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Qaderi K, Shamsabadi A, Haseli A, Ghane Ezabadi S, Asadi L, Jesmani Y, Kalhor M, Jamali B, Kajbafvala M, khodavirdilou R, Mohammadi A, Rasoal D. Changes in screening, diagnosis, management, and outcomes of gestational diabetes during the COVID-19 pandemic: A systematic review. Heliyon 2024; 10:e31943. [PMID: 38845870 PMCID: PMC11154622 DOI: 10.1016/j.heliyon.2024.e31943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024] Open
Abstract
Background Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy, and it can lead to complications for the mother and the infant/fetus. This was especially evident during the COVID-19 pandemic. Therefore, the present systematic review aimed to describe the changes in screening, diagnosis, management, and outcomes of gestational diabetes during the COVID-19 pandemic. Methods The systematic review was conducted from December 2019 until January 1, 2022. To find articles related to the purpose of the study, PubMed, Scopus, Web of Science, and WHO were searched using relevant and validated keywords using MeSH/Emtree. Results In total, 675 entries were ascertained from the database inquiry, and 17 scholarly works were deemed suitable for inclusion in the final review. The salient conclusions derived from this review were as follows: (a) During the COVID-19 pandemic, there was a significant decrease in the use of OGTTs and a rise in the use of HbA1c assays for both GDM screening and diagnosing. (b) A predominant number of physicians incorporated some variation of telemedicine to remotely supervise and conduct follow-up evaluations of patients with GDM. Various strategies are presented for the provision of prenatal care to women afflicted with GDM, such as concentrating on high-risk demographics, the initiation of lifestyle modifications at early stages, and the implementation of remote patient monitoring techniques. The 'single test procedure' is identified as the most suitable for the preliminary screening of GDM. The OGTT should be assigned clinical precedence in patients at high risk during the ongoing COVID-19 pandemic. Additionally, Medical Nutrition Therapy (MNT) was established as the primary management strategy, and the most influential determinant of the transition from dietary adjustments to pharmacotherapy was the Fasting Blood Glucose (FBG) levels during the second trimester. Conclusion Suggested strategies for GDM screening and management during the pandemic integrated into routine antenatal care, emphasized the importance of remote diabetes education and technology utilization during health emergencies.
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Affiliation(s)
- Kowsar Qaderi
- Clinical Research Development Center, Motazedi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahmadreza Shamsabadi
- Department of Health Information Technology, Esfarayen Faculty of Medical Science, Esfarayen, Iran
| | - Arezoo Haseli
- Clinical Research Development Center, Motazedi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajjad Ghane Ezabadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran
| | - Leila Asadi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Younes Jesmani
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehri Kalhor
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bita Jamali
- Department of Nursing and Midwifery, Comprehensive Health Research Center, Babol Branch, Islamic Azad University, Babol, Iran
| | - Mehrnaz Kajbafvala
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rasa khodavirdilou
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aida Mohammadi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Roesler A, Butten K, Taylor P, Morrison M, Varnfield M, Holmes-Truscott E. The experiences of individuals who have had gestational diabetes: A qualitative exploration. Diabet Med 2024:e15374. [PMID: 38853396 DOI: 10.1111/dme.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
AIM To qualitatively explore the experiences of individuals with Gestational Diabetes Mellitus (GDM) in Australia, and to recognise opportunities for leveraging digital health to enhance the support of GDM management. METHOD A cross sectional online survey assessed the experiences of individuals with GDM, the healthcare system and their digital health usage. Respondents (recruited via a national diabetes registry or social media) were adults receiving GDM care within Australia in the last 5 years, who responded to any of three open-ended questions (n = 815) exploring positive, negative and other GDM experiences. Thematic analysis was utilised, and themes were mapped to the socio-ecological systems framework. RESULTS At a system level, themes related to (1) accessibility of care including the value of digital health and the inflexible or inconsistent perception of the (2) implementation of guidelines. At an interpersonal level, themes covered the need for adequate (3) health information provision, and (4) supportive care, as well as highlighting (5) experiences of stigma including a desire for greater awareness of GDM. Individual-level themes included: (6) differential barriers to accessing care; (7) negative emotional burden; (8) internalisation of stigma; (9) dietary freedom and social impact and (10) opportunity for change derived from having GDM. CONCLUSION Findings suggest a demand for more supportive, person-centred GDM care, improved information provision and individualised implementation of clinical guidelines. Such mechanisms may support reduced barriers to accessing care or negative psychosocial impacts of GDM. Though not central to the identified experiences, digital health tools may help address the need for optimised GDM care.
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Affiliation(s)
- Anna Roesler
- The Australian e-Health Research Centre, CSIRO, Herston, Queensland, Australia
| | - Kaley Butten
- The Australian e-Health Research Centre, CSIRO, Herston, Queensland, Australia
| | - Pennie Taylor
- The Australian e-Health Research Centre, CSIRO, Herston, Queensland, Australia
| | - Melinda Morrison
- Diabetes Australia, Canberra, Australian Capital Territory, Australia
| | - Marlien Varnfield
- The Australian e-Health Research Centre, CSIRO, Herston, Queensland, Australia
| | - Elizabeth Holmes-Truscott
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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He Y, Zhu W, Wang T, Chen H, Xin J, Liu Y, Lei J, Liang J. Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study. JMIR Mhealth Uhealth 2024; 12:e55199. [PMID: 38547475 PMCID: PMC11009850 DOI: 10.2196/55199] [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: 12/06/2023] [Revised: 12/19/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. OBJECTIVE This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. METHODS The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. RESULTS We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73%) compared with that for American HMAs (73,907/100,125, 73.81%). Chinese users primarily focus on reliability (2165/16,561, 13.07%) and measurement accuracy (2091/16,561, 12.63%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26%) and data synchronization (12,837/100,125, 12.82%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD (β=.354, P<.001), while cost had the most significant impact on ND (β=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD (β=0.312, P<.001), while data synchronization had the most significant impact on ND (β=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. CONCLUSIONS User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements.
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Affiliation(s)
- Yunfan He
- Center for Health Policy Studies, School of Public Health, Zhejiang University, Hangzhou, China
| | - Wei Zhu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
| | - Tong Wang
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, China
- School of Basic Medical Sciences, Shandong University, Jinan, China
- Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Han Chen
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Junyi Xin
- School of Information Engineering, Hangzhou Medical College, Hangzhou, China
| | | | - Jianbo Lei
- Clinical Research Center, Affiliated Hospital of Southwest Medical University, Luzhou, China
- The First Affiliated Hospital, Hainan Medical University, Haikou, China
- Center for Medical Informatics, Health Science Center, Peking University, Beijing, China
| | - Jun Liang
- Center for Health Policy Studies, School of Public Health, Zhejiang University, Hangzhou, China
- Department of AI and IT, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Cancer Prevention and Intervention,, China National Ministry of Education, School of Medicine, Zhejiang University, Hangzhou, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
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Cross AJ, Geethadevi GM, Magin P, Baker AL, Bonevski B, Godbee K, Ward SA, Mahal A, Versace V, Bell JS, Mc Namara K, O'Reilly SL, Thomas D, Manias E, Anstey KJ, Varnfield M, Jayasena R, Elliott RA, Lee CY, Walker C, van den Bosch D, Tullipan M, Ferreira C, George J. A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e073709. [PMID: 38114278 DOI: 10.1136/bmjopen-2023-073709] [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: 12/21/2023] Open
Abstract
INTRODUCTION Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI MIND will evaluate the efficacy of a multidomain, nurse-led, mHealth supported intervention for assessing dementia risk and reducing associated risk factors in middle-aged adults in the Australian primary care setting. METHODS AND ANALYSIS General practice clinics (n≥26) across Victoria and New South Wales, Australia, will be recruited and randomised. Practice nurses will be trained to implement the HAPPI MIND intervention or a brief intervention. Patients of participating practices aged 45-65 years with ≥2 potential dementia risk factors will be identified and recruited (approximately 15 patients/clinic). Brief intervention participants receive a personalised report outlining their risk factors for dementia based on Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) scores, education booklet and referral to their general practitioner as appropriate. HAPPI MIND participants receive the brief intervention as well as six individualised dementia risk reduction sessions with a nurse trained in motivational interviewing and principles of behaviour change, a personalised risk reduction action plan and access to the purpose-built HAPPI MIND smartphone app for risk factor self-management. Follow-up data collection will occur at 12, 24 and 36 months. Primary outcome is ANU-ADRI score change at 12 months from baseline. Secondary outcomes include change in cognition, quality of life and individual risk factors of dementia. ETHICS AND DISSEMINATION Project approved by Monash University Human Research Ethics Committee (ID: 28273). Results will be disseminated in peer-reviewed journals and at healthcare conferences. If effective in reducing dementia risk, the HAPPI MIND intervention could be integrated into primary care, scaled up nationally and sustained over time. TRIAL REGISTRATION NUMBER ACTRN12621001168842.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Gopisankar Mohanannair Geethadevi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kali Godbee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kevin Mc Namara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Deakin Rural Health, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- School of Exercise and Nutrition Science, Deakin University, Melbourne, Victoria, Australia
| | - Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marlien Varnfield
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Herston, Queensland, Australia
| | - Rajiv Jayasena
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Parkville, Victoria, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Cik Y Lee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Walker
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Denise van den Bosch
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Mary Tullipan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Catherine Ferreira
- North Western Melbourne Primary Health Network, Parkville, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
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Safiee L, Rough D, George P, Mudenha R. Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals. JMIR Hum Factors 2023; 10:e51691. [PMID: 38113070 PMCID: PMC10762626 DOI: 10.2196/51691] [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: 08/08/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management. OBJECTIVE This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women's perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology. METHODS In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62% (16/26) of the participants, including 44% (7/16) of HPs, 50% (8/16) of women with GDM, and 6% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. RESULTS Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women's lifestyle constraints, technology's design not meeting women's needs, and optimizing the technology's design to meet women's needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology's design to improve the quality of care, technology to support women's independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management. CONCLUSIONS The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement.
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Affiliation(s)
- Ladan Safiee
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Daniel Rough
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Priya George
- Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
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Cheng Z, Hao H, Tsofliou F, Katz MD, Zhang Y. Effects of online support and social media communities on gestational diabetes: A systematic review. Int J Med Inform 2023; 180:105263. [PMID: 37907014 DOI: 10.1016/j.ijmedinf.2023.105263] [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: 04/20/2023] [Revised: 09/10/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication in pregnancy that can lead to negative maternal and fetal outcomes. Online support interventions have been suggested as a potential tool to improve the management of GDM. OBJECTIVE This systematic review aimed to summarize the effectiveness of social media and online support interventions for the management of GDM. METHODS We conducted a thorough systematic search across Web of Science, Scopus, and PubMed, following PRISMA guidelines, and supplemented it with a manual search. Our results included both qualitative and quantitative research. We rigorously assessed quantitative studies for bias using ROBINS-I and RoB 2 tools, ensuring the reliability of our findings. RESULTS We incorporated a total of 22 studies, which were comprised of ten qualitative and twelve quantitative studies. Online support interventions were found to have a positive impact on promoting self-care and improving healthcare outcomes for women with GDM. Individualized diet and exercise interventions resulted in lower odds of weight gain and GDM diagnosis, while online prenatal education increased breastfeeding rates. In addition, telemedicine options reduced the need for in-person clinical visits and improved patient satisfaction. CONCLUSIONS Online support interventions show potential to improve outcomes in patients with GDM in this small literature review. Future research is also necessary to determine the effectiveness of different types of online interventions and identify strategies to improve engagement and the quality of the information provided through online resources.
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Affiliation(s)
- Zilin Cheng
- Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
| | - Haijing Hao
- Department of Computer Information Systems, Bentley University, Waltham, MA, USA.
| | - Fotini Tsofliou
- Department of Rehabilitation & Sport Sciences, Bournemouth University, Bournemouth, UK.
| | - Melissa D Katz
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Yiye Zhang
- Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
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Laurie JG, Wilkinson SA, Mcintyre HD, Snoswell C. Gestational diabetes mellitus care re-imagined - A cost-minimisation analysis: Cost savings from a tertiary hospital, using a novel, digital-based gestational diabetes management model. Aust N Z J Obstet Gynaecol 2023; 63:709-713. [PMID: 37144760 DOI: 10.1111/ajo.13695] [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: 09/03/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Diagnosis of gestational diabetes mellitus (GDM) in a pregnancy has a significant impact on health service resources and represents a substantial financial and time impost on women. AIM To describe a cost-minimisation analysis conducted following the demonstration of clinically equivalent care of women using a novel, digital model for GDM management, compared with conventional care. MATERIALS AND METHODS A pre-implementation model of care was compared with the post-implementation model of care which included systematic development and delivery of education videos, use of the Commonwealth Scientific and Industrial Research Organisation 'M♡THer' smart phone app/portal and a dramatically reduced schedule of visits. The Mater Mothers' Hospital Brisbane cares for approximately 1200 women with GDM per annum, on which the cost estimates were based. Service costs were estimated using the resource method, where resource volumes and costs were gathered from experts within the health service. Patient costs were estimated using results from a short survey completed by a cohort of the study population. RESULTS Health service costs showed a modest saving of AU$17 441.78 (US$12 158.92) in the intervention group over a 12-month period. Cost savings for the woman were estimated at $566.56 (US$394.96) per patient after accounting for lost wages, childcare expenses, and travel expenses avoided. This reduction led to an overall saving of $679 872 (US$473 948.82) for the cohort of 1200 women, primarily due to the reduction in face-to-face visits. CONCLUSION Re-imagining GDM patient care by introducing a novel, digital-based GDM model of care has substantial positive cost implications for patients.
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Affiliation(s)
- Josephine G Laurie
- Department of Obstetric Medicine, Mater Health Services, Mater Hospital Brisbane, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Harold D Mcintyre
- Department of Obstetric Medicine, Mater Health Services, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Centaine Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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8
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Laurie JG, Wilkinson SA, Griffin A, McIntyre HD. GDM care re-imagined: Maternal and neonatal outcomes following a major model of care change for gestational diabetes mellitus at a large metropolitan hospital. Aust N Z J Obstet Gynaecol 2023; 63:681-688. [PMID: 37101250 DOI: 10.1111/ajo.13691] [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: 09/03/2022] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The rapidly rising prevalence of gestational diabetes mellitus (GDM) poses major challenges to the efficient, timely and sustainable provision of diabetes care. AIM To assess whether the implementation of a novel, digital model of care would provide improved efficiency without compromising clinical outcomes in a cohort of women with GDM. METHODS A digital model of care was developed, implemented and evaluated using a prospective pre-post study design in 2020-21 at a quaternary centre. We introduced six culturally and linguistically tailored educational videos, home delivery of equipment and prescriptions, and a smartphone app-to-clinician portal for glycaemic review and management. Outcomes were prospectively recorded by an electronic medical record. Associations between model of care and maternal and neonatal characteristics and birth outcomes were examined for all women and separately by treatment received (diet, metformin, insulin). RESULTS Comparing pre-implementation (n = 598) and post-implementation (n = 337) groups, maternal (onset, mode of birth) and neonatal (birthweight, large for gestational age (LGA), nursery admission) clinical outcomes confirmed that the novel model of care was similar to standard, traditional care. Minor birthweight variation was noted when separated by treatment type (diet, metformin, insulin). CONCLUSION This pragmatic service redesign demonstrates reassuring clinical outcomes in a culturally diverse GDM cohort. Despite the lack of randomisation, this intervention has potential generalisability for GDM care and important key learnings for service redesign in the digital era.
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Affiliation(s)
- Josephine G Laurie
- Department of Obstetric Medicine, Mater Health Services, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alison Griffin
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Harold D McIntyre
- Department of Obstetric Medicine, Mater Health Services, Mater Research, The University of Queensland, Brisbane, Queensland, Australia
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Goodman A, Mahoney R, Spurling G, Lawler S. Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review. JMIR Mhealth Uhealth 2023; 11:e45162. [PMID: 37351947 PMCID: PMC10337452 DOI: 10.2196/45162] [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: 12/18/2022] [Revised: 03/07/2023] [Accepted: 04/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. OBJECTIVE This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. METHODS In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. RESULTS Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. CONCLUSIONS This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery.
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Affiliation(s)
- Andrew Goodman
- School of Public Health, The University of Queensland, Turrbal, Jagera Country, Herston, Australia
- Australian eHealth Research Centre (AEHRC), Commonwealth Scientific and Industrial Research Organisation (CSIRO), Turrbal, Jagera Country, Herston, Australia
| | - Ray Mahoney
- College of Medicine and Public Health, Flinders University, Kaurna Country, Adelaide, Australia
| | - Geoffrey Spurling
- General Practice Clinical Unit, The University of Queensland, Turrbal, Jagera Country, Herston, Australia
| | - Sheleigh Lawler
- School of Public Health, The University of Queensland, Turrbal, Jagera Country, Herston, Australia
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Rajkumar T, Freyne J, Varnfield M, Lawson K, Butten K, Shanmugalingam R, Hennessy A, Makris A. Remote blood pressure monitoring in high risk pregnancy - study protocol for a randomised controlled trial (REMOTE CONTROL trial). Trials 2023; 24:334. [PMID: 37198630 DOI: 10.1186/s13063-023-07321-0] [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: 08/06/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Pregnant women at high risk for developing a hypertensive disorder of pregnancy require frequent antenatal assessments, especially of their blood pressure. This expends significant resources for both the patient and healthcare system. An alternative to in-clinic assessments is a remote blood pressure monitoring strategy, in which patients self-record their blood pressure at home using a validated blood pressure machine. This has the potential to be cost-effective, increase patient satisfaction, and reduce outpatient visits, and has had widespread uptake recently given the increased need for remote care during the ongoing COVID-19 pandemic. However robust evidence supporting this approach over a traditional face-to-face approach is lacking, and the impact on maternal and foetal outcomes has not yet been reported. Thus, there is an urgent need to assess the efficacy of remote monitoring in pregnant women at high risk of developing a hypertensive disorder of pregnancy. METHODS The REMOTE CONTROL trial is a pragmatic, unblinded, randomised controlled trial, which aims to compare remote blood pressure monitoring in high-risk pregnant women with conventional face-to-face clinic monitoring, in a 1:1 allocation ratio. The study will recruit patients across 3 metropolitan Australian teaching hospitals and will evaluate the safety, cost-effectiveness, impact on healthcare utilisation and end-user satisfaction of remote blood pressure monitoring. DISCUSSION Remote blood pressure monitoring is garnering interest worldwide and has been increasingly implemented following the COVID-19 pandemic. However, robust data regarding its safety for maternofoetal outcomes is lacking. The REMOTE CONTROL trial is amongst the first randomised controlled trials currently underway, powered to evaluate maternal and foetal outcomes. If proven to be as safe as conventional clinic monitoring, major potential benefits include reducing clinic visits, waiting times, travel costs, and improving delivery of care to vulnerable populations in rural and remote communities. TRIAL REGISTRATION The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p, on October 11th, 2020).
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Affiliation(s)
- Theepika Rajkumar
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.
- Department of Medicine, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia.
| | - Jill Freyne
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Marlien Varnfield
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Kenny Lawson
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kaley Butten
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Renuka Shanmugalingam
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Department of Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Department of Medicine, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
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11
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Moise IK, Ivanova N, Wilson C, Wilson S, Halwindi H, Spika VM. Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review. BMC Pregnancy Childbirth 2023; 23:195. [PMID: 36941565 PMCID: PMC10026210 DOI: 10.1186/s12884-023-05454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Timely access to essential obstetric and gynecologic healthcare is an effective method for improving maternal and neonatal outcomes; however, the COVID-19 pandemic impacted pregnancy care globally. In this global scoping review, we select and investigate peer-reviewed empirical studies related to mHealth and telehealth implemented during the pandemic to support pregnancy care and to improve birth outcomes. METHODS We searched MEDLINE and PubMed, Scopus, CINAHL and Web of Science for this Review because they include peer-reviewed literature in the disciplines of behavioral sciences, medicine, clinical sciences, health-care systems, and psychology. Because our investigative searches reviewed that there is considerable 'grey literature' in this area; we did not restrict our review to any study design, methods, or place of publication. In this Review, peer-reviewed preprints were comparable to published peer-reviewed articles, with relevant articles screened accordingly. RESULTS The search identified 1851 peer reviewed articles, and after removal of duplicates, using inclusion and exclusion criteria, only 22 studies were eligible for inclusion in the review published from January 2020 to May 2022. mHealth interventions accounted for 72.7% (16 of 22 studies) and only 27.3% (6 of 22 studies) were telehealth studies. There were only 3 example studies that integrated digital technologies into healthcare systems and only 3 studies that developed and evaluated the feasibility of mobile apps. Experimental studies accounted 68.8% of mHealth studies and only 33.3% studies of telehealth studies. Key functionalities of the pregnancy apps and telehealth platforms focused on mental and physical wellness, health promotion, patient tracking, health education, and parenting support. Implemented interventions ranged from breastfeeding and selfcare to behavioral health. Facilitators of uptake included perceived benefits, user satisfaction and convenience. Mobile apps and short messaging services were the primary technologies employed in the implemented mHealth interventions. CONCLUSION Although our Review emphasizes a lack of studies on mHealth interventions and data from pregnant women during the COVID-19 crisis, the review shows that implementation of digital health interventions during emergencies are inevitable given their potential for supporting pregnancy care. There is also a need for more randomized clinical trials and longitudinal studies to better understand the effectiveness and feasibility of implementing such interventions during disease outbreaks and emergencies.
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Affiliation(s)
- Imelda K Moise
- Department of Geography & Sustainable Development, College of Arts and Sciences, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL, 33124, USA.
| | - Nicole Ivanova
- Global Health Studies Program, College of Arts and Sciences, University of Miami, 1252 Memorial Drive, Coral Gables, FL, 33146, USA
| | - Cyril Wilson
- Department of Geography & Anthropology, University of Wisconsin-Eau Claire, Eau Claire, WI, 54702-4004, USA
| | - Sigmond Wilson
- Department of History & Political Science, Rogers State University, 1701 W. Will Rogers Blvd, Claremore, OK, 74017, USA
| | - Hikabasa Halwindi
- Department of Community and Family Medicine, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Zambia
| | - Vera M Spika
- University of Miami, 1300 Memorial Drive, Coral Gables, FL, 33124, USA
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Gonçalves RL, Pagano AS, Reis ZSN, Brackstone K, Lopes TCP, Cordeiro SA, Nunes JM, Afagbedzi SK, Head M, Meira W, Batchelor J, Ribeiro ALP. Usability of Telehealth Systems for Noncommunicable Diseases in Primary Care From the COVID-19 Pandemic Onward: Systematic Review. J Med Internet Res 2023; 25:e44209. [PMID: 36787223 PMCID: PMC10022651 DOI: 10.2196/44209] [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: 11/10/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telehealth was expanded without the opportunity to extensively evaluate the adopted technology's usability. OBJECTIVE We aimed to synthesize evidence on health professionals' perceptions regarding the usability of telehealth systems in the primary care of individuals with noncommunicable diseases (NCDs; hypertension and diabetes) from the COVID-19 pandemic onward. METHODS A systematic review was performed of clinical trials, prospective cohort studies, retrospective observational studies, and studies that used qualitative data collection and analysis methods published in English, Spanish, and Portuguese from March 2020 onward. The databases queried were MEDLINE, Embase, BIREME, IEEE Xplore, BVS, Google Scholar, and grey literature. Studies involving health professionals who used telehealth systems in primary care and managed patients with NCDs from the COVID-19 pandemic onward were considered eligible. Titles, abstracts, and full texts were reviewed. Data were extracted to provide a narrative qualitative evidence synthesis of the included articles. The risk of bias and methodological quality of the included studies were analyzed. The primary outcome was the usability of telehealth systems, while the secondary outcomes were satisfaction and the contexts in which the telehealth system was used. RESULTS We included 11 of 417 retrieved studies, which had data from 248 health care professionals. These health care professionals were mostly doctors and nurses with prior experience in telehealth in high- and middle-income countries. Overall, 9 studies (82%) were qualitative studies and 2 (18%) were quasiexperimental or multisite trial studies. Moreover, 7 studies (64%) addressed diabetes, 1 (9%) addressed diabetes and hypertension, and 3 (27%) addressed chronic diseases. Most studies used a survey to assess usability. With a moderate confidence level, we concluded that health professionals considered the usability of telehealth systems to be good and felt comfortable and satisfied. Patients felt satisfied using telehealth. The most important predictor for using digital health technologies was ease of use. The main barriers were technological challenges, connectivity issues, low computer literacy, inability to perform complete physical examination, and lack of training. Although the usability of telehealth systems was considered good, there is a need for research that investigates factors that may influence the perceptions of telehealth usability, such as differences between private and public services; differences in the level of experience of professionals, including professional experience and experience with digital tools; and differences in gender, age groups, occupations, and settings. CONCLUSIONS The COVID-19 pandemic has generated incredible demand for virtual care. Professionals' favorable perceptions of the usability of telehealth indicate that it can facilitate access to quality care. Although there are still challenges to telehealth, more than infrastructure challenges, the most reported challenges were related to empowering people for digital health. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021296887; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296887. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.21801/ppcrj.2022.82.6.
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Affiliation(s)
- Roberta Lins Gonçalves
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, Brazil
| | | | | | | | | | - Sarah Almeida Cordeiro
- Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, Brazil
| | - Julia Macedo Nunes
- Department of Linguistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Michael Head
- University of Southampton, Southampton, United Kingdom
| | - Wagner Meira
- Department of Linguistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Safiee L, Rough DJ, Whitford H. Barriers and Facilitators of Using eHealth to Support Gestational Diabetes Mellitus Self-Management (GDM): A Systematic Literature Review of Perceptions of Healthcare Professionals and Women with GDM (Preprint). J Med Internet Res 2022; 24:e39689. [PMID: 36301613 PMCID: PMC9650580 DOI: 10.2196/39689] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/16/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common medical complications during pregnancy. eHealth technologies are proving to be successful in supporting the self-management of medical conditions. Digital technologies have the potential to improve GDM self-management. Objective The primary objective of this systematic literature review was to identify the views of health professionals (HPs) and women with GDM regarding the use of eHealth for GDM self-management. The secondary objective was to investigate the usability and user satisfaction levels when using these technologies. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the search included primary papers in English on the evaluation of technology to support self-management of GDM from January 2008 to September 2021 using MEDLINE, CINAHL, Embase, ACM, and IEEE databases. The lists of references from previous systematic literature reviews, which were related to technology and GDM, were also examined for primary studies. Papers with qualitative, quantitative, and mixed methodologies were included and evaluated. The selected papers were assessed for quality using the Cochrane Collaboration tool, National Institute for Health and Care Excellence clinical guidelines, Critical Appraisal Skills Programme Qualitative Checklist, and McGill University Mixed Methods Appraisal Tool. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Narrative synthesis was used to analyze the quantitative data. Results A total of 26 papers were included in the review. Of these, 19% (5/26) of studies used quantitative research methodologies, 19% (5/26) used qualitative methods, and 62% (16/26) used mixed methods. In all, 4 themes were identified from the qualitative data: the benefits of using technology, engagement with people via technology, the usability of technology, and discouragement factors for the use of technology. The thematic analysis revealed a vast scope of challenges and facilitators in the use of GDM self-management systems. The challenges included usability aspects of the system, technical problems, data privacy, lack of emotional support, the accuracy of reported data, and adoption of the system by HPs. Convenience, improved GDM self-management, peer support, increased motivation, increased independence, and consistent monitoring were facilitators to use these technologies. Quantitative data showed that there is potential for improving the usability of the GDM self-management systems. It also showed that convenience, usefulness, increasing motivation for GDM self-management, helping with GDM self-management, and being monitored by HPs were facilitators to use the GDM self-management systems. Conclusions This novel systematic literature review shows that HPs and women with GDM encountered some challenges in using GDM self-management systems. The usability of GDM systems was the primary challenge derived from qualitative and quantitative results, with convenience, consistent monitoring, and optimization of GDM self-management emerging as important facilitators.
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Affiliation(s)
- Ladan Safiee
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Daniel John Rough
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Heather Whitford
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
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Buss VH, Varnfield M, Harris M, Barr M. A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study. JMIR Hum Factors 2022; 9:e35065. [PMID: 35536603 PMCID: PMC9131155 DOI: 10.2196/35065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/26/2022] [Accepted: 03/26/2022] [Indexed: 01/16/2023] Open
Abstract
Background Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
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Affiliation(s)
- Vera Helen Buss
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Smyth S, Curtin E, Tully E, Molphy Z, Breathnach F. Smartphone applications for surveillance of Gestational Diabetes: A Scoping Review (Preprint). JMIR Diabetes 2022; 7:e38910. [DOI: 10.2196/38910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
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Bertini A, Gárate B, Pardo F, Pelicand J, Sobrevia L, Torres R, Chabert S, Salas R. Impact of Remote Monitoring Technologies for Assisting Patients With Gestational Diabetes Mellitus: A Systematic Review. Front Bioeng Biotechnol 2022; 10:819697. [PMID: 35310000 PMCID: PMC8929763 DOI: 10.3389/fbioe.2022.819697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/31/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction: In Chile, 1 in 8 pregnant women of middle socioeconomic level has gestational diabetes mellitus (GDM), and in general, 5–10% of women with GDM develop type 2 diabetes after giving birth. Recently, various technological tools have emerged to assist patients with GDM to meet glycemic goals and facilitate constant glucose monitoring, making these tasks more straightforward and comfortable.Objective: To evaluate the impact of remote monitoring technologies in assisting patients with GDM to achieve glycemic goals, and know the respective advantages and disadvantages when it comes to reducing risk during pregnancy, both for the mother and her child.Methods: A total of 188 articles were obtained with the keywords “gestational diabetes mellitus,” “GDM,” “gestational diabetes,” added to the evaluation levels associated with “glucose level,” “glycemia,” “glycemic index,” “blood sugar,” and the technological proposal to evaluate with “glucometerm” “mobile application,” “mobile applications,” “technological tools,” “telemedicine,” “technovigilance,” “wearable” published during the period 2016–2021, excluding postpartum studies, from three scientific databases: PUBMED, Scopus and Web of Science. These were managed in the Mendeley platform and classified using the PRISMA method.Results: A total of 28 articles were selected after elimination according to inclusion and exclusion criteria. The main measurement was glycemia and 4 medical devices were found (glucometer: conventional, with an infrared port, with Bluetooth, Smart type and continuous glucose monitor), which together with digital technology allow specific functions through 2 identified digital platforms (mobile applications and online systems). In four articles, the postprandial glucose was lower in the Tele-GDM groups than in the control group. Benefits such as improved glycemic control, increased satisfaction and acceptability, maternal confidence, decreased gestational weight gain, knowledge of GDM, and other relevant aspects were observed. There were also positive comments regarding the optimization of the medical team’s time.Conclusion: The present review offers the opportunity to know about the respective advantages and disadvantages of remote monitoring technologies when it comes to reducing risk during pregnancy. GDM centered technology may help to evaluate outcomes and tailor personalized solutions to contribute to women’s health. More studies are needed to know the impact on a healthcare system.
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Affiliation(s)
- Ayleen Bertini
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research, Universidad de Valparaíso, Valparaíso, Chile
- Programa de Doctorado en Ciencias e Ingeniería para La Salud, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
- *Correspondence: Rodrigo Salas, ; Ayleen Bertini,
| | - Bárbara Gárate
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaíso, Chile
| | - Fabián Pardo
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research, Universidad de Valparaíso, Valparaíso, Chile
- School of Medicine, Campus San Felipe, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Julie Pelicand
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research, Universidad de Valparaíso, Valparaíso, Chile
- School of Medicine, Campus San Felipe, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, Australia
- Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), São Paulo, Brazil
- Department of Pathology and Medical Biology, University of Groningen, Groningen, Netherlands
- University Medical Center Groningen (UMCG), Groningen, Netherlands
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey, Mexico
| | - Romina Torres
- Faculty of Engineering, Universidad Andres Bello, Viña Del Mar, Chile
| | - Steren Chabert
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Valparaíso, Chile
- Centro de Investigación y Desarrollo en INGeniería en Salud—CINGS, Universidad de Valparaíso, Valparaíso, Chile
| | - Rodrigo Salas
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Millennium Institute for Intelligent Healthcare Engineering, Valparaíso, Chile
- Centro de Investigación y Desarrollo en INGeniería en Salud—CINGS, Universidad de Valparaíso, Valparaíso, Chile
- *Correspondence: Rodrigo Salas, ; Ayleen Bertini,
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Poulter SE, Meloncelli N, Mack M. Use of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus: A pilot study. Diabetes Res Clin Pract 2022; 185:109224. [PMID: 35122904 DOI: 10.1016/j.diabres.2022.109224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
AIMS To determine patient satisfaction, impact on maternal and neonatal outcomes and resource utilisation of a smartphone-based, remote blood glucose level (BGL) monitoring platform with software surveillance inwomen with gestational diabetes (GDM) compared with historical controls. METHODS This intervention study prospectively enrolled 98 women with GDM to the NET-Health smartphone-based application and compared them to 94 historical controls. The application allows automatic, real-time BGL upload to a central server for software monitoring, with automatic alerts generated for out-of-range results. Data recorded included demographics, outcomes and occasions of service (OOS). A validated satisfaction questionnaire was completed post-delivery. RESULTS The groups had comparable baseline characteristics and no significant difference in maternal and neonatal outcomes. The NET-Health application intervention reduced resource utilisation, with 1.9 fewer OOS and 37 min less clinician time - equivalent to AUD$68 saved per woman (based on clinician time only) or AUD$23 after taking into account the cost of the application. Patient satisfaction was high. CONCLUSIONS Use of this smartphone-based application with software surveillance in women with GDM has high patient satisfaction and no differences in maternal or neonatal outcomes despite reduced resource utilisation. It is the first to demonstrate a financial benefit. Larger studies are needed.
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Affiliation(s)
- Sophie E Poulter
- Endocrinology, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Australia.
| | - Nina Meloncelli
- Nutrition and Dietetics, Allied Health, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Australia
| | - Michele Mack
- Endocrinology, Sunshine Coast University Hospital, 6 Doherty St, Birtinya, Australia
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Garg SK, Rodriguez E. COVID-19 Pandemic and Diabetes Care. Diabetes Technol Ther 2022; 24:S2-S20. [PMID: 35475690 DOI: 10.1089/dia.2022.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO
| | - Erika Rodriguez
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO
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Edwards KJ, Maslin K, Andrade J, Jones RB, Shawe J. Mobile health as a primary mode of intervention for women at risk of, or diagnosed with, gestational diabetes mellitus: a scoping review. JBI Evid Synth 2022; 20:2195-2243. [PMID: 35152244 DOI: 10.11124/jbies-21-00294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to map the knowledge related to the use of mHealth as a primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications among women at risk of or diagnosed with gestational diabetes mellitus. We also sought to understand if mHealth for women at risk of or diagnosed with gestational diabetes mellitus incorporated relevant behavior change theory and techniques. INTRODUCTION Prevention and management of gestational diabetes mellitus and its associated adverse outcomes are important to maternal and infant health. Women with gestational diabetes mellitus report high burden of disease management and barriers to lifestyle change post-delivery, which mHealth interventions may help to overcome. Evidence suggests apps could help gestational diabetes mellitus prevention and management, however, less is known about broader applications of mHealth from preconception to interconception and whether relevant behavior change techniques are incorporated. INCLUSION CRITERIA Studies published in English that focused on mHealth use as primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications were considered for inclusion. Telehealth or telemedicine were excluded as these have been reviewed elsewhere. METHODS Six databases were searched: MEDLINE (Ovid), CINAHL (EBSCO), Embase (Ovid), Cochrane Database (Wiley), Scopus, and TRIP. No limits were applied to database exploration periods to ensure retrieval of all relevant studies. Gray literature sources searched were OpenGrey, ISRCTN Registry, ClinicalTrials.gov, EU Clinical Trials Register, and ANZCTR. Two reviewers independently screened abstracts and assessed full texts against the inclusion criteria. Data were extracted using an adapted version of the JBI data extraction instrument. Data are presented in narrative form accompanied by tables and figures. RESULTS This review identified 2166 sources, of which 96 full texts were screened. Thirty eligible reports were included, covering 25 different mHealth interventions. Over half (n = 14) were for self-managing blood glucose during pregnancy. Common features included tracking blood glucose levels, real-time feedback, communication with professionals, and educational information. Few (n = 6) mHealth interventions were designed for postpartum use and none for interconception use. Five for postpartum use supported behavior change to reduce the risk of type 2 diabetes and included additional features such as social support functions and integrated rewards. Early development and feasibility studies used mixed methods to assess usability and acceptability. Later stage evaluations of effectiveness typically used randomized controlled trial designs to measure clinical outcomes such as glycemic control and reduced body weight. Three mHealth interventions were developed using behavior change theory. Most mHealth interventions incorporated two behavior change techniques shown to be optimal when combined and those delivering behavior change interventions included a wider range. Nevertheless, only half of the 26 techniques listed in a published behavior change taxonomy were tried. CONCLUSIONS mHealth for gestational diabetes mellitus focuses on apps to improve clinical outcomes. This focus could be broadened by incorporating existing resources that women value, such as social media, to address needs, such as peer support. Although nearly all mHealth interventions incorporated behavior change techniques, findings suggest future development should consider selecting techniques that target women's needs and barriers. Lack of mHealth interventions for prevention of gestational diabetes mellitus recurrence and type 2 diabetes mellitus suggests further development and evaluation is required.
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Affiliation(s)
- Katie J Edwards
- School of Nursing and Midwifery, University of Plymouth, Devon, UK The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence, Devon, UK School of Psychology, University of Plymouth, Devon, UK Royal Cornwall Hospital Trust, Truro, Cornwall UK
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Negreiros FDDS, Araújo ALD, Mattos SM, Moreira TR, Cestari VRF, Silva LMSD, Moreira TMM. Digital technologies in the care of people with diabetes during the COVID-19 pandemic: a scoping review. Rev Esc Enferm USP 2021; 55:e20210295. [PMID: 34825697 DOI: 10.1590/1980-220x-reeusp-2021-0295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To map evidence on the use of digital technologies in the care of people with diabetes during the COVID-19 pandemic. METHOD This is a scoping review, based on the JBI manual, which included scientific articles and gray literature from nine primary and seven secondary databases. Articles were independently assessed by two reviewers. Rayyan® was used to select the studies. The description of study characterization is presented in a table and tables, ending in a narrative synthesis. RESULTS A total of 1,964 studies were identified and, after selection, 23 publications remained for analysis. It turned out that telemedicine was used in all studies and remote consultation support technologies included continuous glucose monitoring devices, glucose data analysis software, insulin delivery systems, applications, audio and/or voice communication devices, which facilitated remote diabetes mellitus monitoring and management. CONCLUSION Telehealth, monitoring technologies, insulin delivery systems and communication devices were tools used to monitor patients with diabetes during the pandemic.
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Affiliation(s)
| | - Açucena Leal de Araújo
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Samuel Miranda Mattos
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil
| | | | - Virna Ribeiro Feitosa Cestari
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Lucilane Maria Sales da Silva
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Thereza Maria Magalhães Moreira
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil.,Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil
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Ruiz-Burga E, Bruijning-Verhagen P, Palmer P, Sandcroft A, Fernandes G, de Hoog M, Bryan L, Pierre R, Bailey H, Giaquinto C, Thorne C, Christie CDC. The ZIKApp for detection of potential arbovirus infections and pregnancy complications in pregnant women in Jamaica: a pilot study (Preprint). JMIR Form Res 2021; 6:e34423. [PMID: 35896029 PMCID: PMC9377438 DOI: 10.2196/34423] [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: 10/22/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elisa Ruiz-Burga
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Paulette Palmer
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Annalisa Sandcroft
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Georgina Fernandes
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Marieke de Hoog
- University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lenroy Bryan
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Russell Pierre
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
| | - Heather Bailey
- Institute for Global Health, University College London, London, United Kingdom
| | - Carlo Giaquinto
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, Padova, Italy
| | - Claire Thorne
- Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Celia D C Christie
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
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