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Savira F, Gupta A, Gilbert C, Huggins CE, Browning C, Chapman W, Haines T, Peeters A. Virtual Care Initiatives for Older Adults in Australia: Scoping Review. J Med Internet Res 2023; 25:e38081. [PMID: 36652291 PMCID: PMC9892987 DOI: 10.2196/38081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/03/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. OBJECTIVE We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. METHODS A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework. RESULTS Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. CONCLUSIONS Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.
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Affiliation(s)
- Feby Savira
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Adyya Gupta
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Catherine E Huggins
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Colette Browning
- Health Innovation and Transformation Centre, Federation University, Ballarat, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Terry Haines
- National Centre for Healthy Ageing, Monash University, Frankston, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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Lau J, Ng A, Wong GJ, Siew KY, Tan JKH, Pang Y, Tan KK. How effective are digital technology-based interventions at promoting colorectal cancer screening uptake in average-risk populations? A systematic review and meta-analysis of randomized controlled trials. Prev Med 2022; 164:107343. [PMID: 36368343 DOI: 10.1016/j.ypmed.2022.107343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Despite the global prevalence of colorectal cancer (CRC) and efforts in screening advocacy, screening uptake remains relatively low. Considering the greater accessibility and popularity of telemedicine in behaviour change interventions, this meta-analysis seeks to examine the usefulness of digital interventions in promoting CRC screening uptake as compared to existing non-digital strategies. A systematic search on five databases identified articles published before September 2022. Randomized controlled trials comparing the effectiveness of digital interventions to usual care were included and assessed using the Cochrane's Risk of Bias tool. Effectiveness of interventions was measured by CRC screening completion rates, and pooled effect sizes were computed for both digital intervention subtypes identified - decision-making aids and tailored educational interventions. 14 studies (17,075 participants) assessed to have low or some risk of bias were included in this meta-analysis. A random-effects model revealed that digital interventions were more likely to promote CRC screening uptake (OR = 1.31, 95% CI: 1.11-1.56), and using a decision-making aid was almost 1.5 times more likely to result in screening completion (i.e., completed a colorectal investigation using stool-based or direct visualization test) (OR = 1.42, 95% CI: 1.24-1.63). Meanwhile, the tailored educational intervention subtype failed to achieve statistical significance in promoting screening uptake, bearing in mind the significant heterogeneity across studies (I2 = 88.6%). Digital decision-making aids significantly improved CRC screening uptake compared to tailored digital educational interventions and usual care. However, as all included studies were conducted in Western settings, its role in augmenting existing CRC screening promotion strategies especially among Asians should be further evaluated.
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Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Alyssa Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kernix Yuqing Siew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jarrod K H Tan
- Department of Surgery, National University Hospital, Singapore
| | - Yan Pang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Surgery, National University Hospital, Singapore.
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Neil JM, Parker ND, Levites Strekalova YA, Duke K, George T, Krieger JL. Communicating risk to promote colorectal cancer screening: a multi-method study to test tailored versus targeted message strategies. HEALTH EDUCATION RESEARCH 2022; 37:79-93. [PMID: 35234890 PMCID: PMC8947791 DOI: 10.1093/her/cyac002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 05/06/2023]
Abstract
Colorectal cancer (CRC) screening rates are suboptimal, partly due to poor communication about CRC risk. More effective methods are needed to educate patients, but little research has examined best practices for communicating CRC risk. This multi-method study tests whether tailoring CRC risk information increases screening intentions. Participants (N = 738) were randomized with a 2:2:1 allocation to tailored, targeted, and control message conditions. The primary outcome was intention to screen for CRC (yes/no). Additional variables include perceived message relevance, perceived susceptibility to CRC, and free-text comments evaluating the intervention. A chi-square test determined differences in the proportion of participants who intended to complete CRC screening by condition. A logistic-based path analysis explored mediation. Free-text comments were analyzed using advanced topic modeling analysis. CRC screening intentions were highest in the tailored intervention and significantly greater than control (P = 0.006). The tailored message condition significantly increased message relevance compared with control (P = 0.027) and targeted conditions (P = 0.002). The tailored condition also increased susceptibility (P < 0.001) compared with control, which mediated the relationship between the tailored condition and intention to screen (b = 0.04, SE = 0.02, 95% confidence interval = 0.02, 0.09). The qualitative data reflect similar trends. The theoretical mechanisms and practical implications of tailoring health education materials about CRC risk are discussed.
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Affiliation(s)
- Jordan M Neil
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK 73104, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 N.E. 10th Street, Oklahoma City, OK 73104, USA
| | - Naomi D Parker
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, 2043 Weimer Hall, Gainesville, FL 32611, USA
| | - Yulia A Levites Strekalova
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, 2043 Weimer Hall, Gainesville, FL 32611, USA
| | - Kyle Duke
- Department of Statistics, North Carolina State University, 2311 Stinson Drive, 5109 SAS Hall, Raleigh, NC 27695, USA
| | - Thomas George
- Department of Medicine, Hematology & Oncology, College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, 2043 Weimer Hall, Gainesville, FL 32611, USA
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Tang JYM, Wong GHY, Luo H, Liu T, Lum TYS. Cognitive changes associated with mentally active lifestyle and structured cognitive programs: a 2-year longitudinal study. Aging Ment Health 2020; 24:1781-1788. [PMID: 31274010 DOI: 10.1080/13607863.2019.1636204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Mentally stimulating leisure activities and cognitive interventions are associated with delayed cognitive decline, although evidence has not been unequivocal, possibly due to differential contribution of the two types of activities. This study aimed to examine the respective contributions of mentally active lifestyle and structured cognitive programs on cognitive changes in older adults.Methods: This was a 2-year prospective cohort study of 1,793 healthy older adults. We recorded mentally active lifestyle and participation in cognitive program. Cognitive function was assessed using the Montreal Cognitive Assessment. Physical frailty was also screened for the potential effect on cognition.Results: Compared to the mentally inactive group, the mentally active group had better baseline cognitive functioning (standardized mean difference of 0.08, t = -3.8; p < 0.001), but both groups showed a mild cognitive decline over time (both p < 0.05). The mentally active group were less physical frail, more physical independent, and less depressed. Participation in structured cognitive programs was associated with cognition improvement, in older persons who had a mentally active or inactive lifestyle (standardized mean differences of 0.22 and 0.27, respectively; both p < 0.01), but these gains significantly diminished at year 2 in the latter group. Lower baseline cognitive function and higher level of physical frailty predicted greater cognitive gains from structured cognitive programs.Conclusion: Both a mentally active lifestyle and structured cognitive programs contributed to better cognition. Structured cognitive programs appeared to add on to the benefits of a mentally active lifestyle, and predicted cognitive changes regardless of lifestyle.
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Affiliation(s)
| | - Gloria Hoi Yan Wong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.,Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Hao Luo
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.,Department of Computer Science, The University of Hong Kong, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Terry Yat Sang Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Kruse CS, Ehrbar N. Effects of Computerized Decision Support Systems on Practitioner Performance and Patient Outcomes: Systematic Review. JMIR Med Inform 2020; 8:e17283. [PMID: 32780714 PMCID: PMC7448176 DOI: 10.2196/17283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/08/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Computerized decision support systems (CDSSs) are software programs that support the decision making of practitioners and other staff. Other reviews have analyzed the relationship between CDSSs, practitioner performance, and patient outcomes. These reviews reported positive practitioner performance in over half the articles analyzed, but very little information was found for patient outcomes. Objective The purpose of this review was to analyze the relationship between CDSSs, practitioner performance, and patient medical outcomes. PubMed, CINAHL, Embase, Web of Science, and Cochrane databases were queried. Methods Articles were chosen based on year published (last 10 years), high quality, peer-reviewed sources, and discussion of the relationship between the use of CDSS as an intervention and links to practitioner performance or patient outcomes. Reviewers used an Excel spreadsheet (Microsoft Corporation) to collect information on the relationship between CDSSs and practitioner performance or patient outcomes. Reviewers also collected observations of participants, intervention, comparison with control group, outcomes, and study design (PICOS) along with those showing implicit bias. Articles were analyzed by multiple reviewers following the Kruse protocol for systematic reviews. Data were organized into multiple tables for analysis and reporting. Results Themes were identified for both practitioner performance (n=38) and medical outcomes (n=36). A total of 66% (25/38) of articles had occurrences of positive practitioner performance, 13% (5/38) found no difference in practitioner performance, and 21% (8/38) did not report or discuss practitioner performance. Zero articles reported negative practitioner performance. A total of 61% (22/36) of articles had occurrences of positive patient medical outcomes, 8% (3/36) found no statistically significant difference in medical outcomes between intervention and control groups, and 31% (11/36) did not report or discuss medical outcomes. Zero articles found negative patient medical outcomes attributed to using CDSSs. Conclusions Results of this review are commensurate with previous reviews with similar objectives, but unlike these reviews we found a high level of reporting of positive effects on patient medical outcomes.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Nolan Ehrbar
- School of Health Administration, Texas State University, San Marcos, TX, United States
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Zabih V, Kahane A, O'Neill NE, Ivers N, Nathan PC. Interventions to improve adherence to surveillance guidelines in survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:713-729. [PMID: 31338733 DOI: 10.1007/s11764-019-00790-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Many survivors of childhood cancer are at high risk of late effects of their cancer therapy, including cardiac toxicity and subsequent malignant neoplasms (SMN). Current North American guidelines recommend periodic surveillance for these late effects. We conducted a systematic review of the literature to estimate rates of adherence to recommended surveillance and summarize studies evaluating interventions intended to increase adherence. METHODS We searched MEDLINE, Embase, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and September 2018 that reported adherence to surveillance for cardiac toxicity and SMN (breast and colorectal cancer) and interventions implemented to improve completion of recommended testing. Risk of bias was assessed using relevant Cochrane checklists. Due to heterogeneity and overlapping study populations, we used narrative synthesis to summarize the findings. This review was registered in PROSPERO: CRD42018098878. RESULTS Thirteen studies met our inclusion criteria for assessing adherence to surveillance, while five assessed interventions to improve rates of surveillance. No studies met criteria for low risk of bias. Completion of recommended surveillance was lowest for colorectal cancer screening (11.5-30.0%) followed by cardiomyopathy (22.3-48.1%) and breast cancer (37.0-56.5%). Factors such as patient-provider communication, engagement with the health care system, and receipt of information were consistently reported to be associated with higher rates of surveillance. Of five randomized controlled trials aimed at improving surveillance, only two significantly increase completion of recommended testing-one for echocardiography and one for mammography. Both involved telephone outreach to encourage and facilitate these tests. CONCLUSION The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence-based surveillance. There is paucity of rigorous studies evaluating interventions to increase surveillance in this population. IMPLICATIONS FOR CANCER SURVIVORS Robust trials are needed to assess whether tailored interventions, designed based on unique characteristics and needs of each survivor population, could improve adherence.
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Affiliation(s)
- Veda Zabih
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Griffin L, Lee D, Jaisle A, Carek P, George T, Laber E, Lok B, Modave F, Paskett E, Krieger J. Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach. JMIR Hum Factors 2019; 6:e12700. [PMID: 31066688 PMCID: PMC6530259 DOI: 10.2196/12700] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/05/2019] [Accepted: 04/05/2019] [Indexed: 12/22/2022] Open
Abstract
Background Patients are increasingly using mobile health (mHealth) apps to monitor their health and educate themselves about medical issues. Despite the increasing popularity of such apps, poor design and usability often lead to suboptimal continued use of these apps and subsequently to poor adherence to the behavior changes at which they are aimed. One solution to these design problems is for app developers to use user-centered design (UCD) principles to consider the context and needs of users during the development process. Objective This study aimed to present a case study on the design and development process for an mHealth app that uses virtual human technology (VHT) to encourage colorectal cancer (CRC) screening among patients aged 50 years and above. Methods We have first provided an overview of the project and discussed its utilization of VHT. We have then reviewed UCD principles and how they can be incorporated into the development of health apps. We have described how we used UCD processes during the app’s development. We have then discussed the unique roles played by communication researchers, computer scientists, clinicians, and community participants in creating an mHealth app that is credible, usable, effective, and accessible to its target audience. Results The principles of UCD were woven throughout the project development, with researchers collecting feedback from patients and providers at all stages and using that feedback to improve the credibility, usability, effectiveness, and accessibility of the mHealth app. The app was designed in an iterative process, which encouraged feedback and improvement of the app and allowed teams from different fields to revisit topics and troubleshoot problems. Conclusions Implementing a UCD process contributed to the development of an app, which not only reflected cross-disciplinary expertise but also the needs, wants, and concerns of patients.
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Affiliation(s)
- Lauren Griffin
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - Donghee Lee
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - Alyssa Jaisle
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - Peter Carek
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | - Thomas George
- Division of Oncology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Eric Laber
- Statistics Department, North Carolina State University, Raleigh, NC, United States
| | - Benjamin Lok
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, United States
| | - François Modave
- Center for Health Outcomes and Informatics Research, Loyola University Chicago, Chicago, IL, United States
| | - Electra Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Janice Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
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Larsen MB, Gabel P, Andersen B. Effectiveness of self-administered decision aids for people invited to participate in colorectal cancer screening: a systematic review protocol. ACTA ACUST UNITED AC 2017. [DOI: 10.11124/jbisrir-2016-002966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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