Fig 1 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Source publication
Lifestyle behavior changes can prevent progression of prediabetes to diabetes but providers often are not able to effectively counsel about preventive lifestyle changes. We developed and pilot tested the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance primary care providers' counseling about behavior change for patients with...
Context in source publication
Context 1
... total of 54 patients participated in the ADAPT study (see Fig. 1 for study flow). Mean age of the participants was 46 (SD 11) and most were female (83.3%); 38.9% were African-American, 40.7% were Hispanic and 11.1% were White; and 76% had a family history of diabetes. Comorbid- ities such as hypertension and hyperlipidemia were prevalent (44.4% and 29.6%, respectively) and most participants (79.6%) ...
Similar publications
The aim of this article is to bring some of the experience we have got from teaching the subjects Multimedia and Internet Technologies which are part of both teacher training and applied informatics study programme. Students of teacher training do not get so much possibility to have the teacher's role and are not much confronted with own responsibi...
Citations
... One study applied PHR and HCP DS in their DHIs. Mann et al [49] reported no change in HbA 1c and blood glucose levels after the intervention. Effects on T2DM prevention, consumer experience, HCP experience, and health care costs were not included in the study. ...
Background
Digital health interventions (DHIs) have rapidly evolved and significantly revolutionized the health care system. The quadruple aims of health care (improving population health, enhancing consumer experience, enhancing health care provider [HCP] experience, and decreasing health costs) serve as a strategic guiding framework for DHIs. It is unknown how DHIs can impact the burden of type 2 diabetes mellitus (T2DM), as measured by the quadruple aims.
Objective
This study aimed to systematically review the effects of DHIs on improving the burden of T2DM, as measured by the quadruple aims.
Methods
PubMed, Embase, CINAHL, and Web of Science were searched for studies published from January 2014 to March 2024. Primary outcomes were the development of T2DM, hemoglobin A1c (HbA1c) change, and blood glucose change (dysglycemia changes). Secondary outcomes were consumer experience, HCP experience, and health care costs. Outcomes were mapped to the quadruple aims. DHIs were categorized using the World Health Organization’s DHI classification. For each study, DHI categories were assessed for their effects on each outcome, categorizing the effects as positive, negative, or neutral. The overall effects of each DHI category were determined by synthesizing all reported positive, neutral, or negative effects regardless of the number of studies supporting each effect. The Cochrane risk-of-bias version 2 (RoB 2) tool for randomized trials was used to assess the quality of randomized controlled trials (RCTs), while the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool was applied for nonrandomized studies.
Results
In total, 53 papers were included. For the T2DM development outcome, the effects of DHIs were positive in 1 (1.9%) study and neutral in 9 (17%) studies, and there were insufficient data to assess in 4 (7.5%) studies. For the dysglycemia outcome, the effects were positive in 23 (43.4%) studies and neutral in 24 (45.3%) studies, and there were insufficient data in 6 (11.3%) studies. There were mixed effects on consumer experience (n=13, 24.5%) and a lack of studies reporting HCP experience (n=1, 1.9%) and health care costs (n=3, 5.7%). All studies that reported positive population health outcomes used a minimum of 2 distinct categories of DHIs. Among these successful studies, the one that reported delaying the development of T2DM and 16 (69.6%) of those reporting improvements in dysglycemia involved HCP interaction. Targeted communication with persons (TCP), personal health tracking (PHT), and telemedicine (TM) showed some evidence as a potentially useful tool for T2DM prevention and dysglycemia.
Conclusions
The effects of DHIs on T2DM prevention, as measured by the quadruple aims, have not been comprehensively assessed, with proven benefits for population health, mixed results for consumer experience, and insufficient studies on HCP experience and health care costs. To maximize their effectiveness in preventing T2DM and managing dysglycemia, DHIs should be used in combination and strategically integrated with in-person or remote HCP interaction.
Trial Registration
PROSPERO CRD42024512690; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512690
... 21,22 A combination of implementation science and information technology (IT) tools can be used to support intervention implementation, facilitate patient recruitment, 23 and enable primary care staff with more limited time allocated to coaching (eg, as an add-on to their usual work duties) to still be able to effectively coach patients. [24][25][26] Staff-enabling IT tools include prompts to measure weight, add overweight or obesity to the problem list, and identify patients eligible for weight management programs. [24][25][26] Major challenges to designing such IT tools include understanding the workflows involved and the attitudes of providers and staff. ...
... [24][25][26] Staff-enabling IT tools include prompts to measure weight, add overweight or obesity to the problem list, and identify patients eligible for weight management programs. [24][25][26] Major challenges to designing such IT tools include understanding the workflows involved and the attitudes of providers and staff. Another major challenge is enabling scalable deployment of IT tools through standardsbased interoperability. ...
Objectives
This paper reports on a mixed methods formative evaluation to support the design and implementation of information technology (IT) tools for a primary care weight management intervention delivered through the patient portal using primary care staff as coaches.
Methods
We performed a qualitative needs assessment, designed the IT tools to support the weight management program, and developed implementation tracking metrics. Implementation tracking metrics were designed to use real world electronic health record (EHR) data.
Results
The needs assessment revealed IT requirements as well as barriers and facilitators to implementation of EHR-based weight management interventions in primary care. We developed implementation metrics for the IT tools. These metrics were used in weekly project team calls to make sure that project resources were allocated to areas of need.
Conclusion
This study identifies the important role of IT in supporting weight management through patient identification, weight and activity tracking in the patient portal, and the use of the EHR as a population management tool. An intensive multi-level implementation approach is required for successful primary care-based weight management interventions including well-designed IT tools, comprehensive involvement of clinic leadership, and implementation tracking metrics to guide the process of workflow integration. This study helps to bridge the gap between informatics and implementation by using socio-technical formative evaluation methods early in order to support the implementation of IT tools.
Trial registration
clinicaltrials.gov, NCT04420936. Registered June 9, 2020.
... Approximately half the studies in our review were conducted with adult participants in the United States [27,[31][32][33][34][35][36][37][38][39]41,44,45,51]. All studies were conducted to support individuals diagnosed with or meeting one or more clinical criterion for prediabetes. ...
... While most of these studies reported significant positive effects of the digital adaptations of the DPP, it is unclear whether the content would be generalizable to non-US contexts. Only six of the included studies took place outside Asia or North America and most discussed challenges with recruiting diverse samples, representing predominantly female [25,26,31,33,34,39,41,45,46,48,51] and/or racial majority [25,27,31,32,35,36,38,39,47,48,50] participant populations. Having access to the required technology was an explicit or implicit criterion for participation in all studies and most were only offered in one language. ...
... Over one-third of studies [25-27,33-36,38,39,44,45,49,51] tested a digital version of the Centers for Disease Control and Prevention's (CDC) Diabetes Prevention Program, which consists of a 16-week core curriculum focusing on topics such as healthy eating, physical activity, and social triggers, followed by eight months of maintenance programming [25]. Others described theories or strategies underpinning the digital interventions, including motivational interviewing [29,34,40,42,49,51]; theory of planned behaviour [27,49,52]; behavioural change theory [32,47]; Specific, Measurable, Achievable, Relevant and Time-bound (SMART) goal setting[41,48]; stages of change[41,43]; social cognitive theory[27,52]; behavioural economics [27]; cognitive restructuring[40]; and positive psychology[27]. ...
Background
Rates of prediabetes, which can lead to type 2 diabetes, are increasing worldwide. Interventions for prediabetes mainly focus on lifestyle changes to diet and exercise. While these interventions are effective, they are often delivered face-to-face, which may pose a barrier to those with limited access to healthcare. Given the evidence for digital interventions addressing other noncommunicable diseases, these may also be effective for prediabetes self-management. The aim of this scoping review was to assess the breadth of evidence around digital interventions for prediabetes self-management.
Methods
We developed a targeted search strategy and relevant studies were identified through searches conducted in four bibliographic databases (Medline, Embase, PsycInfo, and Scopus). Published studies were eligible if they included a digital intervention to support adults aged 18+ with prediabetes self-management. Titles and abstracts were first screened for relevance by one researcher. Full texts of selected records were assessed against the review criteria independently by two researchers for inclusion in the final analysis.
Results
Twenty-nine studies were included, of which nine were randomised controlled trials. Most efficacy studies reported significant changes in at least one primary and/or secondary outcome, including participants’ glycaemic control, weight loss and/or physical activity levels. About one-third of studies reported mixed outcomes or early significant outcomes that were not sustained at long-term follow-up. Interventions varied in length, digital modalities, and complexity. Delivery formats included text messages, mobile apps, virtually accessible dietitians/health coaches, online peer groups, and web-based platforms. Approximately half of studies assessed participant engagement/acceptability outcomes.
Conclusion
Whilst the evidence here suggests that digital interventions to support prediabetes self-management are acceptable and have the potential to reduce one’s risk of progression to type 2 diabetes, more research is needed to understand which interventions, and which components specifically, have the greatest reach to diverse populations, are most effective at promoting user engagement, and are most effective in the longer term.
... Clinical decision support (CDS) tools can facilitate pointof-care decision-making, particularly when they are thoughtfully designed to be user-centered and maximize principles of human-computer interaction [1,2]. These types of tools, planned as both patient-and clinicianfacing, have been successfully tested to improve a broad range of health outcomes [2,3]. ...
... Clinical decision support (CDS) tools can facilitate pointof-care decision-making, particularly when they are thoughtfully designed to be user-centered and maximize principles of human-computer interaction [1,2]. These types of tools, planned as both patient-and clinicianfacing, have been successfully tested to improve a broad range of health outcomes [2,3]. Breast reconstruction surgery restores the breast shape after mastectomy and can be performed at the time of mastectomy (immediate reconstruction) or months to years later (delayed reconstruction). ...
Introduction
BREASTChoice is a web-based breast reconstruction decision aid. The previous clinical trial—prior to the adaptation of this refined tool in which we explored usability—measured decision quality, quality of life, patient activation, shared decision making, and treatment choice. The current usability study was designed to elicit patients’ and clinicians’ perspectives on barriers and facilitators for implementing BREASTChoice into the clinical workflow.
Methods
We conducted qualitative interviews with patients and clinicians from two Midwestern medical specialty centers from August 2020 to April 2021. Interviews were first double coded until coders achieved a kappa > 0.8 and percent agreement > 95%, then were coded independently. We used a sociotechnical framework to evaluate BREASTChoice’s implementation and sustainability potential according to end-users, human-computer interaction, and contextual factors.
Results
Twelve clinicians and ten patients completed interviews. Using the sociotechnical framework we determined the following. People Using the Tool: Patients and clinicians agreed that BREASTChoice could help patients make more informed decisions about their reconstruction and prepare better for their first plastic surgery appointment. Workflow and Communications: They felt that BREASTChoice could improve communication and process if the patient could view the tool at home and/or in the waiting room. Clinicians suggested the information from BREASTChoice about patients’ risks and preferences be included in the patient’s chart or the clinician electronic health record (EHR) inbox for accessibility during the consultation. Human Computer Interface: Patients and clinicians stated that the tool contains helpful information, does not require much time for the patient to use, and efficiently fills gaps in knowledge. Although patients found the risk profile information helpful, they reported needing time to read and digest.
Conclusion
BREASTChoice was perceived as highly usable by patients and clinicians and has the potential for sustainability. Future research will implement and test the tool after integrating the stakeholder-suggested changes to its delivery process and content. It is critical to conduct usability assessments such as these prior to decision aid implementation to ensure success of the tool to improve risk communication.
... In designing the Tool and User Guide, the intention was for it to guide conversations on movement behaviours that were person-centered and aimed to benefit adults accessing care with or without a health condition(s). Various approaches were taken by PCPs to this end, such as agreeing on relevant and feasible goals [61,62] or using the scaling questions for readiness to elicit change talk [32,63]. Additionally, many PCPs stated that aspects of the Tool and User Guide aligned with how they would approach similar conversations in their practice, including the collaborative spin. ...
Background
Canada’s 24-Hour Movement Guidelines for Adults have shifted the focus from considering movement behaviours (i.e., physical activity, sedentary behaviour, and sleep) separately to a 24-h paradigm, which considers how they are integrated. Accordingly, primary care providers (PCPs) have the opportunity to improve their practice to promote all movement behaviours cohesively. However, PCPs have faced barriers to discussing physical activity alone (e.g., time, competing priorities, inadequate training), leading to low frequency of physical activity discussions. Consequently, discussing three movement behaviours may seem challenging. Tools to facilitate primary care discussions about physical activity have been developed and used; however, few have undergone usability testing and none have integrated all movement behaviours. Following a synthesis of physical activity, sedentary behaviour, and sleep tools for PCPs, we developed the Whole Day Matters Tool and User Guide that incorporate all movement behaviours. The present study aimed to explore PCPs’ perceptions on the usability, acceptability, and future implementation of the Whole Day Matters Tool and User Guide to improve their relevancy among PCPs.
Methods
Twenty-six PCPs were observed and audio–video recorded while using the Tool and User Guide in a think-aloud procedure, then in a near-live encounter with a mock service-user. A debriefing interview using a guide informed by Normalization Process Theory followed. Recordings were transcribed verbatim and analysed using content analysis and a critical friend to enhance rigour.
Results
PCPs valued aspects of the Tool and User Guide including their structure, user-friendliness, visual appeal, and multi-behaviour focus and suggested modifications to improve usability and acceptability. Findings are further discussed in the context of Normalization Process Theory and previous literature.
Conclusions
The Tool and User Guide were revised, including adding plain language, reordering and renaming sections, reducing text, and clarifying instructions. Results also informed the addition of a Preamble and a Handout for adults accessing care (i.e., patients/clients/service-users) to explain the evidence underpinning the 24-Hour Movement Guidelines for Adults and support a person-centered approach. These four resources (i.e., Tool, User Guide, Preamble, Handout) have since undergone a consensus building process to arrive at their final versions before being disseminated into primary care practice.
... Decision tools can facilitate point-of-care decision-making, particularly when they are thoughtfully designed to be user-centered and maximize principles of human-computer interaction [1,2]. These types of tools, planned as both patient-and clinician-facing, have been successfully tested to improve a broad range of health outcomes [2][3][4]. ...
... Decision tools can facilitate point-of-care decision-making, particularly when they are thoughtfully designed to be user-centered and maximize principles of human-computer interaction [1,2]. These types of tools, planned as both patient-and clinician-facing, have been successfully tested to improve a broad range of health outcomes [2][3][4]. ...
Background: BREASTChoice is a web-based decision tool about breast reconstruction after mastectomy. The current focused usability assessment was designed to elicit patients’ and clinicians’ perspectives on barriers and facilitators for implementing BREASTChoice into the clinical workflow.
Methods: We conducted think-aloud protocols and qualitative interviews with patients and clinicians from two Midwestern medical centers from August 2020 to April 2021. We used the sociotechnical framework to evaluate BREASTChoice’s implementation and sustainability potential according to end-users, human-computer interaction, and contextual factors.
Results: Twelve clinicians and ten patients completed interviews. Using the sociotechnical framework, we determined the following. People Using the Tool: Patients and clinicians agreed that BREASTChoice could help patients make more informed decisions about their reconstruction, and prepare better for their first plastic surgery appointment. Workflow and Communications: They felt that BREASTChoice could improve communication and the decision process if the patient could view the tool before the clinical visit. Clinicians suggested the information from BREASTChoice about patients’ risks and preferences be included in the patient’s chart or the clinician electronic health record (EHR) inbox for accessibility during the consultation. Human Computer Interface: Patients and clinicians stated that the tool contains helpful information, does not require much time for the patient to use, and efficiently fills gaps in knowledge. Although patients found the risk profile information helpful, they reported needing time to read and digest it.
Conclusion: BREASTChoice was perceived as highly usable by patients and clinicians and has the potential for sustainability. Future research will implement and test the tool after integrating the stakeholder-suggested changes to its delivery process and content. It is critical to conduct usability assessments such as these prior to decision tool implementation in order to improve workflow and risk communication.
... (O'Connor et al., 2016) To our knowledge, only one prior study has evaluated the application of CDS for managing prediabetes, and another is currently collecting outcome data. (Mann et al., 2016;Desai et al., 2022). ...
... Future studies with the PreDM CDS should follow 'best practices' for CDS implementation and use a randomized design to evaluate the same process and clinical outcomes definitively. Only one prior study has evaluated a CDS intervention intended for use among primary care patients with prediabetes, (Mann et al., 2016;Mann and Lin, 2012) which prompted provider counseling to set specific dietary and physical activity goals with patients. During subsequent visits, providers could track patients' progress at achieving those goals through the CDS tool. ...
... There were no significant differences reported for cardiometabolic markers including weight, HbA1c, or lipid values. (Mann et al., 2016). ...
Prediabetes impacts 88 million U.S. adults, yet uptake of evidence-based treatment with intensive lifestyle interventions and metformin remains exceedingly low. After incorporating feedback from 15 primary care providers collected during semi-structured interviews, we developed a novel Prediabetes Clinical Decision Support (PreDM CDS) from August 2019 to February 2020. This tool included order options enabling prediabetes management in a single location within the electronic health record. We conducted a retrospective observational study examining the feasibility of implementing this tool at Erie Family Health Centers, a large community health center, examining its use and related outcomes among patients for whom it was used vs. not. Overall, 7,424 eligible patients were seen during the implementation period (February 2020 to August 2021), and the PreDM CDS was used for 108 (1.5%). Using the PreDM CDS was associated with higher rates of hemoglobin A1c orders (70.4% vs. 22.2%; p<0.001), lifestyle counseling (38.0% vs. 7.8%; p<0.001), and metformin prescription orders (5.6% vs. 2.6%; p=0.06). Exploratory analyses revealed small, nonsignificant weight loss among patients for whom the PreDM CDS was used. This study demonstrates the feasibility of developing and implementing the PreDM CDS in primary care. Its low use was likely related to not imposing an interruptive ‘pop-up’ alert, as well as major changes in workflows and clinical priorities during the Covid-19 pandemic. Use of the tool was associated with improved process outcomes. Future efforts with the PreDM CDS should follow standard CDS implementation processes that were not possible due to the Covid-19 pandemic.
... In this study, though we performed an objective path planning without considering clinical constraints, practical adjustments would be needed (detailed in the Supplementary Notes). Tool-assisted goal-settings are expected to help timeconstrained clinicians and contribute to better health improvement in patients 53 . Our framework can provide clinicians with understandable and informative health improvement plans based on patient health data and given intervention variables. ...
Clinical decision-making regarding treatments based on personal characteristics leads to effective health improvements. Machine learning (ML) has been the primary concern of diagnosis support according to comprehensive patient information. A prominent issue is the development of objective treatment processes in clinical situations. This study proposes a framework to plan treatment processes in a data-driven manner. A key point of the framework is the evaluation of the actionability for personal health improvements by using a surrogate Bayesian model in addition to a high-performance nonlinear ML model. We first evaluate the framework from the viewpoint of its methodology using a synthetic dataset. Subsequently, the framework is applied to an actual health checkup dataset comprising data from 3132 participants, to lower systolic blood pressure and risk of chronic kidney disease at the individual level. We confirm that the computed treatment processes are actionable and consistent with clinical knowledge for improving these values. We also show that the improvement processes presented by the framework can be clinically informative. These results demonstrate that our framework can contribute toward decision-making in the medical field, providing clinicians with deeper insights. Clinical decision-making regarding treatments based on personal characteristics leads to effective health improvements. Here, the authors introduce a modeling framework to evaluate the actionability of treatment pathways.
... With regard to ensuring one's own commitment, goal setting (i.e., setting specific and challenging goals) is highly effective (Locke & Latham, 1990, 2013 and also well-understood at the team-level (Kleingeld et al., 2011;Kramer et al., 2013). Recent evidence actually indicates that setting SMART goals jointly with a medical expert may be particularly effective in the health domain (Mann et al., 2016). With regard to influencing others, classic research indicates that if-then planning can help implement effective persuasive strategies at the right time (e.g., objecting to racist remarks quickly; Gollwitzer & Brandstätter, 1997). ...
Mastering global challenges such as the 2020 Coronavirus pandemic requires implementing effective responses at various social levels. Leadership teams (governmental, industrial) need to integrate available information to introduce effective regulation and update their decisions as new information becomes available. Groups (families, peers, teams) need to act persistently, even when these actions oppose members’ individual short-term interests. Moreover, individuals need to stay calm and act diligently, while dealing with emotions of threat and resisting counterproductive social influence. Our research programme on implementation intentions at social levels suggests that collective if-then plans facilitate goal attainment for teams, groups, and individuals in social contexts. We therefore analyse how if-then planning can help master global human challenges such as the 2020 Coronavirus pandemic.
... [19][20][21][34][35][36][37][38][39] Numerous studies have explored PA as a stand-alone topic for counselling, 17,[19][20][21]34,37,[39][40][41][42] while others have explored counselling for combinations of PA and other health behaviors (eg nutrition, smoking, and alcohol use). 15,16,18,23,35,36,38,[43][44][45][46][47][48][49][50][51] Among these studies, the outcomes of using eHealth technologies for PA counselling in PHC settings were diverse. 52 This is reflective of the different needs across the wide range of PHC settings. ...
Purpose
Physical inactivity is a global health concern. Physical activity (PA) counselling is an effective intervention for promoting PA in primary health care (PHC) settings. The use of electronic health (eHealth) technology has the potential to support PA counselling. This study aimed to explore PHC providers’ perspectives on the development of an eHealth tool to aid PA counselling in the resource-limited settings.
Methods
This qualitative study employed interpretive phenomenology. The study was conducted at hospital-based PHC clinics among physicians and registered nurses. Data collection involved in-depth interviews (IDIs) and focus group discussions (FGDs). An inductive thematic approach was used to analyze the data.
Results
Three physicians participated in three IDIs and 12 nurses participated in four FGDs at three hospitals. The median age of the participants was 43 years. Participants saw 15–100 patients/day (median 40) and spent 2–20 min with each patient (median 5). Three themes emerged. Theme 1: requirements for PA counselling: the participants reflected the needs and characteristics of eHealth tool that may support PA counselling. Theme 2: enabling an eHealth tool for PA counselling: the eHealth should be easy to use, provide PA prescription function, and support follow-up PA counselling. Theme 3: reducing barriers to PA counselling: the eHealth tool was expected to help reduce service and workforce barriers and patients’ limitations.
Conclusion
A well-designed and practical eHealth tool has the potential to improve PA counselling practice in PHC settings. The eHealth tool may affect an indirect mechanism to reduce barriers to PA counselling. Future research should focus on the usability and utility as well as the process evaluation of the PA counselling eHealth tool that will be implemented in resource-limited settings.
