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Nelson AJ, Pagidipati NJ, Bosworth HB. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol 2024; 21:417-429. [PMID: 38172243 DOI: 10.1038/s41569-023-00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.
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Affiliation(s)
- Adam J Nelson
- Victorian Heart Institute, Melbourne, Victoria, Australia
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Population Health Sciences, Duke University, Durham, NC, USA.
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Redfern J, Tu Q, Hyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, Chow CK. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 3:CD011851. [PMID: 38533994 PMCID: PMC10966941 DOI: 10.1002/14651858.cd011851.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for almost 18 million deaths annually. People with CVDs have a five times greater chance of suffering a recurrent cardiovascular event than people without known CVDs. Although drug interventions have been shown to be cost-effective in reducing the risk of recurrent cardiovascular events, adherence to medication remains suboptimal. As a scalable and cost-effective approach, mobile phone text messaging presents an opportunity to convey health information, deliver electronic reminders, and encourage behaviour change. However, it is uncertain whether text messaging can improve medication adherence and clinical outcomes. This is an update of a Cochrane review published in 2017. OBJECTIVES To evaluate the benefits and harms of mobile phone text messaging for improving medication adherence in people with CVDs compared to usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We also checked the reference lists of all primary included studies and relevant systematic reviews and meta-analyses. The date of the latest search was 30 August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim of improving adherence to medication for the secondary prevention of cardiovascular events. The comparator was usual care. We excluded cluster-RCTs and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were medication adherence, fatal cardiovascular events, non-fatal cardiovascular events, and combined CVD event. Secondary outcomes were low-density lipoprotein cholesterol for the effect of statins, blood pressure for antihypertensive drugs, heart rate for the effect of beta-blockers, urinary 11-dehydrothromboxane B2 for the antiplatelet effects of aspirin, adverse effects, and patient-reported experience. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 18 RCTs involving a total of 8136 participants with CVDs. We identified 11 new studies in the review update and seven studies in the previous version of the review. Participants had various CVDs including acute coronary syndrome, coronary heart disease, stroke, myocardial infarction, and angina. All studies were conducted in middle- and high-income countries, with no studies conducted in low-income countries. The mean age of participants was 53 to 64 years. Participants were recruited from hospitals or cardiac rehabilitation facilities. Follow-up ranged from one to 12 months. There was variation in the characteristics of text messages amongst studies (e.g. delivery method, frequency, theoretical grounding, content used, personalisation, and directionality). The content of text messages varied across studies, but generally included medication reminders and healthy lifestyle information such as diet, physical activity, and weight loss. Text messages offered advice, motivation, social support, and health education to promote behaviour changes and regular medication-taking. We assessed risk of bias for all studies as high, as all studies had at least one domain at unclear or high risk of bias. Medication adherence Due to different evaluation score systems and inconsistent definitions applied for the measurement of medication adherence, we did not conduct meta-analysis for medication adherence. Ten out of 18 studies showed a beneficial effect of mobile phone text messaging for medication adherence compared to usual care, whereas the other eight studies showed either a reduction or no difference in medication adherence with text messaging compared to usual care. Overall, the evidence is very uncertain about the effects of mobile phone text messaging for medication adherence when compared to usual care. Fatal cardiovascular events Text messaging may have little to no effect on fatal cardiovascular events compared to usual care (odds ratio 0.83, 95% confidence interval (CI) 0.47 to 1.45; 4 studies, 1654 participants; low-certainty evidence). Non-fatal cardiovascular events We found very low-certainty evidence that text messaging may have little to no effect on non-fatal cardiovascular events. Two studies reported non-fatal cardiovascular events, neither of which found evidence of a difference between groups. Combined CVD events We found very low-certainty evidence that text messaging may have little to no effect on combined CVD events. Only one study reported combined CVD events, and did not find evidence of a difference between groups. Low-density lipoprotein cholesterol Text messaging may have little to no effect on low-density lipoprotein cholesterol compared to usual care (mean difference (MD) -1.79 mg/dL, 95% CI -4.71 to 1.12; 8 studies, 4983 participants; very low-certainty evidence). Blood pressure Text messaging may have little to no effect on systolic blood pressure (MD -0.93 mmHg, 95% CI -3.55 to 1.69; 8 studies, 5173 participants; very low-certainty evidence) and diastolic blood pressure (MD -1.00 mmHg, 95% CI -2.49 to 0.50; 5 studies, 3137 participants; very low-certainty evidence) when compared to usual care. Heart rate Text messaging may have little to no effect on heart rate compared to usual care (MD -0.46 beats per minute, 95% CI -1.74 to 0.82; 4 studies, 2946 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Due to limited evidence, we are uncertain if text messaging reduces medication adherence, fatal and non-fatal cardiovascular events, and combined cardiovascular events in people with cardiovascular diseases when compared to usual care. Furthermore, text messaging may result in little or no effect on low-density lipoprotein cholesterol, blood pressure, and heart rate compared to usual care. The included studies were of low methodological quality, and no studies assessed the effects of text messaging in low-income countries or beyond the 12-month follow-up. Long-term and high-quality randomised trials are needed, particularly in low-income countries.
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Affiliation(s)
- Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney , Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Hospital, Sydney , Australia
| | - Matthew A Hollings
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clara Zwack
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
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Liquori G, Pio Posa V, De Leo A, Giannetta N, Di Simone E, Di Muzio M, Dionisi S. The Use of mHealth in Promoting Therapeutic Adherence: A Scoping Review. Comput Inform Nurs 2024; 42:71-79. [PMID: 37769234 DOI: 10.1097/cin.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Nonadherence to therapy negatively impacts mortality and quality of life and results in suboptimal efficacy of treatment regimens, threats to patient safety, and increased healthcare costs for disease management. Mobile health solutions can offer users instruments that can promote therapeutic adherence. The objective of this review is to investigate the impact mobile health systems have on therapeutic adherence. Specifically, we want to map the main systems used, the functions implemented, and the different methods of adherence detection used. For this purpose, a scoping review was conducted. The following databases were consulted: PubMed, Cochrane Library, EBSCO (including APA PsycINFO, CINAHL Plus with Full Text, ERIC), including English-language studies published in the last 10 years (2012-2022). The main mobile health systems used are as follows: applications, automated messaging, interactive voice response, and mobile video games. The main features implemented to support medication management were as follows: reminders, self-monitoring instruments, educational support, and caregiver involvement. In conclusion, the use of interactive mobile health instruments intended for use by the patient and/or caregiver can improve objectively and subjectively detected therapeutic adherence. The use of these systems in the therapeutic pathway of users, with a special focus on people with comorbidities and in polypharmacy treatment, represents a challenge to improve caregiver health.
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Affiliation(s)
- Gloria Liquori
- Author Affiliations: Department of Biomedicine and Prevention, University of Rome Tor Vergata (Drs Liquori and De Leo); Department of Clinical and Molecular Medicine, Sapienza University of Rome (Mr Pio Posa, Dr Di Muzio and Di Simone); Nursing, Technical, Rehabilitation, Assistance and Research Department, IRCCS Istituti Fisioterapici Ospitalieri (Drs De Leo); UniCamillus-Saint Camillus International University of Health and Medical Sciences (Dr Giannetta), Rome; and Nursing, Technical and Rehabilitation, Department, DaTeR Azienda Unità Sanitaria Locale di Bologna (Dr Dionisi)
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Aburadwan MK, Hayajneh FA. Health Literacy Among Patients With Acute Coronary Artery Diseases: Predictors, Consequences, and Enhancing Strategies: A Review of the Literature. Crit Care Nurs Q 2024; 47:71-82. [PMID: 38031310 DOI: 10.1097/cnq.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The purpose of this study is to integrate evidence on predictors, consequences, in addition to the strategies for enhancing health literacy (HL) for patients with acute coronary artery diseases. An integrative review was conducted by searching four main electronic databases: the Web of Science, PubMed, ScienceDirect, and MEDLINE. Twenty-three studies met the inclusion criteria and were included in the final review process. The review identified the most common predictors, consequences, and relationship of HL with health outcomes in patients with acute coronary artery disease. In addition to the main strategies that enhance HL, patients with or at risk for acute coronary artery disease need a good level of HL to cope with the disease's consequences. It is recommended to include routine assessment and management of HL levels in acute coronary artery disease treatment protocols to improve clinical outcomes.
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Affiliation(s)
- Maha K Aburadwan
- Royal Medical Services/Continuing Professional Development Center, Amman, Jordan (Dr Aburadwan); and School of Nursing, The University of Jordan, Amman, Jordan (Dr Hayajneh)
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Park LG, Ng F, Handley MA. The use of the Capability-Opportunity- Motivation Behavior (COM-B) model to identify barriers to medication adherence and the application of mobile health technology in adults with coronary heart disease: A qualitative study. PEC INNOVATION 2023; 3:100209. [PMID: 37753273 PMCID: PMC10518702 DOI: 10.1016/j.pecinn.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/06/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
Objective Among patients with coronary heart disease, we sought to address the research questions of: 1) What is the acceptability of applying a technology-enabled approach to support medication adherence?; and 2) What are barriers to medication adherence using the Capability-Opportunity-Motivation Behavior (COM-B) model as a guiding framework? Methods Applying qualitative research methods, we employed a series of 3 focus groups per individual (total 9 sessions). Coded data from thematic analysis were mapped to the COM-B model components for meaningful associations. Results Fourteen participants were recruited (median age 69.5 ± 11, 50% female). Barriers to medication adherence were organized along these COM-B domains: psychological capability (forgetfulness, distractions, fear of side effects), physical opportunity (inaccessible medications, inability to renew prescriptions), reflective (burdening family members), and automatic motivation (medication fatigue, health decline). Conclusions Tailored text messaging and mobile phone apps were perceived as helpful tools for medication adherence. The COM-B model was useful to provide a comprehensive, theory-driven evaluation of patients' beliefs and motivations on whether to engage in medication adherence. Innovation To date, text messaging and mobile applications have not been widely implemented in the clinical setting and provide a major opportunity to innovate on approaches to address medication adherence.
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Affiliation(s)
- Linda G. Park
- University of California, San Francisco School of Nursing, Department of Community Health Systems, San Francisco Veterans Affair Medical Center, 2 Koret Way, Room 531A, San Francisco, CA 94143-0610, United States of America
| | - Fion Ng
- Department of Community Health Programs for Youth, San Francisco Department of Public Health, United States of America
| | - Margaret A. Handley
- Departments of Epidemiology and Biostatistics and Medicine, Division of General Internal Medicine, University of California, San Francisco, United States of America
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Turvey C, Fuhrmeister L, Klein D, McCoy K, Moeckli J, Stewart Steffensmeier KR, Suiter N, Van Tiem J. Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial. JMIR Form Res 2023; 7:e51277. [PMID: 38064267 PMCID: PMC10746966 DOI: 10.2196/51277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. OBJECTIVE This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. METHODS This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. RESULTS The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). CONCLUSIONS A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. TRIAL REGISTRATION ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849.
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Affiliation(s)
- Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Office Rural Health Veterans Rural Health Resource Center, Iowa City, IA, United States
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Lindsey Fuhrmeister
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | | | - Kimberly McCoy
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Office Rural Health Veterans Rural Health Resource Center, Iowa City, IA, United States
| | - Jane Moeckli
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Office Rural Health Veterans Rural Health Resource Center, Iowa City, IA, United States
| | - Kenda R Stewart Steffensmeier
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Office Rural Health Veterans Rural Health Resource Center, Iowa City, IA, United States
| | - Natalie Suiter
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Office Rural Health Veterans Rural Health Resource Center, Iowa City, IA, United States
| | - Jen Van Tiem
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
- Office Rural Health Veterans Rural Health Resource Center, Iowa City, IA, United States
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Singh B, Hazra P, Roy S, Garg R, Bhat S, Patki N, Gharat C, Patel K, Tandel J. Exploring the Need and Benefits of Digital Therapeutics (DTx) for the Management of Heart Failure in India. Cureus 2023; 15:e49628. [PMID: 38161874 PMCID: PMC10755686 DOI: 10.7759/cureus.49628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Indian heart failure (HF) registries consistently indicate high hospital readmissions and increased mortality rates after HF diagnosis. The challenges of Indian cardiologists in HF management include limited longitudinal data, frequent readmissions, low medication adherence, inadequate monitoring and follow-up, insufficient patient education, and lack of standard guidelines on cardiac rehabilitation. This article outlines the adoption of digital therapeutics (DTx) in HF management as a potential solution to address these challenges. DTx services offer improved medication adherence, early symptom identification, remote vital monitoring, timely intervention, patient education on symptoms, self-awareness, and lifestyle. Overall, DTx for HF comprises a dedicated team of cardiologists, health coaches, care managers, and globally certified connected devices to provide comprehensive and proactive monitoring, personalized coaching and support, behavioral engagement to improve adherence, emergency response system, delivery of medications and diagnostic tests at home, and a dedicated application for caregivers. DTx has the potential to enhance HF management in India.
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Affiliation(s)
- Balbir Singh
- Cardiology, Max Super Speciality Hospital, Saket, Delhi, IND
| | - Prakash Hazra
- Cardiology, Advanced Medicare and Research Institute (AMRI) Hospitals, Kolkata, IND
| | - Sanjeeb Roy
- Cardiology, ManglamPlus Medicity, Jaipur, IND
| | - Rajeev Garg
- Cardiology, Aware Gleneagles Global Hospitals, Hyderabad, IND
| | - Sanjay Bhat
- Cardiology, Aster CMI Hospital, Bengaluru, IND
| | | | - Chetan Gharat
- Medical Affairs, Lupin Digital Health Limited, Mumbai, IND
| | - Kamlesh Patel
- Medical Affairs, Lupin Digital Health Limited, Mumbai, IND
| | - Jeeten Tandel
- Medical Affairs, Lupin Digital Health Limited, Mumbai, IND
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Sophasath M, Brisset A, Rose CF, Bémeur C. Nutritional education strategies for patients with cirrhosis: A narrative review. PATIENT EDUCATION AND COUNSELING 2023; 115:107878. [PMID: 37421686 DOI: 10.1016/j.pec.2023.107878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Patients with cirrhosis suffer from many complications, including malnutrition, which must be managed promptly and effectively by the healthcare team. Educating patients about their medical condition, the risk of malnutrition and other complications of cirrhosis, could contribute to optimal nutritional status, quality of life and general health. OBJECTIVE This review provides an overview of the literature on a variety of nutritional education strategies used with patients suffering from cirrhosis. This review also identifies barriers and facilitators which impact the adherence in using these strategies. PATIENT INVOLVEMENT A patient-partner contributed to this review by providing insights on different issues and concerns that patients with cirrhosis might ask themselves regarding nutritional education strategies. The patient-partner was also involved in the overall revision of the review. METHODS Articles published between the years 2000-2023 focusing on nutritional education strategies in patients living with cirrhosis were identified using Google Scholar and PubMed and were screened for inclusion in the study. All selected studies were intervention studies. A quality assessment of the included studies was conducted using the Mixed Methods Appraisal Tool (MMAT). RESULTS Only a few nutritional education strategies in patients with cirrhosis were documented in the literature. The strategies ranged from using traditional printed materials to advanced technologies. These strategies may prove beneficial in complementing routine interventions provided by health professionals, such as registered dietitians, in their clinical practice. DISCUSSION This narrative review clearly highlights the need for further research to elaborate and evaluate nutritional education strategies for people living with cirrhosis. PRACTICAL VALUE Elaborating and evaluating educational strategies in nutrition for patients living with cirrhosis will be an adjuvant to health professionals and dietitians in their clinical practice by providing them, and the patients, with targeted education resources.
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Affiliation(s)
- Manila Sophasath
- Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, 900 R. Saint-Denis Street, R08.720, Montreal, QC H2X 0A9, Canada; Département de nutrition, Faculté de Médecine, Université de Montréal, 2405, Côte-Sainte-Catherine, Montreal, QC H3T 1A8, Canada
| | - Alexandre Brisset
- Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, 900 R. Saint-Denis Street, R08.720, Montreal, QC H2X 0A9, Canada
| | - Christopher F Rose
- Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, 900 R. Saint-Denis Street, R08.720, Montreal, QC H2X 0A9, Canada; Départment de médecine, Faculté de médecine, Université de Montréal, 2900, Edouard-Montpetit Boulevard, Montreal, QC H3T 1J4, Canada
| | - Chantal Bémeur
- Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, 900 R. Saint-Denis Street, R08.720, Montreal, QC H2X 0A9, Canada; Département de nutrition, Faculté de Médecine, Université de Montréal, 2405, Côte-Sainte-Catherine, Montreal, QC H3T 1A8, Canada.
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Bakema R, Smirnova D, Biri D, Kocks JWH, Postma MJ, de Jong LA. The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review. J Med Internet Res 2023; 25:e42474. [PMID: 37751232 PMCID: PMC10565624 DOI: 10.2196/42474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. METHODS We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. RESULTS Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.
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Affiliation(s)
- Robbert Bakema
- Nederlandse Service Apotheek Beheer BV, 's-Hertogenbosch, Netherlands
| | - Daria Smirnova
- Asc Academics, Groningen, Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Despina Biri
- Asc Academics, Groningen, Netherlands
- Victoria Hospital, Kirkcaldy, United Kingdom
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, Netherlands
- Groningen Research Institute Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Lisa A de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Kircher J, Swoboda W, Holl F. Examining standardized tools used for the evaluation of mobile health applications for cardiovascular disease. Front Public Health 2023; 11:1155433. [PMID: 37388154 PMCID: PMC10303135 DOI: 10.3389/fpubh.2023.1155433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Cardiovascular disease is one of the leading causes of death worldwide. Scarce resources and rising costs are pushing healthcare systems to their limits. There is an urgency to develop, optimize and evaluate technologies that provide more effective care for patients. Modern technologies, such as mobile health (mHealth) applications, can provide relief as a key strategy. To integrate digital interventions into care structures, a detailed impact assessment of all professional mHealth applications is needed. The aim of this study is to analyze the standardized tools used in the field of cardiovascular disease. The results show that questionnaires, usage logs, and key indicators are predominantly used. Although the identified mHealth interventions are specific to cardiovascular disease and thus require particular questions to evaluate apps, the user readiness, usability, or quality of life criteria are non-specific. Therefore, the results contribute to understanding how different mHealth interventions can be assessed, categorized, evaluated, and accepted.
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Affiliation(s)
- Jennifer Kircher
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
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Bente BE, Wentzel J, Schepers C, Breeman LD, Janssen VR, Pieterse ME, Evers AWM, van Gemert-Pijnen L. Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study. JMIR Cardio 2023; 7:e43781. [PMID: 36961491 PMCID: PMC10131764 DOI: 10.2196/43781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/26/2023] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients' needs, it is necessary to account for these changes in needs and contexts of use. OBJECTIVE This study aimed to identify and monitor patients' needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: "How do novice and more advanced users experience an online health management platform?" "What user expectations support or hinder the adoption of an online health management platform, from a user perspective?" and "How does actual usage relate to user experiences and adoption?" METHODS A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. RESULTS After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. CONCLUSIONS Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients' needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology.
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Affiliation(s)
- Britt E Bente
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Department of Health Care and Social Work, University of Applied Sciences Windesheim, Zwolle, Netherlands
| | - Celina Schepers
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Linda D Breeman
- Unit of Health, Medical, and Neuropsychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marcel E Pieterse
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Andrea W M Evers
- Unit of Health, Medical, and Neuropsychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
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12
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Arshed M, Mahmud AB, Minhat HS, Ying LP, Umer MF. Effectiveness of mHealth Interventions in Medication Adherence among Patients with Cardiovascular Diseases: A Systematic Review. Diseases 2023; 11:diseases11010041. [PMID: 36975590 PMCID: PMC10047328 DOI: 10.3390/diseases11010041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
mHealth interventions have been reported to improve adherence to long-term therapies in chronic conditions. Therefore, this study aimed at determining the effectiveness of mHealth interventions in medication adherence among patients with cardiovascular diseases (CVDs), a leading cause of mortality globally. Relying on our inclusion criteria and the PRISMA recommendations, a literature search was carried out in the PubMed, Medline, and ProQuest databases for primary studies that investigated the impact of mHealth on medication adherence for cardiovascular disease (CVD) between 2000–2021. A total of 23 randomized controlled trials with 34,915 participants matched the selection criteria. The mHealth interventions used included text messages, mobile phone applications, and voice calls, which were used either as a single intervention or combined. Additionally, studies on enhancing drug adherence had contradictory findings: most of the studies elaborated positive results; however, six studies were unable to reveal any significant effect. Finally, a risk bias analysis revealed varying outcomes across all studies. This review, as a whole, supported the notion that mHealth interventions can be effective in improving adherence to CVD medication even though they could not improve adherence to all CVD medications when compared with controls. Further trials with more refined designs integrated with comprehensive interventions are needed to produce better health outcomes.
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Affiliation(s)
- Muhammad Arshed
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Aidalina Binti Mahmud
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Lim Poh Ying
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor Darul Ehsan, Malaysia
| | - Muhammad Farooq Umer
- Department of Dental Public Health, College of Dentistry, King Faisal University, Hofuf 31982, Saudi Arabia
- Correspondence: ; Tel.: +966-590536962
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Foster M, Xiong W, Quintiliani L, Hartmann CW, Gaehde S. Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis. JMIR Form Res 2022; 6:e41317. [PMID: 36538348 PMCID: PMC9812271 DOI: 10.2196/41317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. OBJECTIVE The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. METHODS Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. RESULTS Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. CONCLUSIONS We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features.
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Affiliation(s)
- Marva Foster
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, United States
- Department of General Internal Medicine, School of Medicine, Boston University, Boston, MA, United States
| | - Wei Xiong
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lisa Quintiliani
- Department of General Internal Medicine, School of Medicine, Boston University, Boston, MA, United States
| | - Christine W Hartmann
- VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Stephan Gaehde
- VA Boston Healthcare System, Department of Medicine, Section of Emergency Services, Boston, MA, United States
- Department of Medicine, School of Medicine, Boston University, Boston, MA, United States
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14
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Li M, Lu X, Yang H, Yuan R, Yang Y, Tong R, Wu X. Development and assessment of novel machine learning models to predict medication non-adherence risks in type 2 diabetics. Front Public Health 2022; 10:1000622. [PMID: 36466490 PMCID: PMC9714465 DOI: 10.3389/fpubh.2022.1000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Medication adherence is the main determinant of effective management of type 2 diabetes, yet there is no gold standard method available to screen patients with high-risk non-adherence. Developing machine learning models to predict high-risk non-adherence in patients with T2D could optimize management. Methods This cross-sectional study was carried out on patients with T2D at the Sichuan Provincial People's Hospital from April 2018 to December 2019 who were examined for HbA1c on the day of the survey. Demographic and clinical characteristics were extracted from the questionnaire and electronic medical records. The sample was randomly divided into a training dataset and a test dataset with a radio of 8:2 after data preprocessing. Four imputing methods, five sampling methods, three screening methods, and 18 machine learning algorithms were used to groom data and develop and validate models. Bootstrapping was performed to generate the validation set for external validation and univariate analysis. Models were compared on the basis of predictive performance metrics. Finally, we validated the sample size on the best model. Results This study included 980 patients with T2D, of whom 184 (18.8%) were defined as medication non-adherence. The results indicated that the model used modified random forest as the imputation method, random under sampler as the sampling method, Boruta as the feature screening method and the ensemble algorithms and had the best performance. The area under the receiver operating characteristic curve (AUC), F1 score, and area under the precision-recall curve (AUPRC) of the best model, among a total of 1,080 trained models, were 0.8369, 0.7912, and 0.9574, respectively. Age, present fasting blood glucose (FBG) values, present HbA1c values, present random blood glucose (RBG) values, and body mass index (BMI) were the most significant contributors associated with risks of medication adherence. Conclusion We found that machine learning methods could be used to predict the risk of non-adherence in patients with T2D. The proposed model was well performed to identify patients with T2D with non-adherence and could help improve individualized T2D management.
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Affiliation(s)
- Mengting Li
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xiangyu Lu
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,The Second Department of Hepatobiliary Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - HengBo Yang
- School of Pharmacy, Chengdu Medical College, Chengdu, China
| | - Rong Yuan
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,Endocrine Department, Sichuan Provincial People's Hospital, Chengdu, China
| | - Yong Yang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,*Correspondence: Yong Yang
| | - Rongsheng Tong
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,Rongsheng Tong
| | - Xingwei Wu
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Department of Pharmacy, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,Xingwei Wu
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15
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Shi W, Ghisi GLM, Zhang L, Hyun K, Pakosh M, Gallagher R. Systematic review, meta‐analysis and meta‐regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. J Clin Nurs 2022. [DOI: 10.1111/jocn.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Gabriela L. M. Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Ling Zhang
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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16
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Nikraftar F, Heshmati Nabavi F, Dastani M, Mazlom SR, Mirhosseini S. Acceptability, feasibility, and effectiveness of smartphone‐based delivery of written educational materials in Iranian patients with coronary artery disease: A randomized control trial study. Health Sci Rep 2022; 5:e801. [PMID: 36101719 PMCID: PMC9455945 DOI: 10.1002/hsr2.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background and Aims Providing education to patients with coronary artery disease (CAD) is one of the crucial roles of nurses and, there are various education methods for these patients. This study aimed to investigate the acceptability, feasibility, and effectiveness of smartphone‐based delivery (SPBD) of written educational materials in Iranian patients with CAD. Methods A total of 104 patients with CAD who were admitted to the cardiovascular unit of a large hospital in the northeast of Iran were randomly divided into control and intervention groups. When the standard educational content was provided, educational materials were delivered to the intervention group using a SPBD and to the control group using the routine print delivery (PD). The authors investigated the usability in the postintervention phase and information satisfaction and medication self‐efficacy in the pre‐ and postintervention phases. Results The mean age and the standard deviation of “patients” age in SPBD and PD groups was 51.8 ± 1.1 and 52.7 ± 1.3 years, respectively. No significant difference was observed between the two groups in terms of mean information satisfaction score (p = 0.726); however, the information satisfaction score was significantly higher in the SPBD group than PD group after the intervention (p = 0.012). The findings showed no statistically difference between two groups in terms of usability score (p > 0.05). The two groups were homogenous in terms of the mean medication self‐efficacy score in the preintervention phase (p = 0.987); however, it was significantly higher in SPBD group than PD group in the postintervention phase (p = 0.045). Conclusion The SPBD method had the same usability as the PD method and at the same time this method was more effective in promoting medication self‐efficacy. Therefore, SPBD could be used to educate patients with CAD and their caregivers and have appropriate effectiveness and acceptability among the Iranian population.
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Affiliation(s)
- Fahimeh Nikraftar
- School of Nursing and Midwifery, Mashhad University of Medical Sciences Mashhad Iran
| | - Fatemeh Heshmati Nabavi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences Mashhad Iran
| | - Mostafa Dastani
- Department of Cardiovascular Disease Faculty of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | - Seyed Reza Mazlom
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences Mashhad Iran
| | - Seyedmohammad Mirhosseini
- Department of Nursing School of Nursing and Midwifery, Shahroud University of Medical Sciences Shahroud Iran
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17
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Runsen Z, Yueying X, Tieguang H, Guoan Y, Yuan Z, Li C, Minyi C. Short message service usage may improve the public's self‐health management: A community‐based randomized controlled study. Health Sci Rep 2022; 5:e850. [PMID: 36189410 PMCID: PMC9498217 DOI: 10.1002/hsr2.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/28/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Zhuang Runsen
- Shenzhen Health Education and Promotion Center Shenzhen China
- Department of Public Health and Preventive Medicine, School of Medicine Jinan University Guangzhou China
| | - Xiang Yueying
- 181st Hospital of Chinese People's Liberation Army Guilin China
| | - Han Tieguang
- Shenzhen Health Education and Promotion Center Shenzhen China
| | - Yang Guoan
- Shenzhen Health Education and Promotion Center Shenzhen China
| | - Zhang Yuan
- Shenzhen Health Education and Promotion Center Shenzhen China
| | - Cao Li
- Shenzhen Health Education and Promotion Center Shenzhen China
| | - Cai Minyi
- Department of Public Health and Preventive Medicine, School of Medicine Jinan University Guangzhou China
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18
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Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol 2022; 27:861-890. [PMID: 35080811 PMCID: PMC9541766 DOI: 10.1111/bjhp.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/28/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Around half of prescribed medications for long-term conditions are not taken as directed. Automated two-way digital communication, such as text messaging and interactive voice response technology, could deliver interventions to improve medication adherence, and subsequently health. However, exploration of how such interventions may improve medication adherence is limited. This review aimed to explore how automated two-way digital communication can improve medication taking with or without using non-digital intervention components, such as phone calls with healthcare professionals. METHODS A theory-informed narrative synthesis systematic review. Several databases were searched including CINAHL, Embase, Medline, and Web of Science using key words relating to 'medication adherence' and digital communication technologies. The Behavior Change Technique (BCT) coding using the BCT Taxonomy V1 and the Behavior Change Wheel were used to identify BCTs delivered within the included interventions. RESULTS A total of 3,018 records were screened with 43 study reports included in the review. Four medication-taking behaviors: taking medication, obtaining medication, self-testing, and asking for support were identified as targets for behavior change within the included interventions. Most BCTs within the digital communication component aimed to increase motivation for medication adherence, with non-digital intervention components included to address other medication taking barriers, such as physical and psychological capability. CONCLUSION Automated two-way digital communication can detect barriers to medication adherence by monitoring performance of the taking medication behavior. Monitoring outcomes from taking medication may increase reflective motivation to take medicines. Addressing physical opportunity to taking medication by facilitating the behavior obtaining medication may also increase adherence.
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Affiliation(s)
- Gemma Donovan
- Faculty of Health Sciences and WellbeingSchool of Pharmacy and Pharmaceutical SciencesUniversity of SunderlandUK
| | - Nicola Hall
- Faculty of Medical SciencesPopulation Health Sciences InstituteNewcastle UniversityUK
| | - Jonathan Ling
- Faculty of Health Sciences and WellbeingUniversity of SunderlandUK
| | | | - Scott Wilkes
- Faculty of Health Sciences and WellbeingSchool of MedicineUniversity of SunderlandUK
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Emadi F, Ghanbarzadegan A, Ghahramani S, Bastani P, Baysari MT. Factors affecting medication adherence among older adults using tele-pharmacy services: a scoping review. Arch Public Health 2022; 80:199. [PMID: 36042508 PMCID: PMC9429665 DOI: 10.1186/s13690-022-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Medication adherence among older adults (aged 60 and above), particularly those with chronic conditions who take several medications, is critical, and tele-pharmacy services are a way to improve medication adherence. This study sought to determine the factors influencing medication adherence (MA) in older adults using tele-pharmacy services. Method The Joana Briggs Institute scoping review methodology was implemented. Searches were conducted in databases PubMed, Scopus, ProQuest, Web of Science, and Embase from 2000 to the present day, to identify both qualitative and quantitative studies focusing on the use of tele-pharmacy by older people. Factors impacting MA were extracted and analyzed into themes using a qualitative approach. A concept map was also designed summarising these factors. Results Of 7495 articles obtained in the initial search, 52 articles met the inclusion criteria. The analysis resulted in 5 themes and 21 sub-themes representing factors that impacted MA with tele-pharmacy. These themes are divided broadly into technology and user related factors. Technology factors included design of the tele-pharmacy intervention, commercial aspects, and adherence measurement method. User factors included user-health constraints, behaviors and perceptions. Conclusion Industry, policymakers, and stakeholders should consider using tele-pharmacy services for improving medication adherence among older adults; however, ensuring interventions facilitate communication between patients and health care teams, and are accompanied by user training and support, is essential for technology uptake and effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00960-w.
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20
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Christensen RE, Ranpariya V, Kammrath LK, Masicampo EJ, Roberson KB, Feldman SR. The presence of accountability in digital interventions targeting non-adherence: A review. PATIENT EDUCATION AND COUNSELING 2022; 105:2637-2644. [PMID: 35101306 DOI: 10.1016/j.pec.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Provider-centered accountability, defined as the anticipation of a social interaction between a patient and their provider, increases patients' adherence to prescribed treatment. Digital adherence interventions based on accountability may be especially effective at promoting adherence. The current study aimed to assess whether publications on digital adherence interventions discuss accountability, include intervention components related to accountability, and measure feelings of patient accountability as an outcome. METHODS PubMed was queried between January 2010 and March 2021 to identify randomized controlled trials incorporating digital adherence interventions. Full-text articles were assessed for participant demographics, interventions utilized, outcomes, and intervention effectiveness. RESULTS A total of 131 publications met inclusion criteria. Only four publications discussed accountability as a potential factor influencing patient adherence. Although 11% of publications included an intervention with direct accountability, only one did so by design. None of the included studies assessed feelings of accountability as an outcome. CONCLUSIONS While provider-centered accountability has the potential to boost the efficacy of digital adherence interventions, accountability is rarely incorporated in studies of such interventions. PRACTICE IMPLICATIONS Additional investigation into the influence of accountability on adherence interventions will allow for the development of these interventions as effective tools applicable to the full range of patients.
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Affiliation(s)
- Rachel E Christensen
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
| | - Varun Ranpariya
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lara K Kammrath
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - E J Masicampo
- Department of Psychology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Kristina B Roberson
- Division of Nursing, School of Health Sciences, Winston-Salem State University, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Department of Dermatology, University of Southern Denmark, Odense, Denmark
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21
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Salisbury KR, Ranpariya VK, Feldman SR. Accountability in reminder-based adherence interventions: A review. PATIENT EDUCATION AND COUNSELING 2022; 105:2645-2652. [PMID: 34953618 DOI: 10.1016/j.pec.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Interventions to elicit accountability capitalize on social behaviors to improve adherence but are distinct from reminders. However, little is known about the impact of accountability in reminder-based adherence interventions. Through a literature review, we aim to identify the frequency and effectiveness of accountability in reminder-based intervention studies. METHODS PubMed and PsycArticles were searched for reminder-based adherence studies. Articles were categorized as reminder-only or reminder with accountability studies. Studies were characterized by outcome measures, and differences between control and intervention groups were compared for studies that used electronic monitoring devices. RESULTS 165 studies met the inclusion criteria; 154 used reminders without accountability (93%). 79 of the 154 reminder-only studies (51%) improved adherence in intervention groups compared to controls. Eleven of the 165 studies (6.6%) included an accountability aspect. The intervention group had better adherence than controls in 10 out of the 11 reminder with accountability studies (91%). CONCLUSIONS Although distinct from reminders, accountability can be incorporated in reminder-based interventions. However, it is not commonly included in reminder-based interventions. PRACTICE IMPLICATIONS It is important to consider accountability's effects on encouraging patient medication adherence. The addition of accountability interventions may further boost adherence, but few studies currently incorporate these types of interventions.
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Affiliation(s)
- Katherine R Salisbury
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA.
| | - Varun K Ranpariya
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, USA; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, USA; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, USA; Department of Dermatology, University of Southern Denmark, Odense, Denmark
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22
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Saragih ID, Schorr E, Porta CM, Batubara SO, Lee BO. Effects of telehealth-assisted interventions for secondary prevention of cardiovascular disease: A systematic review and meta-analysis. J Clin Nurs 2022. [PMID: 35821631 DOI: 10.1111/jocn.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Telehealth-assisted interventions have been used as secondary prevention measures in cardiac rehabilitation, especially for the delivery of information between healthcare service providers and patients. However, as the application of this intervention modality broadens, investigation of its effects in secondary prevention of cardiovascular disease (CVD) is necessary. AIMS To identify the effectiveness of telehealth-assisted interventions for secondary prevention of CVD. DESIGN Systematic review and meta-analysis. METHODS The PRISMA protocol was used to conduct a systematic review and meta-analysis of randomised controlled trials. The full text of articles was obtained from six databases for the period from database establishment to 25 November 2021. To assess the methodological quality of the studies reviewed, the updated Cochrane risk-of-bias checklist for randomised trials was employed. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for secondary CVD prevention. RESULTS The final analysis included 4012 individuals from 18 different trials. Telehealth-assisted interventions were shown to improve medication adherence (standardised mean difference [SMD]: 0.31; 95% confidence interval [CI]: 0.33-0.59) and reduce depression (SMD: -0.28; 95% CI: -0.46 to -0.10). CONCLUSIONS Telehealth-assisted interventions appear to improve adherence to medication and reduce depression of individuals with CVD. These intervention strategies could be offered to both healthcare providers and individuals with CVD as an option in delivering and facilitating the use of health services to improve health behaviours and overall outcomes. Furthermore, this study may be used as guidance for future research to provide an appropriate plan of care for this population. RELEVANCE TO CLINICAL PRACTICE The findings imply that the delivery of care remotely via telehealth-assisted interventions for secondary prevention of CVD is beneficial in improving CVD survivors' health and access to healthcare services. TRIAL REGISTRATION The International Prospective Register of Systematic Review: (PROSPERO): CRD 42021290111.
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Affiliation(s)
| | - Erica Schorr
- Adult & Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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23
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Campbell B, Heitner J, Amos Mwelelo P, Fogel A, Mujumdar V, Adams LV, Boniface R, Su Y. Impact of SMS Text Messaging Reminders on Helmet Use Among Motorcycle Drivers in Dar es Salaam, Tanzania: Randomized Controlled Trial. J Med Internet Res 2022; 24:e27387. [PMID: 35389364 PMCID: PMC9030911 DOI: 10.2196/27387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/20/2021] [Accepted: 11/10/2021] [Indexed: 11/27/2022] Open
Abstract
Background Road traffic injury is a pressing public health issue in Tanzania. Increasing helmet use among motorcycle drivers can help reduce the burden due to road traffic injuries in the country. Helmet adherence can be supported through mobile health interventions. Objective The aim of this study is to evaluate the comparative impact of two different types of SMS text messaging reminders on motorcycle helmet use. Methods Participants were 391 commercial motorcycle taxi drivers in Dar es Salaam, Tanzania. Participants were randomized into three groups, each receiving a different set of messages: (1) social norming messages aimed at emphasizing society’s positive stance on helmet wearing, (2) fear appeal messages that emphasized the dangers of riding without a helmet, and (3) control group messages, which included basic road safety messages unrelated to helmet use. Every participant received the control messages. Adherence to helmet use was evaluated by self-report through surveys conducted at baseline, 3 weeks, and 6 weeks. Results At 6 weeks, the odds of self-reporting consistent helmet use were estimated to be 1.58 times higher in the social norming group than in the control group (P=.04), though this difference was not significant after accounting for multiple testing. There was little difference between fear appeal and control group recipients (odds ratio 1.03, P=.47). Subgroup analysis suggests that both fear appeal and social norming message types might have been associated with increased helmet use among participants who did not consistently wear helmets at baseline (odds ratio 1.66 and odds ratio 1.84, respectively), but this was not significant (P=.11 and P=.07, respectively). Among those who were consistent wearers at baseline, the social norming messages performed better than the fear appeal messages, and this difference reached traditional significance (P=.03), but was not significant after accounting for multiple testing. Conclusions The use of SMS text messaging reminders may improve helmet use among motorcycle drivers when framed as social norming messages. Given that nearly half of the drivers in our sample did not consistently wear their helmets on every trip, strategies to increase consistent usage could greatly benefit public safety. Trial Registration ClinicalTrials.gov NCT02120742; https://clinicaltrials.gov/ct2/show/NCT02120742
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Affiliation(s)
- Benjamin Campbell
- School of Education and Social Work, University of Sydney, Sydney, Australia
| | - Jesse Heitner
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Alexis Fogel
- Benioff Children's Hospital Oakland, University of California San Francisco, San Francisco, CA, United States
| | - Vaidehi Mujumdar
- Department of Obstetrics and Gynecology, Ichan School of Medicine, Mount Sinai, New York City, NY, United States.,Department of Obstetrics and Gynecology, New York City Health and Hospitals Queens, New York City, NY, United States
| | - Lisa V Adams
- Section of Infectious Disease and International Health, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Respicious Boniface
- Anaesthesiology Department, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, WA, United States
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24
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Effectiveness and Acceptability of a Mobile Phone Text Messaging Intervention to Improve Blood Pressure Control (TEXT4BP) among Patients with Hypertension in Nepal: A Feasibility Randomised Controlled Trial. Glob Heart 2022; 17:13. [PMID: 35342691 PMCID: PMC8877709 DOI: 10.5334/gh.1103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Uncontrolled blood pressure (BP) is the leading cause of preventable deaths in low- and middle-income countries. mHealth interventions, such as mobile phone text messaging, are a promising tool to improve BP control, but research on feasibility and effectiveness in resource-limited settings remains limited. Objective: This feasibility study assessed the effectiveness and acceptability of a mobile phone text messaging intervention (TEXT4BP) to improve BP control and treatment adherence among patients with hypertension in Nepal. Methods: The TEXT4BP study was a two-arm, parallel-group, unblinded, randomised controlled pilot trial that included 200 participants (1:1) (mean age: 50.5 years, 44.5% women) with hypertension at a tertiary referral hospital in Kathmandu, Nepal. Patients in the intervention arm (n = 100) received text messages three times per week for three months. The control arm (n = 100) received standard care. The COM-B model informed contextual co-designed text messages. Primary outcomes were change in BP and medication adherence at three months. Secondary outcomes included BP control, medication adherence self-efficacy and knowledge of hypertension. A nested qualitative study assessed the acceptability of the intervention. Results: At three months, the intervention group had greater reductions in systolic and diastolic BP vs usual care [–7.09/–5.86 (p ≤ 0.003) vs –0.77/–1.35 (p ≥ 0.28) mmHg] [adjusted difference: systolic β = –6.50 (95% CI, –12.6; –0.33) and diastolic BP β = –4.60 (95% CI, –8.16; –1.04)], coupled with a greater proportion achieving target BP (70% vs 48%, p = 0.006). The intervention arm showed an improvement in compliance to antihypertensive therapy (p < 0.001), medication adherence (p < 0.001), medication adherence self-efficacy (p = 0.023) and knowledge on hypertension and its treatment (p = 0.013). Participants expressed a high rate of acceptability and desire to continue the TEXT4BP intervention. Conclusion: The TEXT4BP study provides promising evidence that text messaging intervention is feasible, acceptable, and effective to improve BP control in low-resource settings. Trial registration: anzctr.org.au Identifier ACTRN12619001213134.
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25
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Curran D, Lauzon J, Quon D, Marshall S. Feasibility of an Interactive Coaching App to Enhance Post-concussion Outpatient Care. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:660540. [PMID: 35047917 PMCID: PMC8757742 DOI: 10.3389/fmedt.2021.660540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To determine the feasibility of patients to use a web-based health app for management of post-concussion (mTBI) symptoms in an out-patient setting. Participants: Seven (7) patients who were referred to an outpatient specialist clinic (physiatry) with persisting symptoms following a concussion. Participants had to be 18 years of age or older and more than 3 months post injury. Design: This was a prospective cohort study using a web-based platform for chronic disease management to guide patients in managing symptoms based on individual clinical recommendations. Each patient received weekly Symptom Management Plans created by a health coach and a physician specialist, designed to reinforce positive progress with clinical recommendations. Main Measures: Adherence to tracking daily recommendations and symptoms (data collected through the web-interface), The Rivermead Post-Concussion Questionnaire (self report) and a Satisfaction Questionnaire (self report). Results: Adherence to assigned clinical recommendations was close to 100%. Pre-post results on the patient reported outcome measure (Rivermead Post Concussion Tool) showed improvement for most patients in their experience of symptoms. The Satisfaction Questionnaire showed high rates of satisfaction with the App and the intervention in general. Conclusions: Use of a web-based health app with a health coach is feasible in this patient population from both the patient and clinician perspective based on high adherence. There is also some evidence of improvement of symptoms with this intervention over time. Further exploration of the use of this type of intervention with post-concussion patients could potentially impact long-term outcomes.
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Affiliation(s)
- Dorothyann Curran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,The Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, ON, Canada
| | - Julia Lauzon
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Deanna Quon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,The Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shawn Marshall
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,The Ottawa Hospital Rehabilitation Centre, Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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26
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O’Reilly PM, Harney OM, Hogan MJ, Mitchell C, McGuire BE, Slattery B. Chronic pain self-management in middle-aged and older adults: A collective intelligence approach to identifying barriers and user needs in eHealth interventions. Digit Health 2022; 8:20552076221105484. [PMID: 35694121 PMCID: PMC9185015 DOI: 10.1177/20552076221105484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives eHealth refers to health services and health information delivered or
enhanced through the internet and related technologies. The number of
eHealth interventions for chronic pain self-management is increasing.
However, little evidence has been found for the overall efficacy of these
interventions for older adults. The aim of the current study was to use a
Collective Intelligence approach to identify the barriers and specific user
needs of middle-aged and older adults using eHealth for chronic pain
self-management. Methods A Collective Intelligence workshop was conducted with middle-aged and older
adults to generate, clarify, select, and structure ideas in relation to
barriers to eHealth use and specific design requirements for the purposes of
chronic pain self-management. Prior to attending the workshop, participants
received a trigger question requesting the identification of five barriers
to eHealth use for chronic pain self-management. These barriers were
categorised and presented to the group along with barrier-related scenarios
and user need prompts, resulting in the generation of a set of ranked
barriers and a set of user needs. Results A total of 78 barriers were identified, from which six categories emerged:
Content, Support, Technological, Personal, Computer Literacy and
Accessibility. Additional idea-writing and group reflection in response to
these barriers revealed 97 user needs. Conclusion This is the first study to use Collective Intelligence methods to investigate
barriers to eHealth technology use and the specific user needs of
middle-aged and older adults in the context of chronic pain self-management.
The results of the current study provide a platform for the design and
development of enhanced eHealth interventions for this population.
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Affiliation(s)
- Paul M O’Reilly
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Owen M Harney
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Michael J Hogan
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Caroline Mitchell
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospital, Galway, Ireland
| | - Brian E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- Division of Pain Medicine, Galway University Hospital, Galway, Ireland
| | - Brian Slattery
- School of Psychology, Dublin City University, Dublin, Ireland
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27
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Holl F, Kircher J, Swoboda WJ, Schobel J. Methods Used to Evaluate mHealth Applications for Cardiovascular Disease: A Quasi-Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312315. [PMID: 34886039 PMCID: PMC8656469 DOI: 10.3390/ijerph182312315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
In the face of demographic change and constantly increasing health care costs, health care system decision-makers face ever greater challenges. Mobile health applications (mHealth apps) have the potential to combat this trend. However, in order to integrate mHealth apps into care structures, an evaluation of such apps is needed. In this paper, we focus on the criteria and methods of evaluating mHealth apps for cardiovascular disease and the implications for developing a widely applicable evaluation framework for mHealth interventions. Our aim is to derive substantiated patterns and starting points for future research by conducting a quasi-systematic scoping review of relevant peer-reviewed literature published in English or German between 2000 and 2021. We screened 4066 articles and identified n = 38 studies that met our inclusion criteria. The results of the data derived from these studies show that usability, motivation, and user experience were evaluated primarily using standardized questionnaires. Usage protocols and clinical outcomes were assessed primarily via laboratory diagnostics and quality-of-life questionnaires, and cost effectiveness was tested primarily based on economic measures. Based on these findings, we propose important considerations and elements for the development of a common evaluation framework for professional mHealth apps, including study designs, data collection tools, and perspectives.
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Affiliation(s)
- Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-731-9762-1613
| | - Jennifer Kircher
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
| | - Walter J. Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
| | - Johannes Schobel
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
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28
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Delva S, Waligora Mendez KJ, Cajita M, Koirala B, Shan R, Wongvibulsin S, Vilarino V, Gilmore DR, Han HR. Efficacy of Mobile Health for Self-management of Cardiometabolic Risk Factors: A Theory-Guided Systematic Review. J Cardiovasc Nurs 2021; 36:34-55. [PMID: 32040072 PMCID: PMC7713761 DOI: 10.1097/jcn.0000000000000659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although mobile health (mHealth) technologies are burgeoning in the research arena, there is a lack of mHealth interventions focused on improving self-management of individuals with cardiometabolic risk factors (CMRFs). OBJECTIVE The purpose of this article was to critically and systematically review the efficacy of mHealth interventions for self-management of CMRF while evaluating quality, limitations, and issues with disparities using the technology acceptance model as a guiding framework. METHODS PubMed, CINAHL, EMBASE, and Lilacs were searched to identify research articles published between January 2008 and November 2018. Articles were included if they were published in English, included adults, were conducted in the United States, and used mHealth to promote self-care or self-management of CMRFs. A total of 28 articles were included in this review. RESULTS Studies incorporating mHealth have been linked to positive outcomes in self-management of diabetes, physical activity, diet, and weight loss. Most mHealth interventions included modalities such as text messaging, mobile applications, and wearable technologies. There was a lack of studies that are (1) in resource-poor settings, (2) theoretically driven, (3) community-engaged research, (4) measuring digital/health literacy, (5) measuring and evaluating engagement, (6) measuring outcomes related to disease self-management, and (7) focused on vulnerable populations, especially immigrants. CONCLUSION There is still a lack of mHealth interventions created specifically for immigrant populations, especially within the Latino community-the largest growing minority group in the United States. In an effort to meet this challenge, more culturally tailored mHealth interventions are needed.
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29
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Li A, Del Olmo MG, Fong M, Sim K, Lymer SJ, Cunich M, Caterson I. Effect of a smartphone application (Perx) on medication adherence and clinical outcomes: a 12-month randomised controlled trial. BMJ Open 2021; 11:e047041. [PMID: 34373299 PMCID: PMC8354275 DOI: 10.1136/bmjopen-2020-047041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether the Perx app improves medication adherence and clinical outcomes over 12 months compared with standard care in patients requiring polypharmacy. DESIGN Randomised controlled trial with 12-month follow-up. SETTING Outpatient clinics in three tertiary hospitals in Sydney, Australia. PARTICIPANTS Eligible participants were aged 18-75 years, with at least one chronic condition, taking ≥3 different medications (oral medications or injections), with smartphone accessibility. Participants were randomised in a 1:1 ratio. INTERVENTIONS The intervention group used the Perx app that contained customised reminders and gamified interactions to reward verified medication adherence. MAIN OUTCOME MEASURES The primary outcome was medication adherence over 12 months measured using pill counts. Secondary outcomes included clinical outcomes (haemoglobin A1c (HbA1c), cholesterol, blood glucose, triglycerides, creatinine, thyroid function, blood pressure and weight). RESULTS Of 1412 participants screened for eligibility, 124 participants were randomised; 45 in the Perx arm and 40 in the control arm completed the study. The average age was 59.5, 58.9% were women, chronic conditions were cardiovascular disease (78%), type 2 diabetes (75%), obesity (65%) or other endocrine disorders (18%). On average, participants were taking six medications daily. The Perx group had greater improvements in adherence at month 2 (Coef. 8%; 95% CI 0.01 to 0.15), month 3 (Coef. 7%; 95% CI 0.00 to 0.14) and month 12 (Coef. 7%; 95% CI 0.00 to 0.13). The probability of HbA1c ≤6.5% was greater in the Perx group at months 9 and 12 and cholesterol (total and low-density lipoprotein cholesterol) was lower in the Perx group at month 3. The intervention was particularly effective for those with obesity, taking medications for diabetes and taking ≤4 medications. CONCLUSIONS This study provides evidence that app-based behavioural change interventions can increase medication adherence and produce longer-term improvements in some clinical outcomes in adults managing multimorbidity. More trials are needed to build the evidence base. TRIAL REGISTRATION NUMBER ACTRN12617001285347.
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Affiliation(s)
- Ang Li
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Sydney, NSW, Australia
| | - M Gail Del Olmo
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Mackenzie Fong
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Kyra Sim
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Sharyn J Lymer
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Michelle Cunich
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Sydney, NSW, Australia
| | - Ian Caterson
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Abstract
BACKGROUND Many patients are discharged with aspirin (ASA) as an anticoagulant after joint replacement surgery. In studies in which ASA was prescribed, doses were frequently missed. Adherence to postoperative ASA regimen is critical to preventing thrombotic complications. This randomized controlled study evaluated the impact of an existing medication adherence smartphone application (app) on adherence to twice daily ASA 81 mg for 35 days after knee or hip arthroplasty. METHODOLOGY Patients were randomized to either the app (intervention) group or the usual care (control) group. All patients received a baseline interview with a survey and demographics collected prior to randomization, a 36-day follow-up call for phone pill count, and a 6-week in-office interview with surveys and an in-person pill count. A convenience sample of 195 patients enrolled; 122 completed pill counts at both baseline and end of study. Ages ranged from 29 to 89 (mean: 60.4, SD: 10.1) years. The majority had a bachelor's degree or higher (59.3%), made more than $75,000 (or were retired; 51.9%), were of White race (75.9%), and female (53.8%). There were no significant demographic differences between the groups. RESULTS There were no significant group differences in final pill counts, adherence (reasons for missed pills), or ASA Medication self-efficacy scores. However, the intervention group scored significantly higher on the ASA Adherence measure (general ease in and ability to take ASA; p = .020). Higher ASA Adherence scores were associated with lower pill counts at the end of study (better adherence) in the intervention group. There was a high rate of attrition related to failure to bring the ASA to hospital or to the follow-up appointment. CONCLUSIONS Although there were no significant differences in final pill counts between groups, the app group reported more ease in taking pills. With smartphone use virtually ubiquitous, this project provided an opportunity to educate patients and nurses about how technology can support medication adherence. It was also an excellent opportunity to involve clinical nurses in a funded research project.
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31
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D'Anza B, Pronovost PJ. Digital Health: Unlocking Value in a Post-Pandemic World. Popul Health Manag 2021; 25:11-22. [PMID: 34042532 DOI: 10.1089/pop.2021.0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has forever changed health care, spurring a revolution in digital health technologies. Across the world, hundreds of thousands of health care systems are considering a central question: how do we connect with our patients? Digital health has been used as a stopgap in many cases to continue the essential functions of health systems. As the post-pandemic world and our "new normal" come into focus, further needs will have to be met with a digital patient interaction, with an eye toward value transformation. One barrier to fully leveraging digital tools is the lack of a framework for classifying the type of digital health care. This can limit our ability to design, deploy, evaluate, and communicate through digital means. This article presents 3 categories of digital health and their relationships to value metrics: (1) telehealth or direct care delivery, (2) digital access tools, and (3) digital monitoring. An evidence-based discussion reveals past successes, current promises, and future challenges in reducing defects in value through digital care. In the coming years, value transformation will become more crucial to the success of health care systems. By using the taxonomy in this article, health systems can better implement digital tools with a value-driven purpose. Defining the role of digital health in the post-pandemic world is needed to assist health systems and practices to build a bridge to value-based care.
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Affiliation(s)
- Brian D'Anza
- Department of Digital Health/Telehealth, University Hospitals, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Peter J Pronovost
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.,University Hospitals, Cleveland, Ohio, USA.,Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.,Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA
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Ross ES, Sakakibara BM, Mackay MH, Whitehurst DGT, Singer J, Toma M, Corbett KK, Van Spall HGC, Rutherford K, Gheorghiu B, Code J, Lear SA. The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e24530. [PMID: 33988519 PMCID: PMC8164115 DOI: 10.2196/24530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/27/2021] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. OBJECTIVE This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. METHODS This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul's Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. RESULTS There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain-Health-directed activity: -0.13, 95% CI -0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI -0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI -0.22 to 0.29, P=.77; Self-monitoring and insight: -0.14, 95% CI -0.33 to 0.05, P=.15; Constructive attitudes and approaches: -0.10, 95% CI -0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI -0.18 to 0.27, P=.69; Social integration and support: -0.12, 95% CI -0.34 to 0.10, P=.27; and Health services navigation: -0.05, 95% CI -0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference -0.36, 95% CI -0.66 to -0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program. CONCLUSIONS The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. TRIAL REGISTRATION ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.6968.
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Affiliation(s)
- Emily S Ross
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Brodie M Sakakibara
- Centre for Chronic Disease Prevention and Management, University of British Columbia Okanagan, Kelowna, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Martha H Mackay
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mustafa Toma
- Division of Cardiology, Providence Health Care, Vancouver, BC, Canada
| | - Kitty K Corbett
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Kimberly Rutherford
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | | | - Jillianne Code
- Department of Curriculum and Pedagogy, University of British Columbia, Vancouver, BC, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Division of Cardiology, Providence Health Care, Healthy Heart Program St Paul's Hospital, Vancouver, BC, Canada
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Gong M, Zhang S, Xi C, Luo M, Wang T, Wang Y, Wang S, Guo L, Lu C. Comprehensive intervention during pregnancy based on short message service to prevent or alleviate depression in pregnant women: A quasi-experimental study. Early Interv Psychiatry 2021; 15:352-359. [PMID: 32232971 DOI: 10.1111/eip.12953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/11/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Abstract
AIM Women have an increased risk for developing depression during pregnancy, and depression has a serious negative impact on the mother and infant. This study explored the effectiveness and feasibility of a comprehensive intervention based on using a short message service (SMS) to reduce depressive symptoms and prevent depression during pregnancy. METHODS This quasi-experimental study was conducted in three public hospitals with similar levels of care and maternal origin in Jiangmen City, Guangdong Province. One of the three hospitals was randomly selected as the intervention hospital, and the others were control hospitals. There were 4501 pregnant women who participated in this study. Pregnant women in the intervention group received a comprehensive intervention based on SMS after enrollment. Data were collected using questionnaires from August 2016 to August 2018. RESULTS After the intervention, the Edinburgh Postnatal Depression Scale scores of the intervention group were lower than those of the control group (intervention group: 3.9 ± 3.9, control group: 5.2 ± 4.3, P < .001), and the proportion of subjects with positive depression screening results in the intervention group was also significantly lower than that in the control group (intervention group: 9.0%, control group: 16.1%, P < .001). Moreover, compared with women in the intervention group, women in the control group who did not receive the intervention were more likely to be positive for depression in the third trimester (AOR = 2.04, 95% CI = 1.62-2.58). CONCLUSIONS The SMS-based comprehensive intervention used in this study can effectively alleviate depressive symptoms and reduce the risk of depression during pregnancy.
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Affiliation(s)
- Meiqian Gong
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Sheng Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Chuhao Xi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Min Luo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tian Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yingxiang Wang
- Maternity and Child Health Care Hospital of Guangdong, Jiangmen, China
| | - Songbai Wang
- Maternity and Child Health Care Hospital of Guangdong, Jiangmen, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China
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Palmer MJ, Machiyama K, Woodd S, Gubijev A, Barnard S, Russell S, Perel P, Free C. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev 2021; 3:CD012675. [PMID: 33769555 PMCID: PMC8094419 DOI: 10.1002/14651858.cd012675.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors by lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor. Approximately 9% of CVD cases in the EU are attributed to poor adherence to vascular medications. Low-cost, scalable interventions to improve adherence to medications for the primary prevention of CVD have potential to reduce morbidity, mortality and healthcare costs associated with CVD. OBJECTIVES To establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two other databases on 7 January 2020. We also searched two clinical trials registers on 5 February 2020. We searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials investigating interventions delivered wholly or partly by mobile phones to improve adherence to cardiovascular medications prescribed for the primary prevention of CVD. We only included trials with a minimum of one-year follow-up in order that the outcome measures related to longer-term, sustained medication adherence behaviours and outcomes. Eligible comparators were usual care or control groups receiving no mobile phone-delivered component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The main outcomes of interest were objective measures of medication adherence (blood pressure (BP) and cholesterol), CVD events, and adverse events. We contacted study authors for further information when this was not reported. MAIN RESULTS We included 14 trials with 25,633 randomised participants. Participants were recruited from community-based primary and tertiary care or outpatient clinics. The interventions varied widely from those delivered solely through short messaging service (SMS) to those involving a combination of modes of delivery, such as SMS in addition to healthcare worker training, face-to-face counselling, electronic pillboxes, written materials, and home blood pressure monitors. Some interventions only targeted medication adherence, while others additionally targeted lifestyle changes such as diet and exercise. Due to heterogeneity in the nature and delivery of the interventions and study populations, we reported most results narratively, with the exception of two trials which were similar enough to meaningfully pool in meta-analyses. The body of evidence for the effect of mobile phone-based interventions on objective outcomes of adherence (BP and cholesterol) was of low certainty, due to most trials being at high risk of bias, and inconsistency in outcome effects. Two trials were at low risk of bias. Among five trials (total study enrolment: 5441 participants) recording low-density lipoprotein cholesterol (LDL-C), two studies found evidence for a small beneficial intervention effect on reducing LDL-C (-5.30 mg/dL, 95% confidence interval (CI) -8.30 to -2.30; and -9.20 mg/dL, 95% CI -17.70 to -0.70). The other three studies found results varying from a small reduction (-7.7 mg/dL) to a small increase in LDL-C (0.77 mg/dL). All of which had wide confidence intervals that included no effect. Across 13 studies (25,166 participants) measuring systolic blood pressure, effect estimates ranged from a large reduction (MD -12.45 mmHg, 95% CI -15.02 to -9.88) to a small increase (MD 2.80 mmHg, 95% CI 0.30 to 5.30). We found a similar range of effect estimates for diastolic BP, ranging from -12.23 mmHg (95% CI 14.03 to -10.43) to 1.64 mmHg (95% CI -0.55 to 3.83) (11 trials, 19,716 participants). Four trials showed intervention benefits for systolic and diastolic BP with confidence intervals excluding no effect, and among these were all three of the trials evaluating self-monitoring of blood pressure with mobile phone-based telemedicine. The fourth trial included SMS and provider support (with additional varied features). Seven studies (19,185 participants) reported 'controlled' BP as an outcome, and intervention effect estimates varied from negligible effects (odds ratio (OR) 1.01, 95% CI 0.76 to 1.34) to large improvements in BP control (OR 2.41, 95% CI: 1.57 to 3.68). The three trials of clinician training or decision support combined with SMS (with additional varied features) had confidence intervals encompassing benefits and harms, with point estimates close to zero. Pooled analyses of the two trials of interventions solely delivered through SMS were indicative of little or no beneficial intervention effect on systolic BP (MD -1.55 mmHg, 95% CI -3.36 to 0.25; I2 = 0%) and small increases in controlled BP (OR 1.32, 95% CI 1.06 to 1.65; I2 = 0%). Based on four studies (12,439 participants), there was very low-certainty evidence (downgraded twice for imprecision and once for risk of bias) relating to the intervention effect on combined (fatal and non-fatal) CVD events. Two studies (2535 participants) provided low-certainty evidence for the effect of the intervention on cognitive outcomes, with little or no difference between trial arms for perceived quality of care and satisfaction with treatment. There was moderate-certainty evidence (downgraded due to risk of bias) that the interventions did not cause harm, based on six studies (8285 participants). Three studies reported no adverse events attributable to the intervention. One study reported no difference between groups in experience of adverse effects of statins, and that no participants reported intervention-related adverse events. One study stated that potential side effects were similar between groups. One study reported a similar number of deaths in each arm, but did not provide further information relating to potential adverse events. AUTHORS' CONCLUSIONS There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted.
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Affiliation(s)
- Melissa J Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Susannah Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Akinosun AS, Polson R, Diaz-Skeete Y, De Kock JH, Carragher L, Leslie S, Grindle M, Gorely T. Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2021; 9:e21061. [PMID: 33656444 PMCID: PMC7970167 DOI: 10.2196/21061] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/08/2020] [Accepted: 12/01/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. OBJECTIVE The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. METHODS This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. RESULTS Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at -0.29 [-0.44, -0.15], P<.001; high-density lipoprotein SMD at -0.09 [-0.19, 0.00], P=.05; low-density lipoprotein SMD at -0.18 [-0.33, -0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at -0.37 [-1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at -0.06 [-0.20, 0.08], P=.43; systolic BP SMD at -0.03 [-0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at -0.16 [-1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. CONCLUSIONS Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c).
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Affiliation(s)
- Adewale Samuel Akinosun
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Rob Polson
- Highland Health Sciences Library, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Yohanca Diaz-Skeete
- School of Health and Science, Dundalk Institute of Technology, Dundalk, Ireland
| | - Johannes Hendrikus De Kock
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Lucia Carragher
- School of Health and Science, Dundalk Institute of Technology, Dundalk, Ireland
| | - Stephen Leslie
- Cardiology Unit, Raigmore Hospital, NHS Highlands, Inverness, United Kingdom
| | - Mark Grindle
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
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Herring LY, Dallosso H, Schreder S, Smith EJ, Waheed G, Gray LJ, Khunti K, Yates T, Highton PJ, Rowlands AV, Hudson I, Seidu S, Davies MJ. Physical Activity after Cardiac EventS (PACES): a group education programme with subsequent text message support designed to increase physical activity in individuals with diagnosed coronary heart disease: a randomised controlled trial. Open Heart 2021; 8:openhrt-2020-001351. [PMID: 33637567 PMCID: PMC7919588 DOI: 10.1136/openhrt-2020-001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/04/2022] Open
Abstract
AIM To assess the effectiveness of a low-cost pragmatic intervention (structured education and ongoing text message support) to increase daily physical activity in participants 12-48 months after a coronary heart disease cardiac event (myocardial infarction, angina or acute coronary syndrome) diagnosis. METHODS A single-centre randomised controlled trial of 291 adults randomised to a structured education programme (n=145) or usual care (n=146). The programme consisted of two 2.5 hour sessions delivered 2 weeks apart, followed by supplementary text message support. The GENEActiv accelerometer assessed the primary outcome at 12 months (change in overall physical activity (expressed in milli gravitational (mg) units) from baseline). Secondary outcomes included anthropometric, physical function, cardiovascular, biochemical and patient-reported outcome measures. Linear regression was used to compare outcome measures between groups on a modified intention-to-treat basis. RESULTS Participants' mean age was 66.5±9.7 years, 84.5% males, 82.5% white British and 15.5% south Asian. At 12 months, there was no difference between the groups in terms of change in overall physical activity (-0.23 mg (95% CI -1.22 to 0.75), p=0.64) and the programme was well accepted (88% attendance). Exploratory analyses showed that average moderate to vigorous physical activity (MVPA) levels increased in individuals not meeting physical activity guidelines (≥150 min per week) on enrolment compared with those who did, by 8 minutes per day (8.04 (95% CI 0.99 to 15.10), p=0.03). CONCLUSION The programme was well attended but showed no change in physical activity levels. Results show high baseline MVPA levels and suggest that Physical Activity after Cardiac EventS education may benefit cardiac patients not currently meeting activity guidelines. TRIAL REGISTRATION NUMBER ISRCTN91163727.
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Affiliation(s)
- Louisa Y Herring
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Helen Dallosso
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Emily J Smith
- Institute of Psychological Research, De Montfort University, Leicester, UK
| | - Ghazala Waheed
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Heath Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Patrick J Highton
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ian Hudson
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Samuel Seidu
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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Subedi N, Rawstorn JC, Gao L, Koorts H, Maddison R. Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e17957. [PMID: 33245286 PMCID: PMC7732711 DOI: 10.2196/17957] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. OBJECTIVE This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. METHODS MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. RESULTS No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. CONCLUSIONS Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124254.
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Affiliation(s)
- Narayan Subedi
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Jonathan C Rawstorn
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Lan Gao
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| | - Harriet Koorts
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Ralph Maddison
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
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Mao Y, Lin W, Wen J, Chen G. Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2020; 8:8/1/e001225. [PMID: 32988849 PMCID: PMC7523197 DOI: 10.1136/bmjdrc-2020-001225] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 01/02/2023] Open
Abstract
With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.
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Affiliation(s)
- Yaqian Mao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei Lin
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Junping Wen
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Endocrinology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, Fujian, China
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Wong EML, Leung DYP, Chair SY, Sit JWH. Effects of a Web-Based Educational Support Intervention on Total Exercise and Cardiovascular Risk Markers in Adults With Coronary Heart Disease. Worldviews Evid Based Nurs 2020; 17:283-292. [PMID: 32772509 DOI: 10.1111/wvn.12456] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. METHOD A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. RESULTS The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6 months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. LINKING EVIDENCE TO ACTION The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.
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Affiliation(s)
- Eliza Mi-Ling Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sek-Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janet W H Sit
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Gambalunga F, Iacorossi L, Notarnicola I, Serra V, Piredda M, De Marinis MG. Mobile Health in Adherence to Oral Anticancer Drugs: A Scoping Review. Comput Inform Nurs 2020; 39:17-23. [PMID: 32568900 DOI: 10.1097/cin.0000000000000643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In oncology, adherence to oral antineoplastic medication is a key element of treatment, on which the success of any therapeutic intervention depends. Given their widespread use in clinical practice, it is important to identify tools that can facilitate the monitoring and self-management of the patient at home, to avoid the consequences of employing ineffective treatment. One of the tools available today to take action on this phenomenon is mobile health technology. The aim of this review is to describe published studies relating to the use of mobile health to promote adherence to oral antineoplastic medication. This scoping review was conducted using the framework proposed by Arksey and O'Malley, adapted according to Levac et al. Of 1320 articles identified, only seven met the eligibility criteria and therefore were included in the review. All seven articles involved the use of digital means to measure adherence to treatment, patient satisfaction, acceptability and feasibility of the digital means used, and presence of symptoms, but not the effectiveness of the digital instrument used. In conclusion, the use of digital means to assist adherence of cancer patients to oral antineoplastic medication is widely recognized, but its effectiveness in clinical practice is poorly supported by the nature of the published studies.
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Affiliation(s)
- Francesca Gambalunga
- Author Affiliations: Department of Health Professions (DAPS), University Hospital "Policlinico Umberto I" (Ms Gambalunga); IRCCS "Regina Elena" National Cancer Institute (Dr Iacorossi and Ms Serra); Centre of Excellence for Nursing Scholarship OPI Rome Italy (Dr Notarnicola); and Research Unit Nursing Science, Campus Bio-Medico of Rome University (Drs Piredda and De Marinis), Rome, Italy
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Stogios N, Kaur B, Huszti E, Vasanthan J, Nolan RP. Advancing Digital Health Interventions as a Clinically Applied Science for Blood Pressure Reduction: A Systematic Review and Meta-analysis. Can J Cardiol 2020; 36:764-774. [DOI: 10.1016/j.cjca.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/24/2019] [Accepted: 11/10/2019] [Indexed: 01/29/2023] Open
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Zárate-Bravo E, García-Vázquez JP, Torres-Cervantes E, Ponce G, Andrade ÁG, Valenzuela-Beltrán M, Rodríguez MD. Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14680. [PMID: 32130164 PMCID: PMC7076413 DOI: 10.2196/14680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users' attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. OBJECTIVE This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. METHODS A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. RESULTS The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD's external cues not only improved older adults' medication adherence but also mediated family caregivers' involvement. CONCLUSIONS The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. TRIAL REGISTRATION ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97.
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Affiliation(s)
- Ernesto Zárate-Bravo
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | | | - Gisela Ponce
- Facultad de Enfermería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | - Ángel G Andrade
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Marcela D Rodríguez
- Facultad de Ingeniería, Universidad Autónoma de Baja California, Mexicali, Mexico
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Renfrew ME, Morton DP, Morton JK, Hinze JS, Beamish PJ, Przybylko G, Craig BA. A Web- and Mobile App-Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study. J Med Internet Res 2020; 22:e15592. [PMID: 31904578 PMCID: PMC6971514 DOI: 10.2196/15592] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app-based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. OBJECTIVE This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app-based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. METHODS Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard-fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the "mental health" and "vitality" subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. RESULTS Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. CONCLUSIONS A Web- and mobile app-based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.
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Affiliation(s)
- Melanie Elise Renfrew
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Darren Peter Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Jason Kyle Morton
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Jason Scott Hinze
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Peter James Beamish
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Geraldine Przybylko
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
| | - Bevan Adrian Craig
- Lifestyle and Health Research Centre, Avondale University College, Cooranbong, New South Wales, Australia
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Zijp TR, Touw DJ, van Boven JFM. User Acceptability and Technical Robustness Evaluation of a Novel Smart Pill Bottle Prototype Designed to Support Medication Adherence. Patient Prefer Adherence 2020; 14:625-634. [PMID: 32256053 PMCID: PMC7093103 DOI: 10.2147/ppa.s240443] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/27/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Smart medication adherence monitoring devices can provide objective and granular drug utilization data and help patients engaging with their treatment. In this proof-of-concept study, the acceptability and technical robustness of a novel smart pill bottle prototype (SPBP) were assessed in order to allow further optimization. METHODS The SPBP is an app-controlled automatic dispense system, capturing real-time data on a web-based platform, which sends text reminders and measures storage conditions. A heterogeneous group of ten volunteers was asked to dispense placebo capsules with the SPBP and to follow a predefined dosing schedule for a trial period of 2 weeks. Afterwards, a questionnaire was filled out during a short interview. Primary outcome was dispense adherence as measured by the bottle. Other study outcomes included system acceptability (System Usability Scale [SUS]), self-reported adherence (MARS) and technical robustness of the bottle's mechanics (electronic pill dispenser) and sensors (bottle temperature). RESULTS The overall dispense adherence rate as measured by the SPBP was 88%. All participants completed the study and four participants had an adherence rate of 100% during the study. The dispense adherence rates corresponded well with participants' self-reported adherence with an average MARS total score of 23.6 (out of 25). Participants judged the system easy to use, with a mean SUS score of 79.3 (range: 57.5-97.5). The overall mean temperature difference between the bottle sensor and calibrated external sensor was -0.82°C (range: -1.37°C to -0.21°C). CONCLUSION The SPBP was well accepted and this study provides data for further optimization and follow-up studies. Smart adherence technologies such as these may change the way healthcare professionals, trialists and patients manage medication adherence.
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Affiliation(s)
- Tanja R Zijp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pharmaceutical Analysis, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands
- Correspondence: Job FM van Boven University Medical Center Groningen, Hanzeplein 1 (Internal Postcode EB70), Groningen9700 RB, the NetherlandsTel +31503617893 Email
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Sua YS, Jiang Y, Thompson DR, Wang W. Effectiveness of mobile phone-based self-management interventions for medication adherence and change in blood pressure in patients with coronary heart disease: A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2019; 19:192-200. [PMID: 31856596 DOI: 10.1177/1474515119895678] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS The aim of this study was to synthesise and evaluate the effectiveness of mobile phone-based self-management interventions for medication adherence and change in blood pressure in patients with coronary heart disease. METHODS Relevant randomised controlled trials evaluating mobile phone-based self-management interventions for medication adherence and/or change in blood pressure in coronary heart disease patients were identified by searching six electronic databases (PubMed, Cochrane, CINAHL, ProQuest, Scopus and EMBASE) from January 2008 to January 2019. The trials were screened, data were extracted and quality was assessed by two independent reviewers. Meta-analyses were performed for different outcomes while narrative syntheses were conducted for studies that could not be pooled or when there was the presence of high heterogeneity. RESULTS Fifteen trials were included in this review, of which 11 of these trials were meta-analysed. Mobile phone-based self-management interventions were associated with a statistically significant reduction in diastolic blood pressure (combined mean difference of -1.99 (95% confidence interval (CI) -3.20 to -0.78; P=0.0001)). However, the combined effect on medication adherence (medium size effect of d=0.72 (95% CI -0.32 to 1.75; P=0.17)) and change in systolic blood pressure (combined mean difference of -1.08 (95% CI -5.51 to 3.35; P=0.63)) was not statistically significant. There was significant heterogeneity among the trials reviewed. CONCLUSION Mobile phone-based self-management interventions have the potential to improve self-management and adherence in patients with coronary heart disease but better designed, conducted and reported trials are needed to demonstrate this.
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Affiliation(s)
- Yun Shan Sua
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | | | - Wenru Wang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Kim TY, Lee YS, Yu EJ, Kim MS, Yang SY, Hur YI, Kang JH. Effects of a mobile healthcare service provided by public health centers on practicing of health behaviors and health risk factors. Nutr Res Pract 2019; 13:509-520. [PMID: 31814926 PMCID: PMC6883230 DOI: 10.4162/nrp.2019.13.6.509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/25/2018] [Accepted: 06/13/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study evaluated whether a mobile health (mHealth) application can instigate healthy behavioral changes and improvements in metabolic disorders in individuals with metabolic abnormalities. SUBJECTS/METHODS Participants were divided into an mHealth intervention group (IG), which used a mobile app for 24 weeks, and a conventional IG. All mobile apps featured activity monitors, with blood pressure and glucose monitors, and body-composition measuring devices. The two groups were compared after 24 weeks in terms of health-behavior practice rate and changes in the proportion of people with health risks, and health behaviors performed by the IG that contributed to reductions in more than one health risk factor were analyzed using multiple logistic regression. RESULTS Preference for low-sodium diet, reading nutritional facts, having breakfast, and performing moderate physical activity significantly increased in the mHealth IG. Furthermore, the mHealth IG showed a significant increase of eight items in the mini-dietary assessment; particularly, the items “I eat at least two types of vegetables of various colors at every meal” and “I consume dairies, such as milk, yogurt, and cheese, every day.” The proportion of people with health risks, with the exception of fasting glucose, significantly decreased in the mHealth IG, while only the proportion of people with at-risk triglycerides and waist circumference of females significantly decreased in the control group. Finally, compared to those who did not show improvements of health risks, those who showed improvements of health risks in the mHealth IG had an odds ratio of 1.61 for moderate to vigorous physical activity, 1.65 for “I do not add more salt or soy sauce in my food,” and 1.77 for “I remove fat in my meat before eating.” CONCLUSIONS The findings suggest that the additional use of a community-based mHealth service through a mobile application is effective for improving health behaviors and lowering metabolic risks in Koreans.
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Affiliation(s)
- Tae-Yon Kim
- Korea Health Promotion Institute, Seoul 04554, Korea
| | - Yun-Su Lee
- Korea Health Promotion Institute, Seoul 04554, Korea
| | - Eun-Jung Yu
- Korea Health Promotion Institute, Seoul 04554, Korea
| | - Min-Su Kim
- Korea Health Promotion Institute, Seoul 04554, Korea
| | | | - Yang-Im Hur
- Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9, Mareunnae-ro, Jung-gu, Seoul 04551, Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03181, Korea
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Zhao YY, Dang FP, Zhai TT, Li HJ, Wang RJ, Ren JJ. The effect of text message reminders on medication adherence among patients with coronary heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18353. [PMID: 31876709 PMCID: PMC6946488 DOI: 10.1097/md.0000000000018353] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes. METHODS The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software. RESULTS In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07-7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = -6.51; 95% CI -9.79 to -3.23), cholesterol (standard mean difference = -0.26; 95% CI -0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26-1.54). CONCLUSION TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.
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Affiliation(s)
| | - Fang-Ping Dang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Tian-Tian Zhai
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Hui-Ju Li
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Rui-Juan Wang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Jing-Jie Ren
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
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Turan Kavradim S, Özer Z, Boz İ. Effectiveness of telehealth interventions as a part of secondary prevention in coronary artery disease: a systematic review and meta-analysis. Scand J Caring Sci 2019; 34:585-603. [PMID: 31747080 DOI: 10.1111/scs.12785] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronary artery disease is one of the most important health problems among heart diseases in the world, with high morbidity and mortality. Lifestyle changes in particular are recommended in the latest guidelines for implementing secondary prevention. AIM The aim of this study was to evaluate the effectiveness of telehealth interventions as a part of secondary prevention compared to routine care in those with coronary artery disease. METHOD The systematic review with meta-analysis was performed in accordance with Cochrane methods. Science Direct, Springer Link, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, ProQuest and Network Digital Library databases were searched between 2000 and 2018 up to February 2018. The studies chosen conformed to PICOS inclusion and exclusion criteria. The risk of bias was assessed using the Cochrane risk of bias tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used in reporting the study. RESULTS Twenty-four studies with a total of 6773 study participants met the inclusion criteria. It was found that telephone call interventions were the most commonly used, text message interventions came second with seven studies, telephone calls in combination with messages were used in four studies and telemonitoring was used in two studies. Compared to routine care, telehealth interventions had moderate significant effects in reducing waist circumference, total cholesterol and triglyceride, improving medication adherence and physical activity, and had small significant effects in reducing blood pressure and smoking cessation. No significant publication bias was found in the main outcomes. CONCLUSION Results showed that the telehealth interventions yielded positive outcomes in lifestyle changes for coronary artery disease. Therefore, telehealth interventions can be used for effective secondary prevention by health professionals who care for individuals with coronary artery disease. Additionally, this study will provide guidance for studies on the development of telehealth intervention.
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Affiliation(s)
- Selma Turan Kavradim
- Faculty of Nursing, Department of Internal Medicine Nursing, University of Akdeniz, Antalya, Turkey
| | - Zeynep Özer
- Faculty of Nursing, Department of Internal Medicine Nursing, University of Akdeniz, Antalya, Turkey
| | - İlkay Boz
- Faculty of Nursing, Department of Obstetrics and Gynecology Nursing, University of Akdeniz, Antalya, Turkey
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Effects of eHealth-Based Interventions on Adherence to Components of Cardiac Rehabilitation: A Systematic Review. J Cardiovasc Nurs 2019; 35:74-85. [PMID: 31738217 DOI: 10.1097/jcn.0000000000000619] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the effects of eHealth-based interventions on patient adherence to components of cardiac rehabilitation (CR). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided this review. Medline, CINAHL, Embase, and Cochrane Library databases were searched for studies published from January 1996 to December 2017. All studies were included in which eHealth-based components of CR and its effects on patient adherence were measured. Because this review included a heterogeneous group of study designs, the authors qualitatively described the effect of eHealth on adherence into a narrative approach. RESULTS A total of 1520 studies were identified, with 1415 excluded after screening. Of the remaining 105 studies, 90 were excluded after full text assessment, leaving 15 studies for analysis. Most (11) of the 15 studies reported on medication adherence. Other studies focused on adherence to diet, physical activity, vital signs, weight, step counts, smoking, and fluid restriction. The type of eHealth used also varied, ranging from telemonitoring and web-based applications to telephone calls. Of the 15 studies, 7 reported significant improvements with eHealth-based components of CR on adherence. DISCUSSION AND CONCLUSION This review summarizes the effects of eHealth on components of CR and revealed variations in measurement and evaluation methods. The telemonitoring and web-based applications for self-care behaviors were most effective in promoting adherence. The measurement of adherence should be based on an explicit definition of adherence and should be measured with validated scales tested in the CR population.
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Peprah P, Abalo EM, Agyemang-Duah W, Gyasi RM, Reforce O, Nyonyo J, Amankwaa G, Amoako J, Kaaratoore P. Knowledge, attitude, and use of mHealth technology among students in Ghana: A university-based survey. BMC Med Inform Decis Mak 2019; 19:220. [PMID: 31718642 PMCID: PMC6852777 DOI: 10.1186/s12911-019-0947-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
Abstract
Background Interest in mHealth interventions, defined as the use of mobile phones to access healthcare is increasingly becoming popular globally. Given its technology-based applications, university students may be key clients of the mHealth adoption but studies are rare in sub-Saharan Africa. This study provides a snapshot and baseline evidence on knowledge, attitude and use of mHealth among university students in Ghana. Methods Using a self-administered questionnaire, we collected data between April and June 2017 from 963 randomly sampled undergraduate students at the Kwame Nkrumah University of Science and Technology (KNUST). Pearson’s Chi-square (χ2) test assessed the differences between variables whilst logistic regression models estimated the independent predictors of use of mHealth with p < 0.05 as significant. Results Knowledge on mHealth was moderately high. Specifically, more than half of the sample reported awareness of mHealth although the prevalence of use of mHealth stood at 51%. Logistic regressions revealed that mHealth use was positively associated with respondents’ year (second year: OR = 1.704, 95% CI: 1.185–2.452, and third year: OR = 1.528, 95% CI: 1.060–2.202), and monthly income (OR:3.112, 95%CI: 1.180-8.211). However, ethnicity [(OR = 0.761, 95% CI (0.580–0.997)] was negatively associated with the use of mHealth technology. Conclusion Findings suggest that knowledge of mHealth among university students is low. Policy and public health interventions for urgent awareness creation and promotion of use of mHealth as well as its possible integration into the mainstream healthcare system in Ghana are timely.
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Affiliation(s)
- Prince Peprah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel Mawuli Abalo
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Williams Agyemang-Duah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
| | - Okwei Reforce
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Julius Nyonyo
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Godfred Amankwaa
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jones Amoako
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paulinus Kaaratoore
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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