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Interactive Health Communication Appliations for people with chronic disease
Abstract
Background:
Interactive Health Communication Applications (IHCAs) are computer-based, usually web-based health information packages for patients that combine information with at least one of social support, decision support, or behaviour change support. These are innovations in health care and their effects on health are uncertain.
Objectives:
To assess the effects of IHCAs for people with chronic disease.
Search strategy:
We designed a four-part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists from relevant primary and review articles were followed up. As IHCAs require relatively new technology, the search commenced at 1990 where possible.
Selection criteria:
Randomised controlled trials (RCTs) of Interactive Health Communication Applications for adults and children with chronic disease.
Data collection and analysis:
One reviewer screened abstracts. Two reviewers screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using a random effects model and standardised mean differences (SMDs) were calculated to provide net effect sizes.
Main results:
We screened 24,757 unique citations and retrieved 958 papers for further assessment, yielding 28 RCTs involving 4042 participants. One of these had an inadequate method of concealment of allocation, and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses. Results in the abstract are from the meta-analyses excluding data from this study.IHCAs were found to have a positive effect on knowledge (SMD 0.49; 95% confidence interval (CI) 0.14 to 0.84) and on social support (SMD 0.47; 95% CI 0.28 to 0.66). IHCAs were found to have no effect on self-efficacy (SMD 0.15; 95% CI -0.13 to 0.43) or behavioural outcomes (SMD -0.09; 95% CI -0.49 to 0.32). IHCAs had a negative effect on clinical outcomes (SMD -0.32; 95% CI -0.63 to -0.02).
Reviewers' conclusions:
The number and range of IHCAs is increasing rapidly; however there is a shortage of high quality evaluative data. Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful. However, consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present. Further research is needed to determine the reason for this negative effect on clinical outcomes, whether an optimal IHCA can achieve behaviour change and improved health outcomes, and if so, what are the essential features of such an IHCA, and the extent to which they differ according to patient group or condition.
... Interactive Health Communication Applications (IHCA) allow individuals to use an electronic device to access or transmit health information or receive guidance. IHCA seem to have positive effects on behavioral and clinical outcomes of chronic patients 4 . The use of WhatsApp as a psychoeducational resource for older people with depression also seems to be a promising strategy 5 . ...
... The use of WhatsApp as a psychoeducational resource for older people with depression also seems to be a promising strategy 5 . However, further research is needed to determine the most feasible way to deliver IHCA among different groups of patients 4 , and to identify older adults who are most likely to be benefited by these programs 6 . ...
... WhatsApp use is frequent among Brazilians 7 , and it is being increasingly used as a health communication tool in digital mental health programs 4,7 . The widespread of mobile phones in low-and middle-income countries (LMICs) has created an incentive for the use of WhatsApp in primary health care 8 . ...
This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people.
... The use of information and communication technologies (ICTs) may be an answer to improve lung transplant patients' management. Developed during the last decades, ICTs combine techniques used in the treatment and transmission of information, mainly telecommunication, electronic, or internet tools [20]. They are increasingly used in health, especially to facilitate information flow between health professionals and patients [21]. ...
... They are increasingly used in health, especially to facilitate information flow between health professionals and patients [21]. A heterogeneous evidence level was shown for the use of SMS (Short Message Service) for preventive health measures (i.e., smoking, overweight and obesity, attendance of medical appointments, etc.) [20,[22][23][24][25][26][27]. More broadly, there is not enough evidence to conclude that ICT interventions improve patients' adherence [28][29][30][31][32]. ...
... Five ICTs were studied and defined for patients and healthcare professionals as follows [20,21,27]: (1) SMS: the patient receives a text message from an LT center and confirms reading it by sending an acknowledgment; (2) Email: the patient receives an email from am LT center and confirms reading it by sending an acknowledgment; (3) Phone call: the patient receives a phone call from an LT center; in case of no response, a message is left on their answering machine, and the patient has to confirm playback; (4) Internet: the patient can access, by email address and password, a website with general and personalized information; (5) Smartphone application: the patient downloads and installs free software on their smartphone providing access to information modules. Face-to-face communication, which is not a type of ICT and which is defined as oral information provided by a healthcare professional from an LT center during the patient visit, was also studied. ...
Optimal therapeutic management is a major determinant of patient prognosis and healthcare costs. Information and communication technologies (ICTs) represent an opportunity to enhance therapeutic management in complex chronic diseases, such as lung transplantation (LT). The objective of this study was to assess the preferences of LT patients and healthcare professionals regarding ICTs in LT therapeutic management. A cross-sectional opinion survey was conducted among lung transplant patients and healthcare professionals from the French lung transplantation centers. Five ICTs were defined (SMS, email, phone, internet, and smartphone application) in addition to face-to-face communication. An unsupervised approach by Principal Component Analysis (PCA) identified lung transplant patient profiles according to their preferences for ICTs. Fifty-three lung transplant patients and 15 healthcare professionals of the French LT centers were included. Both expected ICTs for treatment management and communication. Phone call, face-to-face, and emails were the most preferred communication tools for treatment changes and initiation. PCA identified four ICTs-related profiles (“no ICT”, “email”, “SMS”, and “oral communication”). “Email” and “oral communication” profiles are mainly concerned with treatment changes and transmission of new prescriptions. The “SMS” profile expected reminders for healthcare appointments and optimizing therapeutic management. This study provides practical guidance to enhance LT therapeutic management by ICT intervention. The type of ICT used should take into account patient profiles to improve adherence and thereby the prognosis. A combination of strategies including information, education by a multidisciplinary team, and reminders is a promising approach to ensure an optimal management of our patients.
... The literature has highlighted web-based selfmanagement programs as a promising way to improve the accessibility for patients with chronic health conditions (Bender et al., 2011;Murray et al., 2005;Stinson et al., 2009;Wantland et al., 2004;Webb et al., 2010). Three interactive coping websites (Kato et al., 2008;Kunin-Batson et al., 2016;O'Conner-Von, 2009) have been developed for young people with cancer, however, they do not: (a) include comprehensive cognitive-behavioral methods to promote self-management skills (b) provide opportunities for meaningful social support or interaction with health care providers or (c) focus on helping adolescents gain skills for independence and transitioning to adulthood and after/adult health care. ...
... Web-based health interventions are a promising avenue to improve access and availability of self-management programs for teens with chronic illnesses (Cuijpers et al., 2008;Devine et al., 2018;Murray et al., 2005). We used a comprehensive, phased, evidence-based approach to develop TTC Cancer, which was based on a qualitative needs assessment with AWC, their parents and health care providers (Stinson et al., 2012). ...
Background: There is a lack of self-management tools for adolescents with cancer (AWC). This study evaluated the feasibility of Teens Taking Charge Cancer, a web-based self-management program. Methods: A pilot randomized control trial (RCT) was conducted across 4 pediatric oncology clinics. AWC (12–18 years) and their caregivers were randomized to either the intervention or control group. All were asked to complete 12 website modules over 12 weeks (at their own pace) and received monthly calls from health coaches. The intervention website was based on cognitive behavioral principals, designed as an interactive self-guided online program, while the control consisted of education and included links to 12 general cancer websites. Outcome assessments occurred at enrollment and 12 weeks post-intervention. The primary outcomes included rate of accrual and retention, adherence to the protocol, acceptability and satisfaction with intervention using questionnaire and semi-structured interviews, adverse events and engagement with the intervention. Results: Eighty-one teen-caregiver dyads were enrolled with a retention rate of 33%. In the intervention group 46% ( n = 18) logged in at least once over the 12-week period. A mean of 2.4 of 12 modules ( SD 3.0) were completed; and no one completed the program. Thirty-three percent of caregivers in the intervention logged into the website at least once and none completed the full program. Discussion: The results from this pilot study suggest that the current design of the Teens Taking Charge Cancer RCT lacks feasiblity. Future web-based interventions for this group should include additional features to promote uptake and engagement with the program.
... Asynchronous e-visits enable PCPs to respond at a time that is suitable for them, eliminating in-session time constraints. Thus, PCPs can deliver tailored treatment to large numbers of patients [23,24]. E-visit invitations can be automated and sent in bulk via the EHR to all patients who meet treatment criteria. ...
Background
Cigarette smoking remains the leading cause of preventable disease and death in the United States. Primary care offers an ideal setting to reach adults who smoke cigarettes and improve uptake of evidence-based cessation treatment. Although U.S. Preventive Services Task Force Guidelines recommend the 5As model (Ask, Advise, Assess, Assist, Arrange) in primary care, there are many barriers to its implementation. Automated, comprehensive, and proactive tools are needed to overcome barriers. Our team developed and preliminarily evaluated a proactive electronic visit (e-visit) delivered via the Electronic Health Record patient portal to facilitate evidence-based smoking cessation treatment uptake in primary care, with promising initial feasibility and efficacy. This paper describes the rationale, design, and protocol for an ongoing Hybrid Type I effectiveness-implementation trial that will simultaneously assess effectiveness of the e-visit intervention for smoking cessation as well as implementation potential across diverse primary care settings.
Methods
The primary aim of this remote five-year study is to examine the effectiveness of the e-visit intervention vs. treatment as usual (TAU) for smoking cessation via a clinic-randomized clinical trial. Adults who smoke cigarettes are recruited across 18 primary care clinics. Clinics are stratified based on their number of primary care providers and randomized 2:1 to either e-visit or TAU. An initial baseline e-visit gathers information about patient smoking history and motivation to quit, and a clinical decision support algorithm determines the best evidence-based cessation treatment to prescribe. E-visit recommendations are evaluated by a patient’s own provider, and a one-month follow-up e-visit assesses cessation progress. Main outcomes include: (1) cessation treatment utilization (medication, psychosocial cessation counseling), (2) reduction in cigarettes per day, and (3) biochemically verified 7-day point prevalence abstinence (PPA) at six-months. We hypothesize that patients randomized to the e-visit condition will have better cessation outcomes (vs. TAU). A secondary aim evaluates e-visit implementation potential at patient, provider, and organizational levels using a mixed-methods approach. Implementation outcomes include acceptability, adoption, fidelity, implementation cost, penetration, and sustainability.
Discussion
This asynchronous, proactive e-visit intervention could provide substantial benefits for patients, providers, and primary care practices and has potential to widely improve reach of evidence-based cessation treatment.
Trial registration
NCT05493254.
... Studies have investigated the effectiveness and significance of using social media in health promotion and disease prevention efforts. For example, a meta-analysis conducted by Murray et al. (2004) revealed that social media has beneficial effects on users' health knowledge, social support, health behaviors, and clinical outcomes. Chou et al. (2013) emphasized that SME must be incorporated into comprehensive health communication strategies involving evaluating public health interventions, which would expand the application of social media in health communication. ...
Social media is a valuable tool that enables public health organizations to communicate effectively. To enhance the reach of health communication on social media, scholars have proposed that emoji be used to convey scientific information. The current study explored the influence of emoji on the effectiveness of health communication on social media. Automated content analysis revealed that the presence of emoji in online health information resulted in higher levels of social media engagement (SME) than the absence of emoji did. Additionally, a 2 (emoji: present versus absent) × 3 (visual complexity of information design: low versus medium versus high) online experiments revealed that the presence of emoji in health information sequentially increased perceived enjoyment and perceived interactivity, thereby promoting SME. However, this effect is influenced by the visual complexity of health information designs. The presence of emoji is only effective in increasing SME with health information presented using a design with low or medium visual complexity. This study provides theoretical and practical insights into visual health communication and health information design.
... Previous research shows that telehealth is indeed able to increase access to care and medical information and has the potential to improve patients' health outcomes and empowerment [15,16]. Furthermore, offering patients telehealth channels is linked to positive effects on health-related knowledge and self-efficacy [17]. As a combination of an aging population and a rise in the number of patients with inflammatory rheumatic diseases limits health care providers' time and resources, telehealth may provide opportunities to lighten the burden of these challenges [18]. ...
Background:
Patients with rheumatic diseases are known to experience drug-related problems at various times during their treatment. As these problems can negatively influence patients' health, they should be prevented or resolved as soon as possible, for which patients might benefit from additional support. Telehealth has the potential to continuously provide information and offers the possibility to easily contact a health care provider in order to support patients with medication use. Knowledge of factors influencing the patient's preference for telehealth channels can improve the actual use of telehealth channels.
Objective:
This study aims to identify factors that influence the preferences of patients with rheumatic diseases regarding telehealth channels for support with medication use.
Methods:
A qualitative study with face-to-face interviews was performed among patients with an inflammatory rheumatic disease in the Netherlands. A total of 4 telehealth channels were used: a frequently asked questions page, a digital human, an app for SMS text messaging with health care providers, and an app for video-calling with health care providers. Using a semistructured interview guide based on domains of the Capability, Opportunity, Motivation, and Behavior (COM-B) model, participants were questioned about (1) their general opinion on the 4 telehealth channels, (2) factors influencing preference for individual telehealth channels, and (3) factors influencing preference for individual telehealth channels in relation to the other available channels. Interviews were recorded, transcribed, and categorically analyzed.
Results:
A total of 15 patients were interviewed (female: n=8, 53%; male: n=7, 47%; mean age 55, SD 16.8 years; median treatment duration of 41, IQR 12-106 months). The following 3 categories of factors influencing patient preference regarding telehealth channels were identified: (1) problem-related factors included problems needing a visual check, problems specifically related to the patient, and urgency of the problem; (2) patient-related factors included personal communication preference and patient characteristics; and (3) channel-related factors included familiarity with the telehealth channel, direct communication with a health care provider, methods of searching, and conversation history.
Conclusions:
Preference for telehealth channels is influenced by factors related to the problem experienced, the patient experiencing the problem, and telehealth channel characteristics. As the preference for telehealth channels varies between these categories, multiple telehealth channels should be offered to enable patients to tailor the support with their medication use to their needs.
... The continual advancements in information and communication technologies have given rise to greater demand for global communication applications and services [1,2,3,4,5,6,7,8] which in turn have led to the deployment of several artificial satellites orbiting the earth [9,10,11,12,13,14,15,16]. Launching and tracking of these satellites in their orbits require accurate knowledge of the orbital parameters [17,18,18,19,20,21,22,23]. The orbits around the oblate earth are significantly affected by the earth's oblateness [24,25,26,27,28,29,30,31,32]. ...
In this paper, development and application of complementary root-based seeded secant (CRSS) iteration method for determination of semi major axis of perturbed orbit is presented. The concept of complementary root is presented along with the detail procedure for the CRSS method and its application in the solution to the orbital equations for the semi major axis and the nominal mean motion of perturbed orbit. A case study perturbed orbit was considered to demonstrate the effectiveness of the CRSS method. According to the result, the initial single guess root value for the semi major axis () is 26,598.53828 km from which a complementary root, g() of 26604.74217 km was obtained and the first root (semi major axis, in km) determined using secant method is 26604.7414 km. The specified error tolerance is − km. The results show that it took two (2) cycles for the CRSS to converge at the semi major axis () value of 26604.7414 km with estimation error of 8.36735 − km at which point the nominal mean motion () is found to be 0.000145489 rad/s. The result of the case study perturbed orbit clearly shows the effectiveness of the CRSS iteration application in the planetary motion studies.
... Patient characteristics were age, sex, area-level income quintile, immigration status, rurality based on postal code at the time of death, disease trajectory based on the cause of death, and number and prevalence of chronic conditions, based on algorithms previously developed at ICES. [22][23][24][25][26][27][28][29][30] We categorized decedents according to major illness trajectories, as in previous research. 4,31,32 The trajectories were terminal illness (e.g., cancer), organ failure (e.g., chronic heart failure), frailty (e.g., Alzheimer disease), sudden death (i.e., unexpected, such as an accident) and other. These trajectories were validated with the use of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes and a modified Delphi process to discriminate how cause of death corresponds to similar costs of health care use and illness trajectories. ...
Background:
Physician home visits are associated with better health outcomes, yet most patients near the end of life never receive such a visit. Our objectives were to describe the receipt of physician home visits during the last year of life after a referral to home care - an indication that the patient can no longer live independently - and to measure associations between patient characteristics and receipt of a home visit.
Methods:
We conducted a retrospective cohort study using linked population-based health administrative databases housed at ICES. We identified adult (aged ≥ 18 yr) decedents in Ontario who died between Mar. 31, 2013, and Mar. 31, 2018, who were receiving primary care and were referred to publicly funded home care services. We described the provision of physician home visits, office visits and telephone management. We used multinomial logistic regression to calculate the odds of receiving home visits from a rostered primary care physician, controlling for referral during the last year of life, age, sex, income quintile, rurality, recent immigrant status, referral by rostered physician, referral during hospital stay, number of chronic conditions and disease trajectory based on the cause of death.
Results:
Of the 58 753 decedents referred in their last year of life, 3125 (5.3%) received a home visit from their family physician. Patient characteristics associated with higher odds of receiving home visits compared to office-based or telephone-based care were being female (adjusted odds ratio [OR] 1.28, 95% confidence interval [CI] 1.21-1.35), being 85 years of age or older (adjusted OR 2.42, 95% CI 1.80-3.26) and living in a rural area (adjusted OR 1.09, 95% CI 1.00-1.18). Increased odds were associated with home care referrals by the patient's primary care physician (adjusted OR 1.49, 95% CI 1.39-1.58) and referrals occurring during a hospital stay (adjusted OR 1.20, 95% CI 1.13-1.28).
Interpretation:
A small proportion of patients near the end of life received home-based physician care, and patient characteristics did not explain the low visit rates. Future work on system- and provider-level factors may be critical to improve access to home-based end-of-life primary care.
... In making such decisions, it is critical to consider the patient's preferences for risks and benefits. Research has found that implementing DM improves adherence to treatment, appropriate use of services, the number of major surgery and emergency admissions, and patient confidence, satisfaction, and coping skills [4,5]. According to health policy researchers, DM may reduce over-diagnosis and over-treatment of conditions, resulting in lower healthcare costs [6]. ...
Background: Generally, decisions related to healthcare issues should be only made according to the clinical criteria. However, in clinical decision-making, there is mutual information sharing, in which health providers share the benefits and adverse effects of potential treatment with their patients, and patients share their values and lifestyle preference with their physicians. The clinical decision is affected by factors either related to patients or physicians; the factors related to patients include socio-economic status. Health insurance reduces the costs of medication and hospitalization of patients, and this allows patients to obtain better medical care while treating various diseases. Therefore, clinical decisions can be affected by the insurance status of patients. Aim: To describe the physicians' knowledge regarding the impact of the insurance status of patients on clinical decision-making. Methods: The study was cross-sectional that was enrolled physicians in private hospitals and clinics. The study was conducted via an online questionnaire that investigated the demographics of physicians and their knowledge. SPSS version 22 was used to analyze the collected data; a P-value≤0.05 was significant. Results: There were 401 physicians who participated in this study; 75.3% were males, 42.9% were consultants, 76.3% were non-Saudi physicians, and 72.1% were working in the private sector. The mean ±SD of the knowledge score was 18.89±4.9. The mean score of knowledge was significantly affected by nationality (P˂0.001) and type of practice (P=0.012). Conclusion: Physicians had inadequate knowledge regarding the impact of health insurance on clinical decision-making. The nationality and type of facility affected the level of physicians‘ knowledge.
... By allowing patients to immediately address concerning side effects, this can increase patient empowerment, self-efficacy, and improve long-term engagement. [76][77][78][79][80][81][82] Clinician-focused features, such as EHR integration and investigation and management algorithms, may help reduce care variation and mediate downstream improvements in patient outcomes and health care utilization. ...
Purpose:
Increasing use of immune checkpoint inhibitors (ICIs) in routine cancer care will increase the incidence of immune-related adverse events (irAEs). Systems are needed to support remote monitoring for irAEs. Electronic patient-reported outcome (ePRO) symptom monitoring systems can help monitor and manage symptoms and side effects. We assessed the content and features of ePRO symptom monitoring systems for irAEs, and their feasibility, acceptability, and impact on patient outcomes and health care utilization.
Methods:
A systematic literature search was conducted in May 2022 on MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials. Quantitative and qualitative data relevant to the review questions were extracted and synthesized in tables.
Results:
Seven papers describing five ePRO systems were included. All systems collected PROs between clinic visits. Two of five used validated symptom questionnaires, 3/5 provided prompts to complete questionnaires, 4/5 provided reminders to self-report, and 3/5 provided clinician alerts for severe/worsening side effects. Four of five provided coverage of ≥26/30 irAEs in the ASCO irAE guideline. Feasibility and acceptability were demonstrated with consent rates of 54%-100%, 17%-27% of questionnaires generating alerts, and adherence rates of 74%-75%. One paper showed a reduction in grade 3-4 irAEs, treatment discontinuation, clinic visit duration, and emergency department presentations, while another showed no difference in these outcomes or the rate of steroid use.
Conclusion:
There is preliminary evidence of the feasibility and acceptability of ePRO symptom monitoring for irAEs. However, further studies are needed to confirm the impact on ICI-specific outcomes, such as the frequency of grade 3-4 irAEs and duration of immunosuppression. Suggestions for the content and features of future ePRO systems for irAEs are provided.
... Supporting interventions for informal caregivers have shown improvements in quality of life and care (Dickinson et al., 2017;Naunton Morgan et al., 2022), reduction in caregiver burden, improve care service delivery or helping to cope with care responsibilities (Alzheimer's Association, 2016) and have the potential to delay nursing and residential care (Alzheimer's Association, 2016;Dickinson et al., 2017). Elearning has shown to be an effective intervention in helping informal caregivers of people living with dementia (Naunton Morgan et al., 2022), demonstrating some benefits on dementia knowledge and social support (Murray et al., 2005;Sitges-Maciá et al., 2021). It has the potential to overcome some constraints from in-person interventions, such as costs and transportation for assisting the sessions (e.g., people living in remote areas), inability to leave home because of caregiving role (Hattink et al., 2015;O'Connor et al., 2014;Wasilewski et al., 2017) and might help to increased service coverage (Pot et al., 2019). ...
Background:
E-learning has shown to be an effective intervention in helping informal caregivers of people living with dementia. It has the potential to reach people living in remote areas, increasing service coverage. As a response to the demographic context in Spain associated with a higher percentage of ageing, depopulation, and the complexities of health service delivery in rural areas, this paper describes the cultural adaptation and co-design of the iSupport online training and support programme for Castilla y León, Spain, as a potential e-health intervention to mitigate these constraints.
Methods:
The translation and cultural adaptation were performed following the WHO guidelines, with some adaptation due to the cultural context of Spain. Three focus groups were conducted with informal caregivers, health professionals, and a group of experts on cognitive impairment and dementia. The co-design process was performed as a Patient and Public Involvement activity with three groups consisting of people living with dementia, informal caregivers, rural population and experts on technology and dementia.
Results:
A total of 435 suggestions were proposed for adaptation associated with erroneous terminology, rewording text/writing, grammatical or punctuation marks errors, and repeated information or need for additional content. Several recommendations were exposed during the co-design process: preference for interactive material such as videos or images, a forum to receive feedback from health care professionals and to leave satisfaction comments, availability in multiple platforms (e.g., tablet, laptop, mobile), slide format for information presentation, and availability to edit letter size and background colours.
Conclusions:
A culturally adapted version of the iSupport was developed for Castilla y León, Spain. The need for modification of words and expressions, information links to local resources websites, adjustments of characters' names and caregivers' scenarios, and additional content to some sections were recommended. Suggestions for the design should be taken into account for further adapted versions and platform developments.
... Findings of the reviewed studies suggested that the asynchronous form of telemedicine, mainly utilizingWeb-based tools, has positive effects on controlling asthma and its symptoms. Based on the findings of review studies, using Web-based interventions leads to better management of chronic conditions, especially asthma(75,76). ...
Background:
Considering the increased prevalence of asthma and its consequences for individuals and society, its effective management and close monitoring is essential. Awareness of the effects of telemedicine can improve asthma management. The present study aimed to systematically review articles examining the effect of telemedicine on the management of asthma, including control of the symptom, patients' quality of life, costs, and adherence to treatment programs.
Materials and methods:
A systematic search was performed on four databases: PubMed, Web of Science, Embase, and Scopus. English language clinical trials investigating the effectiveness of telemedicine in asthma management published from 2005 to 2018 were selected and retrieved. The present study was designed and conducted based on the PRISMA guidelines.
Results:
Out of 33 articles included in this research, telemedicine was employed by 23 studies for the promotion of patient adherence to treatment in the form of reminders and feedback, by 18 for telemonitoring and communicating with healthcare providers, by six for offering remote patient education, and by five for counseling. The most frequently used telemedicine approach was asynchronous (used in 21 articles), and the most commonly utilized tool was Web-based (utilized in 11 articles).
Conclusion:
Telemedicine can improve symptom control, patients' quality of life, and adherence to treatment programs. However, little evidence exists confirming the effectiveness of telemedicine in decreasing costs.
... Synchronous remote asthma reviews using telephone or videoconferencing have become mainstream during the COVID-19 pandemic [21,22]. They are relatively well investigated and have been shown to increase asthma review rates without clinical disadvantage or loss of satisfaction [23][24][25][26][27]. Asynchronous reviews may overcome the temporal limitations of in-person and remote synchronous care, and have the potential to support the care of large numbers of patients with asthma [28]. Existing systematic reviews (see Table 1) have synthesised the evidence for a broad range of digital technologies, telemonitoring and telehealth (the terminology is used inconsistently) [18, [29][30][31][32][33][34][35][36][37] but there are no reviews synthesising the evidence for the effectiveness specifically of asynchronous digital health interventions for routine asthma care, nor exploring the views and experiences of patients and/or professional stakeholders on their utility. ...
Introduction:
People living with asthma require regular reviews to address their concerns and questions, assess control, review medication, and support self-management. However, practical barriers to attending face-to-face consultations might limit routine reviews. Reviewing asthma using asynchronous digital health interventions could be convenient for patients and an efficient way of maintaining communication between patients and healthcare professionals and improving health outcomes. We, therefore, aim to conduct a mixed-methods systematic review to assess the effectiveness of reviewing asthma by asynchronous digital health interventions and explore the views of patients and healthcare professionals about the role of such interventions in delivering asthma care.
Methods:
We will search MEDLINE, Embase, Scopus, PsycInfo, CINAHL, and Cochrane Library from 2001 to present without imposing any language restrictions. We are interested in studies of asynchronous digital health interventions used either as a single intervention or contributing to mixed modes of review. Two review authors will independently screen titles and abstracts, and retrieve potentially relevant studies for full assessment against the eligibility criteria and extract data. Disagreements will be resolved by discussion with the review team. We will use 'Downs and Black' checklist, 'Critical Appraisal Skills Programme', and 'Mixed Methods Appraisal Tool' to assess methodological quality of quantitative, qualitative, and mixed-methods studies respectively. After synthesising quantitative (narrative synthesis) and qualitative (thematic synthesis) data separately, we will integrate them following methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions.
Conclusion:
The findings of this review will provide insights into the role of asynchronous digital health interventions in the routine care of people living with asthma.
Trial registration:
Systematic review registration: PROSPERO registration number: CRD42022344224.
... Technology is increasingly used to support clinical interventions (12), monitor activity levels (13), support behaviour change (14) and encourage self-management for medical conditions (15,16). For adults with stroke, a wrist-worn device was developed which could monitor arm activity using accelerometry and emit a prompt when movement had fallen beyond an agreed threshold in the preceding hour. ...
Aim
To determine whether a wrist-worn triaxial accelerometer-based device and software (including smartphone application), incorporating feedback, is feasible, acceptable, and can lead to increased affected upper limb use during everyday activities in children with unilateral cerebral palsy (UCP).
Methods
Study design : Mixed methods proof of concept study. Participants: Children aged 8–18 years with UCP; age-matched typically developing controls (“Buddies”), therapists. Intervention: Baseline (2 weeks): devices recorded arm activity. Active feedback (6 weeks): devices also gave vibratory prompts if affected arm activity fell below pre-set personalised thresholds (UCP group only; control group continued as per Baseline ). Final 2 weeks: as baseline. Both groups accessed a smartphone application providing feedback on relative arm motion throughout the study. Assessment and analysis: ABILHAND-Kids questionnaires and MACS classifications captured baseline participant characteristics (UCP group). Accelerometer data was used to calculate relative arm activity (signal vector magnitude) corrected for time worn/day, and trends in relative arm activity examined using single case experimental design (both groups). In-depth interviews with families, “Buddies” and therapists assessed feasibility and acceptability of implementation. A framework approach was used for qualitative data analysis.
Results
We recruited 19 participants with UCP; 19 buddies; and 7 therapists. Five participants (two with UCP) did not complete the study. Baseline mean (stdev) ABILHAND-Kids score of children with UCP who completed the study was 65.7 (16.2); modal MACS score was II.
Qualitative analysis demonstrated acceptability and feasibility of the approach. Active therapist input for this group was minimal. Therapists appreciated the potential for summary patient data to inform management. Arm activity in children with UCP increased in the hour following a prompt (mean effect size z = 0.261) for the non-dominant hand, and the dominant hand ( z = 0.247). However, a significant increase in affected arm activity between baseline and intervention periods was not demonstrated.
Discussion
Children with UCP were prepared to wear the wristband devices for prolonged periods. Whilst arm activity increased bilaterally in the hour following a prompt, increases were not sustained. Delivery of the study during the COVID-19 pandemic may have negatively influenced findings. Technological challenges occurred but could be overcome. Future testing should incorporate structured therapy input.
... Telemedicine conducting virtual visits in nonemergency/routine cares, those without COVID-19, particularly high-risk cases (older adults and cases who have underlying diseases) are needed to receive daily care with no exposure to other hospitalized cases [246,247]. Also, these services can be used by physicians in quarantine to care for their patients. Teleradiology and teleconsultation in triaging COVID-19 by a massager for responding to the lack of onsite chest radiologists are conventional methods and new screening and triage approaches to diagnose COVID-19 [248,249]. ...
Concurrent with the global outbreak of COVID-19, the race began among scientists to generate effective therapeutics for the treatment of COVID-19. In this regard, advanced technology such as nanotechnology, cell-based therapies, tissue engineering and regenerative medicine, nerve stimulation and artificial intelligence (AI) are attractive because they can offer new solutions for the prevention, diagnosis and treatment of COVID-19. Nanotechnology can design rapid and specific tests with high sensitivity for detecting infection and synthases new drugs and vaccines based on nanomaterials to directly deliver the intended antiviral agent to the desired site in the body and also provide new surfaces that do not allow virus adhesion. Mesenchymal stem cells and exosomes secreted from them apply in regenerative medicine and regulate inflammatory responses. Cell therapy and tissue engineering are combined to repair or substitute damaged tissues or cells. Tissue engineering using biomaterials, cells, and signaling molecules can develop new therapeutic and diagnostic platforms and help scientists fight viral diseases. Nerve stimulation technology can augment body's natural ability to modulate the inflammatory response and inhibit pro-inflammatory cytokines and consequently suppress cytokine storm. People can access free online health counseling services through AI and it helps very fast for screening and diagnosis of COVID-19 patients. This study is aimed first to give brief information about COVID-19 and the epidemiology of the disease. After that, we highlight important developments in the field of advanced technologies relevant to the prevention, detection, and treatment of the current pandemic.
... Use of wearable technology to monitor activity levels (13) has the potential for marked behaviour change (14,15). Smartphone applications and other "mHealth" technologies (mobile technologies for health) (16) promoting selfmonitoring and self-management are becoming popular for young people with chronic health problems, e.g., diabetes and epilepsy (17,18). There are significant challenges in developing mHealth interventions tailored to children (19). ...
Background
Unilateral (Hemiplegic) cerebral palsy (UCP) causes weakness and stiffness affecting one sided of the body, often impacting activities of daily living. Upper limb therapy at effective intensity is not accessible to most.AimTo determine stakeholder views on design of an approach using wrist-worn devices and a smartphone application to encourage use of the affected upper limb for children with hemiplegia.Method
Four participatory design workshops and one young people's advisory group workshop incorporating views of five young people with hemiplegia, 13 typically developing peers aged 8–18 years, four parents, three occupational therapists, one teacher and two paediatricians. Two special educational needs co-ordinators were consulted separately. Peers were included to explore a study design whereby each child with hemiplegia would have a participating “buddy”. Topics included views on an acceptable wrist-worn device and smartphone application, participant age range, involvement of a buddy, and barriers to using the technology in a school setting. Ethical/welfare considerations included data security, and potential risks around providing smartphones to young children.ResultsChildren wanted a comfortable, conventional-appearing wristband incorporating a watch face and a secure, well-fitting strap. They were prepared to wear a band on each wrist. They wanted support with explaining the study to schoolteachers. Most schools restricted smartphone use during the school day: the study design accommodated this. Children agreed with a game as reward but had different views on an acceptable game; direct access to feedback data was preferred by some. Parents commented on the lack of access to upper limb therapy for children with UCP; therapists concurred. The proposed participant age range was widened based on feedback. Typically developing children were prepared to be buddies to help a friend with CP. Stakeholders were reassured by data security explanations and plans to provide internet safety information to participants.Conclusion
The participatory design process informed plans for the proof-of-concept stage of the study, hopefully leading to an approach that will be fun, easy to integrate into everyday life, and have the capacity to increase use of the affected arm and hand.
... While broadening the definition of self-help, let us be careful not to open it so far that research evidence is ignored or that patient care is compromised. A recent Cochrane Collaboration review (Murray, Burns, See Tai, Lai, & Nazareth, 2004) provides a sage warning that indiscriminate use of health-related Internet materials can prove deleterious. The review of 28 studies and 4,042 people with chronic medical disorders found that those who used the Internet to locate information on their disorders reported (a) more feelings of social support and (b) more knowledge about their disorders and treatments. ...
Psychotherapy integration typically refers to the synthesis of diverse methods and schools of psychotherapy. This chapter expands that definition to consider the combination of psychotherapy with self-help materials. Clinicians frequently desire to integrate self-help into psychotherapy but question how and what to do with clients. The authors address types of self-help resources, their effectiveness with and without psychotherapy, and ways to seamlessly integrate them into formal treatment. The chapter considers a variety of self-help (e.g., self-help books, websites, mobile apps, commercial films). The clinician’s behavior can significantly enhance the effectiveness of recommended self-help and can produce a broader integration of effective change methods.
... eHealth-facilitated interventions can be effective on health-and cost-related outcome measures [9]. In addition to the potential of eHealth-facilitated interventions to reduce re-hospitalisation rates and shorten length of stay [111][112][113], such interventions can improve patients' medical and behavioural outcomes in view of symptom severity, quality of life (QoL), medication adherence [7][8][9][10][11] and other behavioural performance measures [3,114,115]. While eHealthfacilitated ICMs have been tested in trial settings, their successful implementation in clinical settings remains a challenge [116][117][118]. ...
Background
While effectiveness outcomes of eHealth-facilitated integrated care models (eICMs) in transplant and oncological populations are promising, implementing and sustaining them in real-world settings remain challenging. Allogeneic stem cell transplant (alloSCT) patients could benefit from an eICM to enhance health outcomes. To combat health deterioration, integrating chronic illness management, including continuous symptom and health behaviour monitoring, can shorten reaction times. We will test the 1st-year post-alloSCT effectiveness and evaluate bundled implementation strategies to support the implementation of a newly developed and adapted eICM in allogeneic s te m cell transplantation facilitated by eHealth (SMILe–ICM).
SMILe-ICM has been designed by combining implementation, behavioural, and computer science methods. Adaptions were guided by FRAME and FRAME-IS. It consists of four modules: 1) monitoring & follow-up; 2) infection prevention; 3) physical activity; and 4) medication adherence, delivered via eHealth and a care coordinator (an Advanced Practice Nurse). The implementation was supported by contextually adapted implementation strategies (e.g., creating new clinical teams, informing local opinion leaders).
Methods
Using a hybrid effectiveness-implementation randomised controlled trial, we will include a consecutive sample of 80 adult alloSCT patients who were transplanted and followed by University Hospital Basel (Switzerland). Inclusion criteria are basic German proficiency; elementary computer literacy; internet access; and written informed consent. Patients will be excluded if their condition prevents the use of technology, or if they are followed up only at external centres. Patient-level (1:1) stratified randomisation into a usual care group and a SMILe-ICM group will take place 10 days pre-transplantation. To gauge the SMILe–ICM’s effectiveness primary outcome (re-hospitalisation rate), secondary outcomes (healthcare utilization costs; length of inpatient re-hospitalizations, medication adherence; treatment and self-management burden; HRQoL; Graft-versus-Host Disease rate; survival; overall survival rate) and implementation outcomes (acceptability, appropriateness, feasibility, fidelity), we will use multi-method, multi-informant assessment (via questionnaires, interviews, electronic health record data, cost capture methods).
Discussion
The SMILe–ICM has major innovative potential for reengineering alloSCT follow-up care, particularly regarding short- and medium-term outcomes. Our dual focus on implementation and effectiveness will both inform optimization of the SMILe-ICM and provide insights regarding implementation strategies and pathway, understudied in eHealth-facilitated ICMs in chronically ill populations.
Trial registration
ClinicalTrials.gov. Identifier: NCT04789863 . Registered April 01, 2021.
... Although various self-management interventions have been evaluated, many are not theoretically driven or evidence-based, nor are they informed by patient preferences [22]. Digital health interventions (DHIs) are an efficient and effective method of providing interventions to improve knowledge and self-management behaviors and to actively involve individuals in their care, resulting in improved outcomes for people with long-term conditions [23]. Implementation barriers often associated with face-to-face interventions, such as time and transport, can be addressed using DHIs, which provide more accessible, acceptable, tailored, and interactive information and support [24,25]. ...
Background:
Health care self-management is important for people living with nondialysis chronic kidney disease (CKD). However, the few available resources are of variable quality.
Objective:
This work describes the systematic codevelopment of "My Kidneys & Me" (MK&M), a theory-driven and evidence-based digital self-management resource for people with nondialysis CKD, guided by an established process used for the successful development of the diabetes education program MyDESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed, DESMOND).
Methods:
A multidisciplinary steering group comprising kidney health care professionals and researchers and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behavior change. A patient and public involvement group helped identify the needs and priorities of MK&M and co-design the resource. MK&M was developed in 2 sequential phases. Phase 1 involved the codevelopment process of the MK&M resource (content and materials), using Intervention Mapping (IM) as a framework. The first 4 IM steps guided the development process: needs assessment was conducted to describe the context of the intervention; intervention outcomes, performance objectives, and behavioral determinants were identified; theory- and evidence-based change methods and practical strategies to deliver change methods were selected; and program components were developed and refined. Phase 2 involved the adoption and adaptation of the existing MyDESMOND digital platform to suit the MK&M resource.
Results:
The needs assessment identified that individuals with CKD have multiple differing needs and that delivering a self-management program digitally would enable accessible, tailored, and interactive information and support. The intended outcomes of MK&M were to improve and maintain effective self-management behaviors, including physical activity and lifestyle, improve knowledge, promote self-care skills, increase self-efficacy, and enhance well-being. This was achieved through the provision of content and materials designed to increase CKD knowledge and patient activation, reduce health risks, manage symptoms, and improve physical function. Theories and behavior change techniques selected include Self-Management Framework, Capability, Opportunity, Motivation Behavior model components of Behaviour Change Wheel and taxonomy of behavior change techniques, Health Action Process Approach Model, Common Sense Model, and Social Cognitive Theory. The program components developed comprised educational and behavior change sessions, health trackers (eg, monitoring blood pressure, symptoms, and exercise), goal-setting features, and forums for social support. The MyDESMOND digital platform represented an ideal existing platform to host MK&M; thus, the MyDESMOND interface and features were adopted and adapted for MK&M.
Conclusions:
Applying the IM framework enabled the systematic application of theory, empirical evidence, and practical perspectives in the codevelopment of MK&M content and materials. Adopting and adapting a preexisting platform provided a cost- and time-efficient approach for developing our digital intervention. In the next stage of work, the efficacy of MK&M in increasing patient activation will be tested in a randomized controlled trial.
... Mobile health interventions allow real-time monitoring of behavior in an ambulatory setting [40][41][42][43][44]. Our objective is to test the efficacy of a 10-h TRE intervention, compared to habitual prolonged eating window (>14 h, HABIT), on CVD risk in metabolically unhealthy adults. ...
Re-aligning eating patterns with biological rhythm can reduce the burden of metabolic syndrome in older adults with overweight or obesity. Time-restricted eating (TRE) has been shown to result in weight loss and improved cardiometabolic health while being less challenging than counting calories. The New York Time-Restricted EATing study (NY-TREAT) is a two-arm, randomized clinical trial (RCT) that aims to examine the efficacy and sustainability of TRE (eating window ≤10 h/day) vs. a habitual prolonged eating window (HABIT, ≥14 h/day) in metabolically unhealthy midlife adults (50–75 years) with overweight or obesity and prediabetes or type 2 diabetes (T2D). Our primary hypothesis is that the TRE will result in greater weight loss compared to HABIT at 3 months. The efficacy of the TRE intervention on body weight, fat mass, energy expenditure, and glucose is tested at 3 months, and the sustainability of its effect is measured at 12 months, with ambulatory assessments of sleep and physical activity (ActiGraph), eating pattern (smartphone application), and interstitial glucose (continuous glucose monitoring). The RCT also includes state-of-the-art measurements of body fat (quantitative magnetic resonance), total energy expenditure (doubly-labelled water), insulin secretion, insulin resistance, and glucose tolerance. Adherence to self-monitoring and reduced eating window are monitored remotely in real-time. This RCT will provide further insight into the effects of TRE on cardiometabolic health in individuals with high metabolic risk. Sixty-two participants will be enrolled, and with estimated 30% attrition, 42 participants will return at 12 months. This protocol describes the design, interventions, methods, and expected outcomes.
Clinical trial registration: NCT04465721
IRB: AAAS7791.
... DHIs refer to interventions delivered via technologies using a range of digital modalities, such as smartphones, applications ("apps"), wearable devices, robotics, websites, social media, or text messaging. DHIs can be used as a platform to help treat a range of physical and psychiatric disorders (6) promote positive health behaviors (7) and even improve outcomes of people with long term conditions (8). There is considerable optimism within the medical community that digital technologies-especially apps used on smartphones, tablets, and watches-could open a new frontier for the implementation of interventions to aid in the recovery from a range of disorders (9). ...
The rapid expansion of access to and engagement with digital technology over the past 15 years has transformed the potential for remote delivery of evidence-based digital health interventions (DHIs). Digital and remote behavioral interventions have the potential to address current gaps in the provision of evidence-based therapies in healthcare services. As the lack of access to behavioral treatments for people with tic disorders is a pressing issue across the world, there is great potential for DHIs to close this treatment gap. Here, we present a critical synthesis of the recent key advances in the field of digitally delivered, remote therapy for tics, outlining the research evidence for the clinical and cost-effectiveness and acceptability of digital or remotely delivered therapy. We found five trials aimed at reducing tic severity in children and young people and one trial for adults. The evidence supports the clinical utility of DHIs to deliver tic therapies, which shows promise in being clinically efficacious compared to an active control. Furthermore, DHIs in trials show good adherence and engagement and are acceptable to patients. The role of human support (including therapists and parents for young people) is likely to be important to encourage adherence. DHIs, where the main therapeutic content is delivered via web-based chapters, are likely to reduce clinical time, and maintain intervention fidelity, but further research is required to understand cost-effectiveness. Despite utilizing randomized controlled trials, only two trials were sufficiently powered to address efficacy and only one trial explored contextual factors that may influence engagement. Moreover, only one trial followed patients for >12 months, thus further long-term follow-ups are required. Specifically, we note that despite an emerging evidence base, DHIs for tics are yet to be routinely implemented in healthcare provision in any country. Drawing on the existing evidence, we conclude by proposing a stepped care model, in which digital therapy is implemented as a widely accessible first-line treatment using a purely online or therapist-supported approach.
... Although various self-management interventions have been evaluated, many are not theoreticallydriven or evidence based, nor are they informed by patient preferences - [22]. Digital health interventions (DHIs) are an efficient and effective method of providing interventions to improve knowledge, self-management behaviours, and to actively involve individuals in their care, resulting in improved outcomes for people with long-term conditions [23]. Implementation barriers that are often associated with face-to-face interventions, such as time and transport, can be addressed using DHIs which provide more accessible, acceptable, tailored, and interactive information and support [24,25]. ...
BACKGROUND
Healthcare self-management is important for people living with non-dialysis chronic kidney disease (CKD). However, the few available resources are of variable quality.
OBJECTIVE
This work describes the systematic co-development of ‘My Kidneys & Me’ (MK&M), a theory-driven and evidenced-based digital self-management resource for people with non-dialysis CKD, guided by an established process used for the successful development of the diabetes education programme MyDESMOND.
METHODS
A multidisciplinary steering group comprising kidney healthcare professionals and researchers, and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behaviour change. A Patient and Public Involvement group helped identify the needs and priorities of MK&M, and co-design the resource. The development of MK&M was conducted in two sequential phases. Phase 1 involved the co-development process of the MK&M resource (content and materials), using Intervention Mapping (IM) as a framework. The first four IM steps guided the development process: (1) needs assessment to describe the context of the intervention was conducted; (2) intervention outcomes, performance objectives, and behavioural determinants were identified; (3) theory- and evidenced-based change methods and practical strategies to deliver change methods were selected; and (4) programme components were developed and refined. Phase 2 involved the adoption and adaptation of the existing MyDESMOND digital platform to suit the MK&M resource.
RESULTS
The needs assessment identified that individuals with CKD have multiple differing needs, and that delivering a self-management programme digitally would enable accessible, tailored, and interactive information and support. The intended outcomes of the MK&M programme were to improve and maintain effective self-management behaviours, including physical activity and lifestyle, improve knowledge, promote self-care skills, increase self-efficacy, and enhance well-being. This was achieved through provision of content and materials designed to increase CKD knowledge, patient activation, reduce health risks, managing symptoms, and improve physical function. Theories and behaviour change techniques selected include Self-Management Framework, COM-B components of Behaviour Change Wheel and Taxonomy of Behaviour Change Techniques, Health Action Process Approach Model, Common Sense Model, Social Cognitive Theory. The programme components developed comprised educational and behaviour change sessions, health trackers (e.g., monitoring blood pressure, symptoms, exercise), goal setting features, and forums for social support. The MyDESMOND digital platform represented an ideal existing platform to host MK&M, thus the MyDESMOND interface and features were adopted and adapted for MK&M.
CONCLUSIONS
Applying the IM framework enabled the systematic application of theory, empirical evidence, and practical perspectives in the co-development of MK&M content and materials. Adopting and adapting a pre-existing platform provided a cost- and time-efficient approach to developing our digital intervention. In the next stage of work, the efficacy of MK&M in increasing patient activation will be tested in a randomised controlled trial.
... Ubiquitous computing, the availability and usage of technology everywhere, has changed the paradigm of traditional in-person, face-to-face clinical interactions. Accordingly, research has shifted toward utilizing health technology as a means to promote healthy behaviors and lifestyle changes [27] via tablets, smartphones, portable trackers, and web-based interventions that use gamification [28]. Gamification using a virtual platform can increase motivation and improve user engagement, fostering health-enhancing behaviors [28,29]. ...
Background:
It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD.
Objective:
We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV.
Methods:
This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV.
Results:
The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022.
Conclusions:
This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD.
Trial Registration:
ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952
... The simple identification of similar cases or symptoms among individuals with similar problems in discussion groups can be a great tool to manage chronic conditions, including FM, offering improvements to the health of users, promoting greater autonomy and proactivity, in addition to benefits such as improvements to social life, reduction of hopelessness, more knowledge about the disease, expansion of behavioral strategies and better clinical results, especially in the areas of rheumatic diseases and syndromes [63,65]. ...
Health education is one of the main items to enable the promotion of health for individuals with fibromyalgia (FM) in Primary Health Care (PHC) in Brazil. The purpose of this study was to validate a multidisciplinary educational health promotion program called Amigos de Fibro (Fibro Friends) for individuals with FM. Methodological research involving 23 health professionals (expert judges) and 45 individuals with FM (target audience) used an instrument to assess the objectives, proposed themes and initiatives, relevance, writing style, and structure of the program through the Delphi technique. The content validity index (CVI) ≥ 0.78 and coefficient kappa ≥ 0.61 were used for data analysis. All 25 items evaluated in both groups presented considerable minimum CVI by CVI and the kappa coefficient. In the global evaluation of Amigos de Fibro, the CVI of the specialist judges was 0.90, while the values of the target audience judges were 0.95. The kappa coefficient of the expert judges was 0.90 and that of the target audience judges was 0.85. Amigos de Fibro, a light technology in health, was considered with adequate content validity and internal consistency and is, therefore, valid in the use by health professionals with the target audience in PHC, making it possible for them to act as health-promoting agents.
... Aside from building a sense of community, utilizing the internet and posting activities also improves a sense of agency in patients to feel empowered in their own decision making (60). Interactive health communication has been shown to improve disease knowledge, clinical outcomes, and social support (61), and in the study below is hypothesized to also improve medication adherence. ...
Background:
Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE.
Methods:
A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results.
Results:
Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence (n = 3), quality of life (n = 3), fatigue (n = 2), pain (n = 2), depressive symptoms (n = 1), anxiety (n = 1), and health-related outcomes including disease severity (n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function (n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue).
Conclusion:
This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.
... The role of digital mental health interventions in addressing health inequalities is yet to be determined. On the one hand, they provide the potential to reduce health disparities, by providing personalized, low-cost, infinitely reusable resources that can increase access to health interventions [25,26]. On the other hand, they may increase inequity where there remain barriers to access and usability for disadvantaged groups [27,28]. ...
Background
Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom.
Objective
The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants’ subjective experiences of using Wakey!
Methods
The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020.
Results
In total, 5413 people fit the inclusion criteria and were included in the final sample—65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being.
Conclusions
This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions.
Trial Registration
ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296
... The challenge also raised over 115 million dollars for ALS research (The ALS Foundation, 2020). Although internet metrics and analytics on awareness do not necessarily equate to offline behavior change, social media has proven Twitter Trend potential for health promotion and improved traditional health outcomes (Murray et al., 2005) and continues to be a valuable tool for disseminating health information. Data derived from the Impact Tracking Sheet revealed that WhatsApp had the highest engagement (86.3%). ...
Measures put in place to curb the spread of the coronavirus have inadvertently fostered a reduction in physical activity. This study reports a virtual campaign designed to promote the health and physical activity level of individuals and increase awareness on practices to curb the spread of Coronavirus. The campaign enlisted a total of 141 volunteers recruited via a public call for volunteers to share promotional e-posters through their social media platforms for eight days; Each day focused on a different theme such as setting up an ergonomic home office, proper posture and home workout sessions across age groups. The reach was measured in terms of total engagement with 130 posts on 5 social media platforms. Total engagement defined as all interactions with the content was 15,889. WhatsApp recorded the highest engagement (86.3%), while engagement from Facebook (0.04%) was the lowest. The peculiarity of the online platforms ensures content can still be viewed irrespective of when posted, therefore the reach of the campaign can increase over time without promotional efforts.
... Technological advancements empower individuals to engage in self-management and well-being [1]. There is also the unparalleled opportunity of digital technologies to transform the prevention [2], health promotion [3,4], health monitoring [5], health management [6,7], health equity [8], and surveillance for public health disasters [9][10][11]. ...
Background: Rapid developments and implementation of digital technologies in public health domains throughout the last decades have changed the landscape of health delivery and disease prevention globally. A growing number of countries are introducing interventions such as online consultations, electronic health records, or telemedicine to their health systems to improve their populations’ health and improve access to health care. Despite multiple definitions for digital public health and the development of different digital interventions, no study has analyzed whether the utilized technologies fit the definition or the core characteristics of digital public health interventions. A scoping review is therefore needed to explore the extent of the literature on this topic.
Objective: The main aim of this scoping review is to outline real-world digital public health interventions on all levels of health care, prevention, and health. The second objective will be the mapping of reported intervention characteristics. These will include nontechnical elements and the technical features of an intervention.
Methods: We searched for relevant literature in the following databases: PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), IEEE (Institute of Electrical and Electronics Engineers) Xplore, and the Association for Computing Machinery (ACM) Full-Text Collection. All original study types (observational studies, experimental trials, qualitative studies, and health-economic analyses), as well as governmental reports, books, book chapters, or peer-reviewed full-text conference papers were included when the evaluation and description of a digital health intervention was the primary intervention component. Two authors screened the articles independently in three stages (title, abstract, and full text). Two independent authors will also perform the data charting. We will report our results following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.
Results: An additional systematic search in IEEE Xplore and ACM, performed on December 1, 2021, identified another 491 titles. We identified a total of 13,869 papers after deduplication. As of March 2022, the abstract screening state is complete, and we are in the state of screening the 1417 selected full texts for final inclusion. We estimate completing the review in April 2022.
Conclusions: To our knowledge, this will be the first scoping review to fill the theoretical definitions of digital public health with concrete interventions and their characteristics. Our scoping review will display the landscape of worldwide existing digital public health interventions that use information and communication technologies. The results of this review will be published in a peer-reviewed journal in early 2022, which can serve as a blueprint for the development of future digital public health interventions.
... Although technology may broadly assist patients in beneficial health behaviors, 33 patients' input in design is critical for success. [34][35][36] For technologies to be effective, they must meet users' needs, be easy to use, and be perceived as useful. ...
Background
Immunosuppression nonadherence may be the most important factor limiting long-term allograft survival.
Objective
Following user-centered design, we explored the essential priorities and preferences of kidney transplant recipients and healthcare providers (HCP) to inform development of a smartphone app to improve immunosuppression adherence and communication.
Design
A qualitative descriptive research design was used.
Setting
The University of Alberta Hospital adult kidney transplant program in Edmonton, Canada.
Participants
Participants were recruited by convenience sampling and included 32 kidney transplant recipients and 11 HCPs.
Methods
Seven focus groups (5 with recipients and 2 with HCPs) were conducted to inform app development. Sessions were recorded, and transcripts were coded to elucidate themes.
Results
App development to improve adherence was not a priority for HCP. Recipients prioritized choice: that all features be optional. Recipients preferred support while traveling; access to laboratory results; and use by younger or newly transplanted recipients. Both recipients and HCP preferred linkage to pharmacy; and self-management and accountability. For the app to improve communication, HCPs believed the priorities to be addressed included: clarity on scope of app; legal, ethical, and professional obligations; and charting. Both recipients and HCP prioritized HCP workload, and broader medication and health concerns. Healthcare providers preferred tech support; both recipients and HCPs preferred app access for nontransplant HCP.
Limitations
Limitations include underrepresentation of physicians, recipients with racial/ethnic diversity, and potential selection bias of transplant recipients who perceived themselves to be adhering to immunosuppression medications.
Conclusion
Future research is needed for the app to become a comprehensive, secure platform for broader communication between recipients and HCP, pharmacies, and nontransplant clinicians while streamlining HCP workload.
... There is no doubt that technology in educational settings will continue to play a major role in student learning. In recent decades, there has been accumulating evidence supporting the value of interventions delivered through digital technology, including but not limited to texting, telecommunications, and real time monitoring of symptoms and emotions [13][14][15][16]. Consequently, there is a need for individuals to learn and apply such technologies to help people make informed decisions about individual and community health [17][18][19][20]. ...
Unstructured:
The disruption of traditional, in-person learning due to the COVID-19 pandemic necessitated the rapid development and use of revised and novel learning opportunities using a variety of remote instructional methodologies. This viewpoint describes the process used by an undergraduate Public Health program to transition a traditional, in-person, semester-long, 480-hour internship to a virtual-only learning experience guided by the existing student learning outcomes. Working closely with public health professionals at existing internship agencies, alumni from the program, and the student interns, program faculty developed a modified virtual internship composed of six components. Development of this modified virtual internship model was guided by previous research on the components of successful internships and the elements of high-impact learning practices.
... As the burden of chronic disease competes with academic attainment, schools and healthcare teams must link up [108], aiming to minimize school absenteeism attributed to appointments and flare-ups. Whilst asthma health technology [109] is eagerly embraced by adolescents, more evidence is required in proving that applications [110] for medication adherence, disease monitoring, and health literacy are effective. Human-computer interactions for inhaler technique competency, peak flow monitoring, and medication reminders are promising and complement current practices [111,112] but require further patient engagement to fulfil unmet needs [113]. ...
Known for their pre-occupation with body image, self-identity creation, peer acceptance, and risk-taking behaviors, adolescents with asthma face unique challenges. Asthma is a heterogeneous disease and accurate diagnosis requires assessment through detailed clinical history, examination, and objective tests. Diagnostic challenges exist as many adolescents can present with asthma-like symptoms but do not respond to asthma treatment and risk being mis-diagnosed. Under-recognition of asthma symptoms and denial of disease severity must also be addressed. The over-reliance on short-acting beta-agonists in the absence of anti-inflammatory therapy for asthma is now deemed unsafe. Adolescents with mild asthma benefit from symptom-driven treatment with combination inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) on an as-required basis. For those with moderate-to-persistent asthma requiring daily controller therapy, maintenance and reliever therapy using the same ICS-LABA controller simplifies treatment regimes, while serving to reduce exacerbation risk. A developmentally staged approach based on factors affecting asthma control in early, middle, and late adolescence enables better understanding of the individual’s therapeutic needs. Biological, psychological, and social factors help formulate a risk assessment profile in adolescents with difficult-to-treat and severe asthma. Smoking increases risks of developing asthma symptoms, lung function deterioration, and asthma exacerbations. Morbidity associated with e-cigarettes or vaping calls for robust efforts towards smoking and vaping cessation and abstinence. As adolescents progress from child-centered to adult-oriented care, coordination and planning are required to improve their self-efficacy to ready them for transition. Frequent flare-ups of asthma can delay academic attainment and adversely affect social and physical development. In tandem with healthcare providers, community and schools can link up to help shoulder this burden, optimizing care for adolescents with asthma.
... Digital health interventions (DHIs), such as those that can be provided by smartphone apps, have been proposed as a promising mode for supporting self-management in people with chronic conditions [10]. In a recent systematic review on the use of DHIs for supporting self-management of LBP, we found that the literature was heterogeneous in terms of reporting intervention details, making it difficult to understand what might work best, for whom, and in what circumstances [11]. ...
Background:
International guidelines consistently endorse the promotion of self-management for people with low back pain (LBP); however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode of supporting self-management in people with chronic conditions, including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak, and detailed descriptions and documentation of the interventions are lacking. Structured intervention mapping (IM) constitutes a 6-step process that can be used to guide the development of complex interventions.
Objective:
The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of nonspecific LBP to reduce pain-related disability.
Methods:
The first 5 steps of the IM process were systematically applied. The core processes included literature reviews, brainstorming and group discussions, and the inclusion of stakeholders and representatives from the target population. Over a period of >2 years, the intervention content and the technical features of delivery were created, tested, and revised through user tests, feasibility studies, and a pilot study.
Results:
A behavioral outcome was identified as a proxy for reaching the overall program goal, that is, increased use of evidence-based self-management strategies. Physical exercises, education, and physical activity were the main components of the self-management intervention and were designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by the behavior change theory and the normalization process theory.
Conclusions:
We describe a detailed example of the application of the IM approach for the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency in the developmental process of the intervention and can be a possible blueprint for designing and creating future digital health interventions for self-management.
... Per promuovere lo sviluppo dell'autonomia, l'utilizzo di strumenti interattivi per la gestione a distanza del paziente con IRC può considerarsi un ulteriore strumento utile per aiutare i pazienti nello sviluppo di queste competenze e per favorire una maggior consapevolezza dei processi di cura a cui sono sottoposti [17]. ...
Hemodialysis is the most common treatment in patients with end-stage chronic kidney disease and the wide accessibility of this therapy has prolonged the patients' lifespan. However, it involves alterations in their emotional sphere and, often, a reduction in therapeutic compliance as the chronicity of kidney disease requires lifestyle changes difficult to maintain in the long term. The management of a chronic medical condition is in fact a complex process that necessarily requires multidisciplinary action. The concepts of "Self-efficacy" and "Self-management" fall within the Self-Determination Theory and are relevant in this context because they refer to the beliefs that everyone has about their abilities to control behavior and determine the success in adhering to prescribed therapies. Furthermore, the promotion of self-efficacy and self-management through an educational approach that makes use of so-called "eHealth" tools can help develop greater self-awareness in dialysis patient, a better control over their care choices and an increased adherence to therapeutic-dietary indications. This article aims at highlighting the importance of implementing an approach based on eHealth in the management of hemodialysis patients. It also wants to raise awareness of the related multidisciplinary theories to be applied in this clinical context to promote greater therapeutic adherence, and therefore a better quality of life and care.
... People with diabetes mellitus are 10-15 times more likely to receive lower extremity amputation than non-diabetic individuals (Van Houtum, 1997). Furthermore, lower extremity amputation is associated with high morbidity and mortality (Abdullah and Abdullah, 2010;Li et al, 2014;Muhammad-Lutfi et al, 2014;Ahmad Sharoni et al, 2017), 40.7% of patients became institutionalised after having an amputation (Lavery et al, 2003;Murray et al, 2005;Singh et al, 2005;Wong, 2005). The suboptimal outcome poses a heavy health and socioeconomic burden on the healthcare resources and society. ...
Foot complications from diabetes mellitus are one of main causes of lower limb amputation, however, public awareness of diabetic foot care is low. A mobile app “Happy Feet” was developed,s targeting patients with diabetic foot ulcers (DFU). Patients foot awareness substantially increased after three and six months of using the application. Mean total scores between baseline and three months were significantly increased (baseline versus three months, 22.80 versus 25.54; p<0.01), and between three and six months in “examining between the toes” and “breaking in new shoes slowly” (p<0.01).
Policymakers and medical professionals benefit from the mobile app by providing accurate and precise information from this group of patients.
The health belief model (HBM), prodigiously researched, has enjoyed sustained popularity amid evolving social norms, theories and models, and the recent developments of advanced technology influencing health behavior change (→ Health Communication; Planned Social Change through Communication). Developed by US Public Health Service social psychologists in the 1950s, the HBM was conceptualized to model the failure of individuals to engage in disease prevention or detection programs (→ Prevention and Communication). Around 1974, and later in the 1980s, additional components (knowledge about the disease, self‐efficacy or confidence in one's ability to perform the action of interest, cues to action), such as those examining responses to diagnosed illnesses and symptoms and adherence to medical regimens, were added to the model (Janz et al. 2003; → Health Literacy).
Compared with traditional channels of information dissemination, social media allow users to explore, to reveal and to share all kinds of information via web, reinforcing word spreading effect with such online interactivities. Convincing health information often contains clear data, distinct hierarchies and strong visual appeal. This study investigated how the application of emoji and design complexity affects social media engagement and the level of perceived visual informativeness of health information. We conducted an online experiment with a 2 (emoji: with versus without) X 2 (information design complexity: high versus low) between-subjects research. A total of 277 subjects participated in this study. Results show that, firstly, health information with emoji leads to higher social media engagement and perceived visual informativeness. Secondly, high complexity information was more convincing in terms of increasing perceived visual informativeness. Thirdly, a significant interaction effect was found on perceived visual informativeness between emoji and the design complexity of health information. In addition, visual symbols, such as emoji, are more meaningful in health information with higher design complexity than those without visual intervention or low complexity. The evidence from this study provides strategies for making visual information in health more persuasive and engaging.
Background:
Given the importance of self-management in type 2 diabetes mellitus (T2DM) (T2D), a major aspect of health is providing diabetes self-management education and support (DSME/S). There are known barriers including access, availability, and lack of follow through on referral to education programs. Virtual education and support have increased in use, particularly over the last few years.
Objective:
The purpose of the Diabetes LIVE (Learning in a Virtual Environment) study was to compare the effects of the LIVE intervention (educational 3D world) on diet and physical activity behaviors, behavioral and metabolic outcomes in adults with T2DM over 12 months to an online DSME/S control website.
Methods:
The LIVE study was a 52-week multi-site randomized controlled trial with longitudinal repeated measures. Participants were randomized to Diabetes LIVE (n =101) or a web control site (n=110). Both contained the same educational materials, but the VE was synchronous and interactive and the other was a flat website. Data were collected at baseline, 3, 6, and 12 months using surveys, clinical, laboratory, and Fitbit measures. Descriptive statistics for baseline characteristics and demographics were used. The effects of the intervention on outcomes were initially examined by comparing the means and standard deviations across the four time points of the outcomes between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months.
Results:
211 participants consented to participate in this trial. The mean age of participants was 58.85 (+10.1) years, and a majority were White (60.2%), non-Hispanic (93.8%), married (56.3%), and female (59.2%). Mean A1c at baseline was 7.64% (+1.79) and the mean BMI was 33.51 (+7.25). We examined weight loss status vs. randomized group, where data with no weight change were eliminated, and we found a statistically significant difference with the LIVE group experiencing more weight loss than the WebControl group (P=.04). There were no statistically significant differences between groups in changes in physical activity and dietary outcomes, but each group showed an increase in physical activity. Both groups experienced a decrease in mean A1c, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline A1c was 8.6 or higher.
Conclusions:
This study confirmed that there were minor positive changes on metabolic controlglycemic targets in both groups over the 12-month study period, however, the majority of the participants began with optimal metabolic controlA1c levels. We did find clinically relevant metabolic changes in those who began with an A1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM.
Clinicaltrial:
nCT02040038.
Introduction:
Surgery is the most common treatment for colorectal cancer (CRC) and can cause relative long average length of stay (LOS) and high risks of unplanned readmissions and complications. Enhanced Recovery After Surgery (ERAS) pathways can reduce the LOS and postsurgical complications. Digital health interventions provide a flexible and low-cost way of supporting patients to achieve this. This protocol describes a trial aiming to evaluate the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention in decreasing the hospital LOS in patients undergoing CRC surgery.
Methods and analysis:
The two-arm randomised controlled trial will assess the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention compared with usual care (control) in patients with CRC. The intervention consists of a website and a series of automatic prompts and alerts to support patients to adhere to the patient-led ERAS recommendations. The primary trial outcome is the length of hospital stay. Secondary outcomes include days alive and out of hospital; emergency department presentations; quality of life; patient knowledge and behaviours related to the ERAS recommendations; health service utilisation; and intervention acceptability and use.
Ethics and dissemination:
The trial has been approved by the Hunter New England Research Ethics Committee (2019/ETH00869) and the University of Newcastle Ethics Committee (H-2015-0364). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team will facilitate its adoption within the Local Health District for widespread adaptation and implementation.
Trial registration number:
ACTRN12621001533886.
We developed a Web-based experiential learning intervention named Friend Supporter to reduce the general public’s cancer-related stigma. This study investigated the participants’ perceptions and experiences of Friend Supporter using the think-aloud method. From June to August 2021, we used snowball sampling and recruited participants aged ≥20 years who had never been diagnosed with cancer. We conducted the 5-week intervention with the participants in a natural setting. We also administered a questionnaire survey to 13 participants after each module, conducted review interviews with 8 participants after completing the intervention, and respectively extracted 7 and 12 categories using content analysis. The results indicated that participants highly evaluated the intervention’s content, although specific participants were dissatisfied with the intervention. A few participants reported the need to consider older people and their difficulties in managing worksheets that lacked concrete examples. Optimizing the intervention requires refining the system, offering detailed instructions or supplementary materials, and presenting the option to view actual cases. We suggest that these measures can enhance the intervention’s usability and feasibility.
Every four years since 2004, the Copenhagen Consensus Center has organized and hosted a high profile thought experiment about how a hypothetical extra $75 billion of development assistance money might best be spent to solve twelve of the major crises facing the world today. Collated in this specially commissioned book, a group of more than 50 experts make their cases for investment, discussing how to combat problems ranging from armed conflicts, corruption and trade barriers, to natural disasters, hunger, education and climate change. For each case, 'Alternative Perspectives' are also included to provide a critique and make other suggestions for investment. In addition, a panel of senior economists, including four Nobel Laureates, rank the attractiveness of each policy proposal in terms of its anticipated cost-benefit ratio. This thought-provoking book opens up debate, encouraging readers to come up with their own rankings and decide which solutions are smarter than others.
Objective:
Connected health technologies have the potential to improve access to cancer care and support and reduce costs. We aimed to assess the impacts of interventions delivered using connected health technologies on psychological and quality of life (QoL) outcomes in people living with and beyond cancer.
Methods:
PUBMED, PsycINFO, Web of Science, and EMBASE were searched using terms relating to (i) cancer, (ii) connected health, and (iii) QoL/psychological wellbeing. Studies were included if they evaluated interventions using connected health technologies and assessed psychological and/or QoL outcomes for adults at any stage of cancer treatment or survivorship.
Results:
37 studies met the inclusion criteria with a total of 8,956 participants. Connected health technologies included web-based applications (n=24), smart applications (n=12), and wearable devices (n=1). Studies were heterogeneous in terms of intervention components. We identified five clusters: (i) Psychosocial support and rehabilitation, (ii) psychoeducation and information support, (iii) symptom monitoring, reporting and self-management, (iv) peer and social support, and (v) health coaching and physical activity training. Due to heterogeneity of outcome measures, the meta-analysis included only seven RCTs; pooled mean estimates showed connected health interventions were moderately effective in reducing symptoms of depression (SMD: -0.226, 95% CI -0.303/-0.149) and anxiety (SMD: -0.188, 95% CI: 0.279/-0.0963) compared with usual care.
Conclusion:
While the considerable heterogeneity observed highlights the need for more rigorous studies to improve reproducibility and efficiency, results suggest that connected health interventions have the potential to improve psychological wellbeing and QoL outcomes in people living with and beyond cancer. This article is protected by copyright. All rights reserved.
The introduction of Internet and ICT (information and communication technologies) in the health context has brought new challenges for health systems represented both by the availability of online medical medication, whose inaccuracy can be detrimental for public health, and the implementation of telehealth with the pharmaceutical context. As all other healthcare practitioners, the pharmacist has to became an active actor to foster a safe use of these innovations.
My studies have focused on these two topic that are raising more and more interest among researchers with the aim to understand the implications that this breakthrough represents for the pharmacist. In both studies, I used Internet-based questionnaires to gather and analyse a consistent dataset. The first study has shown a high use of online medical information among Italian users and a variable awareness of threats connected to misinformation according mainly to age. In this respect, older users are those who are more prone to have a higher trust in online medical information and a lower perception of risks.
The second one has pointed out a scarce implementation of telemedicine in Italian pharmacies mainly imputable to a low commitment of health authorities in supporting this integration process.
Considering these findings, both academic and governmental interventions are strongly desirable to ensure the acquisition of those skills that the pharmacist requires to keep the pace with the evolving healthcare setting.
Purpose
The purpose of this study was to investigate the adoption and actual use of a digital dietary monitoring system (DDMS) and its impact on patient satisfaction with the provided hospital care, body weight changes and health-related quality of life (HRQoL) in patients with potentially curable esophageal cancer planned for surgery. The DDMS enables patients and dietitians to monitor patients’ nutritional intake and body weight during the preoperative period.
Methods
In this prospective observational study, the first 47 included patients received usual nutritional care, and were followed from diagnosis until surgery. After implementation of the DDMS 37 patients were followed, again from diagnosis until surgery. Main outcomes were actual use of the DDMS, by means of adoption and usage measures, overall patient satisfaction (EORTC-INPATSAT32), weight change and HRQoL (EORTC QLQ-C30 and EORTC-OG25). Outcomes were assessed immediately after diagnosis, and 6 and 12 weeks later.
Results
The system had an adoption rate of 64% and a usage rate of 78%. No significant effects on patient satisfaction were found at 12 weeks after diagnosis between the intervention and the usual care group. The implementation of the DDMS also had no significant effect on body weight and HRQoL over time.
Conclusions
Patients with potentially curable esophageal cancer planned for surgery were able to use the DDMS. However, no significant effects on patient satisfaction, body weight changes and HRQoL were observed. Further research should focus on the specific needs of patients regarding information and support to preoperatively optimize nutritional intake and nutritional status.
Abstract
Substance addiction is the continuation of substance intake and inability to stop it, despite the physical,
mental or social problems that arise in the process of taking the substance (Arıkan & Doğan, 1999:53,
akt; Daşbaş, Polat, & Kesen, 2013). Substance use is a broad term used for addictive substances like
alcohol, cigarette, caffeine, but in this research it will indicate drug use. Recently, substance use has increased especially among adolescents in Turkey. Therefore, the therapy and rehabilitation services should
be increased and become diversified in relation to this augmentation. Since addiction is a relapsing
situation, recovery of it requires multidimensional interventions during and after the treatment. It
should be noted that recovery of substance addiction necessitates physical treatment as well as psycho-social interventions. In this regard, this research aims to investigate the methods used in the treatment and
rehabilitation process of substance addiction through the existing literature.Keywords: substance addiction, therapy and rehabilitation models, psycho-social interventions
Background:
Infection control protocols, including visitor restrictions, implemented during the COVID-19 pandemic threatened the ability to provide compassionate, family-centered care to patients dying in the hospital. In response, clinicians used videoconferencing technology to facilitate conversations between patients and their families.
Objectives:
To understand clinicians' perspectives on using videoconferencing technology to adapt to pandemic policies when caring for dying patients.
Methods:
A qualitative descriptive study was conducted with 45 clinicians who provided end-of-life care to patients in 3 acute care units at an academically affiliated urban hospital in Canada during the first wave of the pandemic (March 2020-July 2020). A 3-step approach to conventional content analysis was used to code interview transcripts and construct overarching themes.
Results:
Clinicians used videoconferencing technology to try to bridge gaps in end-of-life care by facilitating connections with family. Many benefits ensued, but there were also some drawbacks. Despite the opportunity for connection offered by virtual visits, participants noted concerns about equitable access to videoconferencing technology and authenticity of technology-assisted interactions. Participants also offered recommendations for future use of videoconferencing technology both during and beyond the pandemic.
Conclusions:
Clinician experiences can be used to inform policies and practices for using videoconferencing technology to provide high-quality end-of-life care in the future, including during public health crises.
Addressing the unmet needs of individuals with cancer in a timely manner is imperative for true implementation of person-centered care. Interactive health communication (ie, people's interactions with health information technologies) and more sustainable forms of support (eg, trained volunteers), are increasingly recognized as promising means to address the many barriers to accessing cancer-related support. This pilot study is timely as it tested an accessible cancer supportive approach that included e-handouts on 25 cancer distress-related topics and supportive phone calls by trained volunteers. The study objectives were to document participants’ preferences for the types of support offered, assess changes in distress pre and post, and determine the usability of the approach. Individuals with various types and stages of cancer (N = 88), diagnosed within the past 6 months were recruited from a university-affiliated cancer center in Montreal, Quebec, Canada. Participants completed the Cancer Support Community Distress measure at baseline, and they were prompted to request different types of support. Participants completed a follow-up questionnaire including the distress measure one to four weeks post support provision. Of the 88 participants who filled out baseline questionnaires, 68 completed the follow up measures. Of the former, 76% (n = 67) made at least one request (e-handouts/phone calls/or both). The most frequently requested e-handout addressed pain/physical discomfort (37 requests) and phone calls were requested mostly for sleep problems (8 requests). Participants who requested both support modalities reported significantly lower distress [F (3,64) = 3.52, P = .02] at follow-up compared to those who made no requests. Ninety-two percent of participants who requested e-handouts reported that other patients would benefit from these. Participants who requested phone calls agreed or strongly agreed that volunteers were knowledgeable. The usability score was excellent (mean = 85.5/100; SD = 16.36). Preliminary findings indicate that this supportive approach is promising. Future work would document the differential contributions of supportive modalities that compare, for instance, professional versus lay (trained) support.
Background:
Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear.
Objective:
The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone.
Methods:
A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)-compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected.
Results:
Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93%) into the course than those from the control group (35/45, 78%; χ21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91% vs 27/45, 60%, respectively; χ21=11.4; P=.001). Of the participants enrolled in the intervention group, 43% (19/44) completed the course, and of those in the control group, 31% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48%) and control groups (14/27, 52%; χ21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups.
Conclusions:
Telephone support improves participants' registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy.
Trial registration:
Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167.
Background:
Adults living with Chronic Obstructive Pulmonary Disease (COPD) often have difficulties when trying to access health care services. Interactive communication technologies are a valuable tool to enable patients to access supportive interventions to cope with their disease. The aim of this revision and meta-analysis is to analyze the content and efficacy of web-based supportive interventions in quality of life in COPD.
Methods:
Medline (via PubMed), Web of Science, and Scopus were the databases used to select the studies for this systematic review. A screening, analysis, and assessment of the methodological quality was carried out by two independent researchers. A meta-analysis of the extracted data was performed.
Results:
A total of 9 of the 3089 studies reviewed met the inclusion criteria. Most repeated web content elements were educational and involved communication with healthcare professional content. Finally, seven of the nine studies were included in a quantitative analysis. Web-based supportive interventions significantly improved quality of life when added to usual care (SMD = -1.26, 95% CI = -1.65, -0.86; p < 0.001) but no significant differences were found when compared with an autonomous pedometer walking intervention (p = 0.64) or a face-to-face treatment (p = 0.82).
Conclusion:
This systematic review and meta-analysis suggests that web-based supportive interventions may complement or accompany treatments in COPD patients due to the advantages of online interventions. The results obtained should be treated with caution due to the limited number of studies in this area and methodological weaknesses.
Introduction
Non-specific low back pain (LBP) is an idiopathic musculoskeletal condition that affects 4 out of 5 individuals in their lifetime and is the leading cause of job-related disability in the United States (US). The interest in interactive and dynamic telehealth treatments for LBP continues to grow, and it is important for the medical community to remain up-to-date on the state of the science.
Literature survey
Relevant studies published from March 2016 until March 2021 were identified through a systematic search of EMBASE, MedLine and Web of Science. The search strategy combined the concepts of back pain, telehealth and mobile applications.
Methodology
Titles and abstracts were screened to select full text randomized controlled trials or protocols and methodological quality and risk of bias was assessed using the Cochrane risk-of-bias tool. Data were synthesized narratively.
Synthesis
We included seven concluded randomized controlled trials and two study protocols reporting mobile health (mHealth) solutions for LBP. Six of the seven concluded trials found a significant improvement in self-reported numerical pain rating scale compared to the control group. A single trial compared a mHealth solution to physical therapy, with the majority of studies comparing interventions to “usual care.” Substantial heterogeneity in reporting of sample characteristics was found, indicating a lack of standardization through the field.
Conclusions
mHealth solutions may positively impact people with LBP. Larger trials should be encouraged and the field should coalesce around a set of baseline variables for collection and reporting. As many interventions involve patient engagement, future trials should aim to further quantify adherence levels and begin to define telehealth ‘doses’ associated with better outcomes.
This article is protected by copyright. All rights reserved.
Packy & Marlon, an interactive video game designed to improve self-care among children and adolescents with diabetes, was evaluated in a six-month randomized controlled trial. In the game, players take the role of animated characters who manage their diabetes by monitoring blood glucose, taking insulin injections, and choosing foods, while setting out to save a diabetes summer camp from marauding rats and mice who have stolen the diabetes supplies. Study participants were patients aged 8 to 16 from two separate diabetes clinics. Each participant received a Super Nintendo video game system at an initial clinic visit and was randomly assigned to receive either Packy & Marlon (treatment group, N = 31) or an entertainment video game containing no diabetes-related content (control group, N = 28). Participants were interviewed and a parent filled out a questionnaire at baseline, three months, and six months. The findings in this study indicate that well-designed, educational video games can be effective interventions. There was improvement in the treatment group relative to the control group in terms of diabetes-related self-efficacy, communication with parents and friends about diabetes, and self-care behaviors, and a decrease in unscheduled urgent and emergency doctor visits. Participants in the study were, in general, well-controlled patients who were receiving excellent medical care.
The Comprehensive Health Enhancement Support System (CHESS) is an interactive computer system containing information, social support and problem solving tools. It was developed with intensive input from potential users through needs-assessment surveys and field testing. CHESS had previously been used by women in the middle and upper socio-economic classes with high school and college education. This article reports on the results of a pilot study involving eight African-American women with breast cancer from impoverished neighborhoods in the city of Chicago. CHESS was very well received, extensively used and produced feelings of acceptance, motivation, understanding and relief.
Objective: The Diabetes Network (D-Net), a randomized trial of an Internet-based, diabetes self-management and peer support intervention, was evaluated after 3 months. Design: The study assessed separate and combined effects of diabetes self-management and peer support. Outcomes included physiologic, behavioral, mental health, and website usage. Results are presented on the first 160 type 2 diabetes patients recruited from 16 primary care offices. Of those eligible, 61 % participated in the study. Results: There was significant overall improvement, especially on dietary behavior, but no significant between-condition differences. Conclusions: Providing basic diabetes information as well as a "personal coach," self-management intervention entirely over the Internet proved feasible. Even novice computers users will participate in an Internet-based program to assist themselves in managing their diabetes. Validated Internet interventions could prove to be valuable resources that overcome many costs and limitations of conventional diabetes management. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
CHESS (the Comprehensive Health Enhancement Support System) is an interactive, computer-based system to support people facing health-related crises or concerns. CHESS provides information, referral to service providers, support in making tough decisions and networking to experts and others facing the same concerns. CHESS will improve access to health and human services for people who would otherwise face psychological, social, economic or geographic barriers to receiving services. CHESS has developed programs in five specific topic areas: Academic Crisis, Adult Children of Alcoholics, AIDS/HIV Infection, Breast Cancer and Sexual Assault. The lessons learned, and the structures developed, will serve as a model for future implementation of CHESS programs in a broad range of other topic areas. CHESS is designed around three major desired outcomes: 1) improving the emotional health status of users; 2) increasing the cost-effective use of health and human services; and 3) reducing the incidence of risk-taking behaviors that can lead to injury or illness. Pilot-testing and initial analysis of controlled evaluation data has shown that CHESS is extensively used, is useful and easy-to-use, and produces positive emotional outcomes. Further evaluation in continuing.
To evaluate Diabeto, a computer-assisted diet education system.
One hundred five patients with insulin-dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) were divided into two randomized groups to participate in the evaluation of Diabeto. With free access through Minitel, the French public videotex network, Diabeto helps diabetic patients self-monitor their diets and balance their meals with personalized counseling.
During the first 6-mo study, group A (54 patients) used Diabeto, whereas group B (51 patients) were control subjects. For the second 6-mo study, group B used the system. Evaluation was based on patients' dietetic knowledge, dietary habits, and metabolic balance.
Diabeto led to a significant improvement of dietetic, knowledge in group A (P less than 0.0005) and also to improved dietary habits; decreased caloric intake in patients initially overeating (P less than 0.05), increase of dietary carbohydrate from 39.7 +/- 0.7 to 42.9 +/- 0.9% in patients with an initial intake less than 45% carbohydrate, and decrease of fat intake from 41.9 +/- 0.9 to 37.4 +/- 1.1% in patients with an initial intake of greater than 35% fat (P less than 0.0005). In the second study, in addition to similar improvements to those observed in the first study, HbA1 decreased from 11.0 +/- 0.4 to 9.9 +/- 0.4% (P less than 0.005) and fructosamine from 5.00 +/- 0.17 to 4.57 +/- 0.17% (P less than 0.001). Diabeto appears to be an effective therapeutic tool in the control of metabolic diseases.
CHESS (the Comprehensive Health Enhancement Support System) is an interactive, computer-based system to support people facing AIDS/HIV Infection and other health-related crises or concerns. CHESS provides information, referral to service providers, support in making tough decisions and networking to experts and others facing the same concerns. CHESS is designed to improve access to health and human services for people who would otherwise face psychological, social, economic or geographic barriers to receiving services. CHESS has been evaluated in a random-assignment study with over 200 men and women living with AIDS and HIV infection. When CHESS was placed in subjects' homes for 3-6 months, use of CHESS was extremely heavy, with the average subject using CHESS 138 times for 39 hours. Compared with a control group which did not receive CHESS, subjects who used CHESS reported significantly higher quality of life in several dimensions, including social support and cognitive functioning. Users also reported significant reductions in some types of health care costs, especially inpatient services (hospitalizations). All segments of the study population used and benefited from CHESS, including women, minorities and those subjects with lower levels of education. Thus, CHESS appears to be an effective means of delivering education and support to the diverse populations which are affected by AIDS and HIV infection.
A study of use of an interactive computer system (CHESS--Comprehensive Health Enhancement Support System) by HIV-Positive people was conducted in Madison and Milwaukee during Fall 1992 and Winter 1993. Computers were placed in homes, and use monitored by the computer. Results showed that the system was used heavily by both samples, and that gender (women used it more) age, (younger used it more), living arrangements (those living alone used it more), and need for health care information (those who felt the most need used it more) but not education predicted use of CHESS. The authors argue that heavy CHESS use by a wide variety of HIV-positive people suggests that the computer can overcome "information poor" barriers in health information campaigns.
Internet‐based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges. Previous studies have informed us about the content of online exchanges between support group members, but we know little about the ability of these interventions to change participants' perceptions of support. A randomized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions: (a) diabetes information only, (b) a personal self‐management coach, (c) a social support intervention, or (d) a personal self‐management coach and the support intervention. After 3 months, individuals in the 2 support conditions reported significant increases in support on a diabetes‐specific support measure and a general support scale. Participants' age was significantly related to change in social support, but intervention effects were still significant after accounting for this relationship. This report is a critical first step in evaluating the long‐term effects of Internet‐based support for diabetes self‐management. The discussion identifies directions for future research.
Health informatics has much to offer community health care. Computer networks and telecommunications provide particular support that can enhance the collaboration among clinicians, care providers and patients. Special-purpose computer tools referred to as Consumer Health Informatics (CHI) represent the application of computer and information technologies specifically to support the health information and communication needs of patients and lay persons. Research projects like ComputerLink and CHESS demonstrate that CHI is acceptable to patients and promotes self-care and disease management. Three grand challenges must be faced to insure realization of the promise of health informatics to community health care: development of knowledge management and information discovery tools for patients, insurance of health information literacy for all persons, and re-engineering clinical practice to capitalize on patients as full partners in health care.
Caregivers of persons with Alzheimer's disease (AD) are confronted with novel decision-making tasks that leave them at risk for social isolation. ComputerLink is a computer network providing information, communication, and decision-support functions for caregiver of persons with AD. One hundred two AD caregivers participated in a randomized field experiment to evaluate the effects of ComputerLink on confidence in decision making, decision-making skill, and social isolation. During the 1 year study period, AD caregivers averaged two encounters per week with ComputerLink for sessions lasting an average of 13 minutes. Access to ComputerLink enhanced caregiver's decision-making confidence. Decision-making skill was unaffected. ComputerLink access did not lead to changes in social isolation as measured by standard instruments. The decision-support function was used least often. Postings to ComputerLink's public bulletin board included both information-seeking and supportive messages. These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems.
Computer networks of informal caregivers may serve as an alternative to more traditional face-to-face support services. This investigation examines whether a computer support network for family caregivers of persons with Alzheimer, s disease affects their use of support groups for family members. Two competing hypotheses are examined: one posits that the use of a computer network will be substituted for participation in support groups, while the alternative hypothesis suggests that the computer network will supplement or increase support group use. A longitudinal analysis indicated a relationship between use of the computer network and changes in support group attendance. The relationship, however, is sometimes supplementation and sometimes substitution, depending on the caregiver's previous use of support groups. We offer an interpretation of the changing relationship that is based on the predispositions, abilities, and needs of the caregiver for support services.
This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review will place particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups.
OBJECTIVE There is a pressing need for brief practical interventions that address diabetes management. Using a randomized design, we evaluated a medical office-based intervention focused on behavioral issues relevant to dietary self-management.
RESEARCH DESIGN AND METHODS There were 206 adult diabetes patients randomized to usual care or brief intervention, which consisted of touchscreen computer-assisted assessment to provide immediate feedback on key barriers to dietary self-management, and goal setting and problem-solving counseling for patients. Follow-up components to the single session intervention included phone calls and interactive video or videotape instruction as needed.
RESULTS Multivariate analyses of covariance revealed that the brief intervention produced greater improvements than usual care on a number of measures of dietary behavior (e.g., fewer calories from saturated fat, fewer high-fat eating habits and behaviors) at the 3-month follow-up. There were also significant differences favoring intervention on changes in serum cholesterol levels and patient satisfaction but not on glycosylated hemoglobin. The intervention effects were relatively robust across a variety of patient characteristics, the two participating physicians, and intervention staff members.
CONCLUSIONS If the long-term results are equally positive and generalize to other setting, this intervention could provide a prototype for a feasible cost-effective way to integrate patient views and behavioral management into office-based care for diabetes.
There has been a long-standing dispute about the efficacy of computer assisted instruction (CAI) with regard to the interpretation of effect size estimates in reviews using techniques of meta-analysis. It has been claimed that the data used to calculate these estimates come from studies which are methodologically flawed. The aim of this study was to provide an updated meta-analysis on the learning effect of (CAI) over a broad range of study features with particular attention focused on the effectiveness debate. Using standard procedures, the results and estimates were similar to previous reviews and showed a learning benefit for CAI. The mean effect size for CAI was (.24) for the years 1987–1992, with more recent studies showing an average of (.33). Although moderate, these estimates tended to raise the average student from at least the 50th and 60th percentile. However, studies which controlled for teacher and materials, and were of longer duration, and studies using pencil and paper equivalents of CAI s...
In working with adult learners, the application of some well established principles will enhance the potential for learning. Adult learners work best in a non‐threatening atmosphere where they enjoy a good relationship with their teachers; they need opportunities to assess themselves against a standard, and having done so, prefer to select their own learning experiences — to be self directing. They prefer a problem oriented approach to learning, want to apply their newly‐acquired knowledge and skills immediately and need to know how they are progressing through constructive feedback. They want to help others to learn, and themselves learn much in the process of teaching others.
Alcohol and drug workers whose responsibility it is to educate other health workers, will find these principles are applicable in their field endeavour.
Changes in the organization and financing of health care delivery have resulted in increasing the responsibilities of family members who care for people with cancer and other chronic diseases. These family caregivers need to develop skills in problem-solving and in preventing physical, emotional, and social crises at home. For problem-solving education to affect caregiving behavior, family caregivers need ongoing reinforcement of what they have learned about problem-solving. Such support can come from the creative use of technology, such as computer or voice bulletin boards, which offer a wide array of services that are directly available at home for health education or counseling purposes. This article describes two computer-driven sources of information and support: the CHESS Program and the Telepracticc and COPELINE systems, which are specifically designed to reinforce problem-solving learning among family caregivers of people with cancer.
Paper presented to Interactive Video Conference: Eastbourne, England, 1st June, 1983. Three main considerations in developing interactive video are: (1)Application. (2) The system. (3) The resources available. All three feature significantly and they are interdependent. Logically the starting point is the application because it sets the criteria for the system and indicates the resources which are needed. Because interactive video can do a lot of things, applications exist in abundance: from teaching and training to exhibition advertising and surrogate travel. But on this occasion I consider something very necessary and a common requirement of many industries at the moment ‐ training.
This chapter discusses unique advantages of video games as media that can motivate and support health behavior change in children and adolescents. To engage young people in a health topic, video games can present appealing role-model characters that players control or interact with, provide scenarios that involve making health decisions and carrying out self-care skills, and depict realistic consequences in response to players’ decisions and actions.
The chapter also discusses mediating, or intervening, factors that games can improve in players and that can in turn lead to better health behaviors and outcomes, and it cites supporting theory and research evidence. Mediating factors that can be enhanced by playing well designed games include attention to and active processing of health promotion messages, increased motivation to learn about the health topic, knowledge about prevention and self-care related to a health topic, self-efficacy for specific health behaviors, and communication about one’s own health and the health topic in general with friends and family who can provide social support. The chapter provides a variety of evidence-based design strategies for integrating standalone and online video games into health interventions for people of all ages.
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Bibliographic reference:
Lieberman, D.A. (1997). Interactive video games for health promotion: Effects on knowledge, self-efficacy, social support, and health. Chapter in R.L. Street, W.R. Gold, & T. Manning (Eds.), Health promotion and interactive technology: Theoretical applications and future directions. Mahwah, NJ: Lawrence Erlbaum Associates, pp. 103-120.
Objective To evaluate the costs and effects of incremental components of a weight-loss program.Design A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity.Subjects/setting The study included 588 individuals (BMI > 25kg/m2) in a freestanding health maintenance organization and achieved an 81% completion rate.Intervention Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a workbook alone, b) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors, and c) the addition of both computers and staff consultation.Main outcome measures Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and physical activity.Statistical analysis performed Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysis assessed the relationship between weight loss and other variables.Results For the increasing levels of intervention intensity, the mean 12-month weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost per participant being $12.33, $41.99, and $133.74. The decreases in mean BMIs for these respective intervention levels were 0.4, 0.9 and 1.2. All groups reported a decrease in energy and fat intake and an increase in blocks walked (P
