattarai P, Wrammert J, Kc A. NeuroMotion smartphone application for remote General Movements Assessment: a feasibility study in Nepal. BMJ Open 2024; 14:e080063. [PMID: 38431302 PMCID: PMC10910581 DOI: 10.1136/bmjopen-2023-080063] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening infants for cerebral palsy in Kathmandu, Nepal. METHOD Thirty-one term-born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women's Hospital, 1 October 2021 to 7 January 2022. Parents filmed their children at home using the application at 3 months' age and the videos were assessed for technical quality using a standardised form and for fidgety movements by Prechtl's General Movements Assessment. The usability of the application was evaluated through a parental survey. RESULTS Twenty families sent in altogether 46 videos out of which 35 had approved technical quality. Sixteen children had at least one video with approved technical quality. Three infants lacked fidgety movements. The level of agreement between assessors was acceptable (Krippendorf alpha 0.781). Parental answers to the usability survey were in general positive. INTERPRETATION Engaging parents in screening of cerebral palsy with the help of a smartphone-aided remote General Movements Assessment is possible in the urban area of a South Asian lower middle-income country.
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Affiliation(s)
- Antti Juhani Kukka
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Region Gävleborg, Gävle, Sweden
| | - Heléne E K Sundelin
- Division of children's and women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Prajwal Paudel
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | - Katarina Svensson
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Nick Brown
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Region Gävleborg, Gävle, Sweden
| | - Helena Litorp
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rejina Gurung
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Golden Community, Lalitpur, Nepal
| | | | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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45
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Augustin M, Wenzel AS, Licata-Dandel M, Breeman LD, Bilgin A, Wolke D, Ziegler M, Mall V, Friedmann A. App-based intervention for parents of children with crying, sleeping, and feeding problems: Usability, usefulness and implications for improvement. Internet Interv 2024; 35:100700. [PMID: 38221943 PMCID: PMC10784306 DOI: 10.1016/j.invent.2023.100700] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
Background There is a lack of evidence-based app guidance for parents of children with crying, sleeping, and feeding problems who are often highly burdened and not likely to seek professional help. A new psychoeducational app for parents providing scientifically sound information via text and videos, a diary function, selfcare strategies, a chat forum and a regional directory of specialized counseling centers may serve as a low-threshold intervention for this target group. Objective We investigated how parents perceived the app in terms of the following: (1) overall impression and usability, (2) feedback on specific app functions regarding usefulness and (3) possible future improvements. Methods Our clinical sample of N = 137 parents of children aged from 0 to 24 months was recruited from a cry baby outpatient clinic in Southern Germany between 2019 and 2022. A convergent parallel mixed methods design was used to collect and analyse cross-sectional data on app evaluation. After app use within the framework of a clinical trial, parents filled in an app evaluation questionnaire. Results Most participants used the app at least once a week (86, 62.8 %) over an average period of 19.06 days (SD = 15.00). Participants rated overall impression and usability as good, and the informational texts, expert videos and regional register of counseling centers as appealing and useful. The diary function and chat forum were found to be helpful in theory, but improvements in implementation were requested, such as a timer function for the diary entry. Regarding future functionality, parents posed several suggestions such as the option to contact counseling centers directly via app, and the inclusion of the profile of their partners. Conclusions Positive ratings of overall impression, usability, and specific app functions are important prerequisites for the app to be effective. App-based guidance for this target group should include easy-to-use information. The app is intended to serve as a secondary preventive low-threshold offer and to complement professional counseling.
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Affiliation(s)
- Michaela Augustin
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Anne Sophie Wenzel
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Maria Licata-Dandel
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
- Department of Psychology, Charlotte-Fresenius-University, Infanteriestr.11a, 80797 Munich, Germany
| | - Linda D. Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, Netherlands
| | - Ayten Bilgin
- Department of Psychology, University of Essex, Colchester CO4 3SQ, United Kingdom
| | - Dieter Wolke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
- Department of Psychology, University of Warwick, Coventry CV4 7HL, United Kingdom
| | - Margret Ziegler
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Volker Mall
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Anna Friedmann
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
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46
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Douma ER, Wirtz S, Fernandez MS, Schäfer H, Widdershoven JW, Habibović M, Gil CP, Bosch JA, Schmitz B, Kop WJ. Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators. Internet Interv 2024; 35:100728. [PMID: 38405384 PMCID: PMC10883827 DOI: 10.1016/j.invent.2024.100728] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR. Purpose To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR. Methods Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation. Results The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior. Conclusions Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.
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Affiliation(s)
- Emma R. Douma
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Svenja Wirtz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Manuela Sestayo Fernandez
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Hendrik Schäfer
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Jos W.M.G. Widdershoven
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
- Elisabeth-TweeSteden Hospital, Department of Cardiology, Tilburg, the Netherlands
| | - Mirela Habibović
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Carlos Peña Gil
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Jos A. Bosch
- University of Amsterdam, Faculty of Social and Behavioral Sciences, Amsterdam, the Netherlands
| | - Boris Schmitz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Willem J. Kop
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
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Keogh A, Brennan C, Johnston W, Dickson J, Leslie SJ, Burke D, Megyesi P, Caulfield B. Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study. JMIR Form Res 2024; 8:e52442. [PMID: 38427410 PMCID: PMC10959238 DOI: 10.2196/52442] [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: 09/04/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. OBJECTIVE This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. METHODS A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. RESULTS Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. CONCLUSIONS The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs.
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Affiliation(s)
- Alison Keogh
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Carol Brennan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - William Johnston
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
| | - Jane Dickson
- Physiotherapy Department, Beacon Hospital, Dublin, Ireland
- Cardiology, Beacon Hospital, Dublin, Ireland
| | | | - David Burke
- Cardiology, Beacon Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Peter Megyesi
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Brian Caulfield
- Insight Centre Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Cervera García A, Goussens A. [Cybersecurity and use of ICT in the health sector]. Aten Primaria 2024; 56:102854. [PMID: 38219392 PMCID: PMC10823061 DOI: 10.1016/j.aprim.2023.102854] [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: 11/01/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Cybercrime in the health sector is a growing threat in the digital age. With computerization of medical records and telemedicine on the rise, cyberattacks can have devastating consequences. Leaking sensitive data or hijacking systems can compromise patient's privacy and jeopardize healthcare. To counter this threat, robust cybersecurity measures are required as a protective measure. This article aims to expose the main dangers and threats faced by ICT, as well as present cybersecurity with its bioethical implications and, finally, the ideal scheme for it in the health sector in order to create a safer and more efficient environment. This article aims to address these issues and provide a comprehensive view of how cybersecurity and ICT can coexist safely and effectively in the healthcare field.
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Affiliation(s)
- Alejandro Cervera García
- L'Equip d'Atenció Primària de Figueres (EAP Figueres), Institut Català de la Salut, Girona, España
| | - Alyson Goussens
- L'Equip d'Atenció Primària de Figueres (EAP Figueres), Institut Català de la Salut, Girona, España.
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Kocol D, Geiger S, Schweda A, Beckord J, Schadendorf T, Jansen C, Robitzsch A, Skoda EM, Teufel M, Bäuerle A. An e-mental health intervention to reduce depression symptoms in individuals with obesity: study protocol for the randomized, controlled, two-armed, confirmatory LightMood trial. Trials 2024; 25:149. [PMID: 38419096 PMCID: PMC10900592 DOI: 10.1186/s13063-024-07970-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Patients with obesity often experience psychological distress, specifically depression symptoms. Due to various barriers, such as limitations of healthcare offers, digital interventions, for example medical apps, can provide a suitable approach to support affected people. In the envisaged prospective randomized controlled trial, we aim to examine the efficacy of the LightMood intervention. The LightMood intervention is a manualized and user-centered, digital intervention for patients with obesity, with a duration of 4 months, which contains elements of cognitive behavioral therapy and mindfulness-based and skills-based exercises. We expect the LightMood intervention to be superior to treatment as usual (TAU) in terms of reducing depression symptoms. METHODS The trial incorporates four distinct measurement time points: the baseline assessment, the post-treatment assessment, and 1- and 3-month follow-up assessments. Furthermore, we implemented in-treatment assessments for both groups. Participants will be randomized into two groups (LightMood intervention vs TAU). The aim is to include 128 participants (64 per group) in the study. Inclusion criteria are patients who are obese, at least 18 years old, with a private Internet access, and with adequate digital literacy and show depression symptoms (PHQ ≥ 10). Exclusion criteria are weekly outpatient individual psychotherapy, obesity surgery within the last year or planned within the next 7 months, no private Internet access, and the prescription of a new psychotropic drug within the last 2 weeks. The primary outcome is the post-assessment reduction in depression symptoms. Secondary outcomes will include the improvement in self-efficacy, quality of life, mindfulness, reduction in eating disorder symptoms, and body mass index (BMI). Furthermore, we expect a positive development of depression symptoms throughout the different time points (T1, T2, and T3) in patients with obesity. DISCUSSION LightMood is an evidence-based, efficient, low-threshold online intervention that aims to reduce depression symptoms in people with obesity. Online interventions could offer a promising alternative to conventional face-to-face therapy. The primary objective of the current study is to add essential insight into the feasibility, efficacy, effectiveness, and acceptance of e-mental health interventions for people with obesity and depression symptoms. TRIAL REGISTRATION German Clinical Trial Register (DRKS), DRKS00029219. Registered on May 19, 2023.
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Affiliation(s)
- Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.
| | - Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Jil Beckord
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Theresa Schadendorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Anita Robitzsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Myllykangas K, Härkönen H, Kääriäinen M, Kärppä M, Jansson M. Patient experiences on the quality of cerebrovascular diseases counselling using digital solutions in hospital-A qualitative research study. J Clin Nurs 2024. [PMID: 38413773 DOI: 10.1111/jocn.17025] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/29/2023] [Accepted: 01/15/2024] [Indexed: 02/29/2024]
Abstract
AIM To describe patients' experiences of the quality of counselling to develop new digital counselling solutions for patients with cerebrovascular disease. DESIGN A descriptive, qualitative approach. METHODS Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and treated as inpatients at a single university hospital in Finland between September 2021 and February 2022. Data were analysed using deductive and inductive content analysis. RESULTS The identified facilitators, barriers and possible solutions for the development of new digital counselling solutions were deductively categorized into five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency, and (5) effects and 12 generic categories. Patients with cerebrovascular diseases worry about symptoms affecting their ability to receive information and valued a supportive atmosphere. Staff should have more time for counselling and use motivational digital counselling solutions in plain language, moderate length and with multimedia content. Patients desired reminders, easy search functions and possibilities for two-way communication. CONCLUSION New digital counselling solutions could be beneficial in supporting the patients' knowledge, emotions and adherence. For the success of such solutions, patients' special needs concerning different levels of cognitive impairment need to be considered. IMPACT The results of this study may benefit healthcare organizations in the development of digital counselling solutions that meet the patients' needs. REPORTING METHOD We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION Patients were involved as the study population.
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Affiliation(s)
- Kirsi Myllykangas
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Henna Härkönen
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mikko Kärppä
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital and Research Unit of Clinical Medicine, Neurology, Oulu University, Oulu University Hospital, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Sciences and Technology (HST), University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Royal Melbourne Institute of Technology RMIT University, Melbourne, Australia
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