Improvement of knowledge following diabetes self-management education with respect to socioeconomic status: A retrospective cohort study among type 2 diabetes in Eastern India

Introduction

We assessed the baseline knowledge and the improvement and retention of knowledge after attending diabetes self-management education (DSME) programs with respect to different socioeconomic status (SES). We also looked into the change in body mass index (BMI), blood pressure, and glycemic parameters after attending the DSME sessions.

Materials and Methods

This was a retrospective, cohort study carried out via chart review based on data collected from manual or electronic medical records (EMR) and questionnaire responses of 160 adult patients with type 2 diabetes (T2D) who attended two DSME sessions with a gap of at least six months.

Results

Baseline knowledge on diabetes was uniform (P = 0.06), irrespective of differences in SES, and DSME sessions significantly improved the knowledge in all socioeconomic classes (P value < 0.05 in each SES group). However, SES did have a significant influence on the finally acquired knowledge of diabetes as was evident from the final score after attending two DSME sessions. A significant number of patients (48.1%) from our cohort either improved or retained their knowledge of diabetes over a mean follow-up of 15.5 months. The BMI of our cohort was significantly reduced from baseline to final follow-up (P = 0.016).

Conclusion

DSME sessions were effective in improving knowledge and awareness among T2D patients, irrespective of socioeconomic classes in Eastern India. The acquired knowledge from DSME sessions was retained over a long time.

Conversational Agents and Avatars for Cardiometabolic Risk Factors and Lifestyle-Related Behaviors: Scoping Review

BACKGROUND

In recent years, there has been a rise in the use of conversational agents for lifestyle medicine, in particular for weight-related behaviors and cardiometabolic risk factors. Little is known about the effectiveness and acceptability of and engagement with conversational and virtual agents as well as the applicability of these agents for metabolic syndrome risk factors such as an unhealthy dietary intake, physical inactivity, diabetes, and hypertension.

OBJECTIVE

This review aimed to get a greater understanding of the virtual agents that have been developed for cardiometabolic risk factors and to review their effectiveness.

METHODS

A systematic review of PubMed and MEDLINE was conducted to review conversational agents for cardiometabolic risk factors, including chatbots and embodied avatars.

RESULTS

A total of 50 studies were identified. Overall, chatbots and avatars appear to have the potential to improve weight-related behaviors such as dietary intake and physical activity. There were limited studies on hypertension and diabetes. Patients seemed interested in using chatbots and avatars for modifying cardiometabolic risk factors, and adherence was acceptable across the studies, except for studies of virtual agents for diabetes. However, there is a need for randomized controlled trials to confirm this finding. As there were only a few clinical trials, more research is needed to confirm whether conversational coaches may assist with cardiovascular disease and diabetes, and physical activity.

CONCLUSIONS

Conversational coaches may regulate cardiometabolic risk factors; however, quality trials are needed to expand the evidence base. A future chatbot could be tailored to metabolic syndrome specifically, targeting all the areas covered in the literature, which would be novel.

MyDiabetes—The Gamified Application for Diabetes Self-Management and Care

Gamified applications are regarded as useful for patients in facilitating daily self-care management and the personalization of health monitoring. This paper reports the development of a gamified application by considering a design that had previously been investigated and reported. Numerous game elements were installed in the application, which covered several tasks aimed at managing diabetes mellitus. The development process utilized the Rapid Application Development (RAD) methodology in terms of system requirements, user design, construction, and cutover; this paper refers to the user design and cutover processes. The developed application was tested through system testing and usability testing. The usability testing adopted the Software Usability Scale (SUS) to assess the usability of the application. Twenty participants were involved in the testing. The result showed that the gamified application is easy and practical to use for an individual with or without diabetes. All the provided functions worked as designed and planned, and the participants accepted their usability. Overall, this study offers a promising result that could lead to real-life implementation.

Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis

BACKGROUND

Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications.

OBJECTIVE

The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined.

METHODS

Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed.

RESULTS

Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1).

CONCLUSIONS

We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

Decision-making surrounding the use of preimplantation genetic testing for aneuploidy reveals misunderstanding regarding its benefit

PURPOSE

We aimed to explore how patients make decisions regarding use of preimplantation genetic testing for aneuploidy (PGT-A) for in vitro fertilization (IVF).

METHODS

This is a cross-sectional survey at an academic medical center. Three hundred subjects initiating an IVF cycle over 8 weeks were asked to complete a validated survey to determine how they decided whether or not to pursue PGT-A. All patients were previously counseled that the primary goal of PGT-A is to maximize pregnancy rates per embryo transfer. Survey responses were compared between those who elected PGT-A and those who did not with a chi-squared or t test.

RESULTS

Of 191 subjects who completed the survey, 117 (61%) planned PGT-A, while 74 (39%) did not. Among those who decided to undergo PGT-A, 56% stated their primary reason was to have a healthy baby, while 18% chose PGT-A to reduce the incidence of birth defects, and 16% aimed to decrease the risk of miscarriage. Patients who decided not to pursue PGT-A stated they prioritized avoiding the scenario in which they might have no embryos to transfer (36%) or reducing cost (31%). Both groups rated physicians as the single most important source of information in their decision-making (56% vs 68%, p = NS).

CONCLUSIONS

Patients who chose to undergo PGT-A have different priorities from those who do not. Many patients planning PGT-A do so for reasons that are not evidence-based. While patients cite physicians as their primary source of information in the decision-making process, rationales for selecting PGT-A are inconsistent with physician counseling.

Best-practices for the design and development of prescription medication information: A systematic review

OBJECTIVE

To present evidence supporting best-practices for prescription drug labeling and educational materials.

METHODS

Articles were selected from three online databases (PubMed, Embase, CINAHL). Eligible manuscripts were: 1) English-language, 2) randomized, controlled trials, and 3) focused on improving prescription drug labeling practices.

RESULTS

Forty-nine articles were reviewed, and included both regulated label materials and pharmacy or health systems-generated tools. Best-practices included use of plain language principles, typographic cues, quantitative descriptors, and standardized formats, when applicable. Common outcomes included preference and comprehension, while few studies examined actual medication use (e.g. adherence, harms) or clinical health outcomes. Approximately half of studies directly engaged patients' perspectives in intervention development, which may have helped increase tool effectiveness.

CONCLUSIONS

Several best practices were apparent in the literature, particularly for written materials and pharmacy-generated container labeling. Design principles for supplemental instructions and multimedia tools were less cohesive, albeit less researched. The impact of patient involvement in tool design is promising, though requiring further study.

PRACTICE IMPLICATIONS

Definitive studies to inform practice standards on how to best communicate medication information to consumers are needed, especially as communication modalities continue to evolve. Increased research on if and how to incorporate patient-centered decision-making into the development process should be considered.

Health literacy in the eHealth era: A systematic review of the literature

OBJECTIVES

This study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era.

METHODS

To identify the relevant literature published since 2010, we performed four rounds of selection-database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications.

RESULTS

The themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior.

CONCLUSION

Barriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy.

PRACTICE IMPLICATIONS

Efforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs.