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Zhang H, Wu L, Wu X, Chen Y, Tian FY, Yin A, Hu F, Tong J, Huang X, Wan Y, Niu J. Maternal BMI changes from the prepregnancy to postpartum period are associated with postpartum cardiometabolic risk factors: a longitudinal study. Arch Gynecol Obstet 2024; 309:2591-2603. [PMID: 37526682 PMCID: PMC11147864 DOI: 10.1007/s00404-023-07154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE This study aimed at investigating the associations between the total body mass index (BMI) change at 3 or 4 years postpartum compared to the prepregnancy and cardiometabolic risk factors. METHODS This longitudinal study included 1305 participants. Based on the total postpartum BMI changes, they were divided into < 0 units, 0-1.7 units, and > 1.7 units groups using the interquartile range. Multiple linear regression models were used to analyze the associations. RESULTS Compared to the reference group, there was a progressive increase in the βcoefficient (βcoef) of homeostasis model assessment of insulin resistance (HOMA-IR) of cardiometabolic risk in the following groups: the '0-1.7 units' group with the 'overweight traj' [βcoef 0.33; 95% confidence intervals (CI) 0.22, 0.44)] or the 'obesity traj' [0.66; (0.45, 0.88)] and the '> 1.7 units' group with the 'normal traj' [0.33; (0.22, 0.44)], the 'overweight traj' [0.54; (0.41, 0.67)] or the 'obesity traj' [0.97; (0.79, 1.15)]. The same increasing trend of βcoef was also found in DBP, FPG, LDL, WHR, BF%. However, the '< 0 units' group with the 'low traj' [0.13; (0.06, 0.21)] and the '0-1.7 units' group with the 'low traj' [0.08; (0.03, 0.13)] had higher high-density lipoprotein cholesterol (HDL-C) level than the reference group. CONCLUSION Women with a postpartum BMI gain > 1.7 units are positively associated with cardiometabolic risk factors, especially for those in the 'obesity traj' or 'traj D'. Conversely, women with a postpartum BMI loss > 0 units have negative association with cardiometabolic risk factors, especially for those in the 'low traj' or 'traj B'.
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Affiliation(s)
- Huafan Zhang
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Linlin Wu
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Xiaoxia Wu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Yixuan Chen
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Fu-Ying Tian
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Aiqi Yin
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Fengqiao Hu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Jianing Tong
- Department of Obstetrics and Gynecology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Xuna Huang
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Yanmei Wan
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China
| | - Jianmin Niu
- Department of Obstetrics, Shenzhen Maternity and Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, 518028, China.
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Kim HS, Chung MY. A Motivational Technology Perspective on the Use of Smart Wrist-Worn Wearables for Postpartum Exercise and Weight Management. HEALTH COMMUNICATION 2024:1-15. [PMID: 38644619 DOI: 10.1080/10410236.2024.2343472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Exercise and weight management is crucial in preventing postpartum depression and long-term obesity that carries the risk of chronic illness among postpartum women. Although communication devices, such as a smart wrist-worn wearable (SWW), can help users be more physically active, the extent to which postpartum women might benefit from this technology is unknown. We examined how SWWs promoted exercise and helped postpartum women return to pre-pregnancy weight. We tested a model based on the premise that a motivational device that prompts users to engage with it can establish healthy daily routines. An online survey of 309 postpartum women who were living in the United States and were current users of SWWs revealed that the device encouraged them to spend time completing workout goals. Technological affordances (i.e. customization, navigability, and interactivity) and subsequent user engagement with the device positively predicted total workout hours among postpartum women. We present practical implications for postpartum care programs and smart wearable developers.
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Nicklas JM, Pyle L, Soares A, Leiferman JA, Bull SS, Tong S, Caldwell AE, Santoro N, Barbour LA. The Fit After Baby randomized controlled trial: An mHealth postpartum lifestyle intervention for women with elevated cardiometabolic risk. PLoS One 2024; 19:e0296244. [PMID: 38194421 PMCID: PMC10775990 DOI: 10.1371/journal.pone.0296244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/03/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Postpartum women with overweight/obesity and a history of adverse pregnancy outcomes are at elevated risk for cardiometabolic disease. Postpartum weight loss and lifestyle changes can decrease these risks, yet traditional face-to-face interventions often fail. We adapted the Diabetes Prevention Program into a theory-based mobile health (mHealth) program called Fit After Baby (FAB) and tested FAB in a randomized controlled trial. METHODS The FAB program provided 12 weeks of daily evidence-based content, facilitated tracking of weight, diet, and activity, and included weekly coaching and gamification with points and rewards. We randomized women at 6 weeks postpartum 2:1 to FAB or to the publicly available Text4baby (T4B) app (active control). We measured weight and administered behavioral questionnaires at 6 weeks, and 6 and 12 months postpartum, and collected app user data. RESULTS 81 eligible women participated (77% White, 2% Asian, 15% Black, with 23% Hispanic), mean baseline BMI 32±5 kg/m2 and age 31±5 years. FAB participants logged into the app a median of 51/84 (IQR 25,71) days, wore activity trackers 66/84 (IQR 43,84) days, logged weight 17 times (IQR 11,24), and did coach check-ins 5.5/12 (IQR 4,9) weeks. The COVID-19 pandemic interrupted data collection for the primary 12-month endpoint, and impacted diet, physical activity, and body weight for many participants. At 12 months postpartum women in the FAB group lost 2.8 kg [95% CI -4.2,-1.4] from baseline compared to a loss of 1.8 kg [95% CI -3.8,+0.3] in the T4B group (p = 0.42 for the difference between groups). In 60 women who reached 12 months postpartum before the onset of the COVID-19 pandemic, women randomized to FAB lost 4.3 kg [95% CI -6.0,-2.6] compared to loss in the control group of 1.3 kg [95% CI -3.7,+1.1] (p = 0.0451 for the difference between groups). CONCLUSIONS There were no significant differences between groups for postpartum weight loss for the entire study population. Among those unaffected by the COVID pandemic, women randomized to the FAB program lost significantly more weight than those randomized to the T4B program. The mHealth FAB program demonstrated a substantial level of engagement. Given the scalability and potential public health impact of the FAB program, the efficacy for decreasing cardiometabolic risk by increasing postpartum weight loss should be tested in a larger trial.
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Affiliation(s)
- Jacinda M. Nicklas
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Laura Pyle
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Andrey Soares
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jennifer A. Leiferman
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Sheana S. Bull
- Department of Community and Behavioral Health, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Suhong Tong
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Ann E. Caldwell
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility & Reproductive Sciences, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Linda A. Barbour
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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Roesler A, Butten K, Calyx C, Holmes-Truscott E, Taylor P. Use and Preferences of Health Apps among Women and Healthcare Professionals Regarding GDM Postpartum Care Related to Diet, Physical Activity, and Weight Management: A Cross-Sectional Survey. Nutrients 2023; 15:3304. [PMID: 37571242 PMCID: PMC10420904 DOI: 10.3390/nu15153304] [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: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a common medical complication of pregnancy, which is associated with increased risk of future diabetes. mHealth (mobile health, in this paper applications abbreviated to apps) can facilitate health modifications to decrease future risks. This study aims to understand mHealth app use and preferences among women with past GDM and healthcare professionals (HCP) in Australia. An explorative cross-sectional online survey was disseminated via social media, a national diabetes registry, and professional networks. Descriptive analyses were conducted on valid responses (women with prior GDM: n = 1475; HCP: n = 75). One third (33%) of women with prior GDM have used health apps, and a further 80% of non-app users were open to using a health app if recommended by their HCP. Over half (53%) of HCPs supported health information delivery via mHealth, although only 14% had recommended a health app to women post-GDM, and lack of knowledge about mHealth apps was common. Health app users reported that they preferred tracking features, while non-users desired credible health and dietary information and plans. Expanding mHealth app use could facilitate healthy behaviours, but endorsement by HCPs is important to women and is still currently lacking.
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Affiliation(s)
- Anna Roesler
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
| | - Kaley Butten
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
| | - Cobi Calyx
- School of Humanities and Languages, UNSW Sydney, Sydney, NSW 1466, Australia
| | - Elizabeth Holmes-Truscott
- School of Psychology, Institute for Health Transformation, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia;
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 15-31 Pelham Street, Carlton, VIC 3053, Australia
| | - Pennie Taylor
- The Australian e-Health Research Centre, CSIRO, Herston, QLD 4006, Australia; (K.B.); (P.T.)
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Yee LM, Leziak K, Jackson J, Niznik C, Saber R, Yeh C, Simon MA. SweetMama: Usability Assessment of a Novel Mobile Application Among Low-Income Pregnant People to Assist With Diabetes Management and Support. Diabetes Spectr 2023; 36:171-181. [PMID: 37193207 PMCID: PMC10182966 DOI: 10.2337/ds22-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Mobile health tools may be effective strategies to improve engagement, education, and diabetes-related health during pregnancy. We developed SweetMama, a patient-centered, interactive mobile application (app) designed to support and educate low-income pregnant people with diabetes. Our objective was to evaluate the SweetMama user experience and acceptability. Methods SweetMama is a mobile app with static and dynamic features. Static features include a customized homepage and resource library. Dynamic features include delivery of a theory-driven diabetes-specific curriculum via 1) motivational, tip, and goal-setting messages aligning with treatment and gestational age; 2) appointment reminders; and 3) ability to mark content as "favorite." In this usability assessment, low-income pregnant people with gestational or type 2 diabetes used SweetMama for 2 weeks. Participants provided qualitative feedback (via interviews) and quantitative feedback (via validated usability/satisfaction measures) on their experience. User analytic data detailed the duration and type of interactions users had with SweetMama. Results Of 24 individuals enrolled, 23 used SweetMama and 22 completed exit interviews. Participants were mostly non-Hispanic Black (46%) or Hispanic (38%) individuals. Over the 14-day period, users accessed SweetMama frequently (median number of log-ins 8 [interquartile range 6-10]), for a median of 20.5 total minutes, and engaged all features. A majority (66.7%) rated SweetMama as having moderate or high usability. Participants emphasized design and technical strengths and beneficial effects on diabetes self-management and also identified limitations of the user experience. Conclusion Pregnant people with diabetes found SweetMama to be user-friendly, informative, and engaging. Future work must study its feasibility for use throughout pregnancy and its efficacy to improve perinatal outcomes.
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Affiliation(s)
- Lynn M. Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karolina Leziak
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jenise Jackson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Charlotte Niznik
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Chen Yeh
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melissa A. Simon
- Departments of Obstetrics and Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Ghaben SJ, Mat Ludin AF, Mohamad Ali N, Beng Gan K, Singh DKA. A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review. Digit Health 2023; 9:20552076231191014. [PMID: 37599901 PMCID: PMC10437210 DOI: 10.1177/20552076231191014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.
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Affiliation(s)
- Suad J Ghaben
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Al Azhar University, Gaza, Palestine
| | - Arimi Fitri Mat Ludin
- Faculty of Health Sciences, Biomedical Science Programme & Center for Healthy Ageing and Wellness (H=CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazlena Mohamad Ali
- Institute of Visual Informatics (IVI), Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Kok Beng Gan
- Department of Electrical, Electronic and Systems Engineering, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Devinder Kaur Ajit Singh
- Faculty of Health Sciences, Physiotherapy Programme & Center for Healthy Ageing & Wellness, (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Wu CC, Huang CW, Wang YC, Islam MM, Kung WM, Weng YC, Su CH. mHealth Research for Weight Loss, Physical Activity, and Sedentary Behavior: Bibliometric Analysis. J Med Internet Res 2022; 24:e35747. [PMID: 35675126 PMCID: PMC9218882 DOI: 10.2196/35747] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Research into mobile health (mHealth) technologies on weight loss, physical activity, and sedentary behavior has increased substantially over the last decade; however, no research has been published showing the research trend in this field. OBJECTIVE The purpose of this study was to provide a dynamic and longitudinal bibliometric analysis of recent trends of mHealth research for weight loss, physical activity, and sedentary behavior. METHODS A comprehensive search was conducted through Web of Science to retrieve all existing relevant documents published in English between January 1, 2010, and November 1, 2021. We developed appropriate research questions; based on the proven bibliometric approaches, a search strategy was formulated to screen the title for eligibility. Finally, we conducted bibliometric analyses to explore the growth rate of publications; publication patterns; and the most productive authors, institutions, and countries, and visualized the trends in the field using a keyword co-occurrence network. RESULTS The initial search identified 8739 articles, of which 1035 were included in the analyses. Our findings show an exponential growth trend in the number of annual publications of mHealth technology research in these fields. JMIR mHealth and uHealth (n=214, 20.67%), Journal of Medical Internet Research (n=71, 6.86%), and BMC Public Health (n=36, 3.47%) were the top 3 journals, publishing higher numbers of articles. The United States remained the leading contributor in these areas (n=405, 39.13%), followed by Australia (n=154, 14.87%) and England (n=125, 12.07%). Among the universities, the University of Sydney (n=36, 3.47%) contributed the most mHealth technology research in these areas; however, Deakin University (n=25, 2.41%) and the National University of Singapore (n=23, 2.22%) were in the second and third positions, respectively. CONCLUSIONS Although the number of papers published on mobile technologies for weight loss, physical activity, and sedentary behavior was initially low, there has been an overall increase in these areas in recent years. The findings of the study indicate that mobile apps and technologies have substantial potential to reduce weight, increase physical activity, and change sedentary behavior. Indeed, this study provides a useful overview of the publication trends and valuable guidance on future research directions and perspectives in this rapidly developing field.
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Affiliation(s)
- Chieh-Chen Wu
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
- Department of Healthcare Information and Management, School of Health Technology, Ming Chuan University, Taipei, Taiwan
| | - Chih-Wei Huang
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yao-Chin Wang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Md Mohaimenul Islam
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- AESOP Technology, Taipei, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Yung-Ching Weng
- Department of Healthcare Information and Management, School of Health Technology, Ming Chuan University, Taipei, Taiwan
| | - Chun-Hsien Su
- Graduate Institute of Sport Coaching Science, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
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8
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Kip H, Keizer J, da Silva MC, Beerlage-de Jong N, Köhle N, Kelders SM. Methods for Human-Centered eHealth Development: Narrative Scoping Review. J Med Internet Res 2022; 24:e31858. [PMID: 35084359 PMCID: PMC8832261 DOI: 10.2196/31858] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Julia Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Marcia C da Silva
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Nienke Beerlage-de Jong
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Nadine Köhle
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Abstract
Many telemedicine interventions fail to be implemented in medical care with non-use and discontinued use by patients being among the major reasons. The aim of this scoping review was to provide an overview of barriers associated with non-use and discontinued use of telemedicine. An electronic search was conducted in Pubmed in October 2019 and updated in November 2020, followed by a hand search in the beginning of 2021. All potential articles were screened by two independent reviewers based on predefined inclusion and exclusion criteria. A qualitative content analysis according to Mayring was carried out. The topics 'intervention', 'context of use' and 'user' were chosen as overarching themes. Out of 1377 potentially relevant articles, 73 were included. User-related barriers were mentioned in most of the analysed studies, followed by barriers related to the intervention. The analysis provides the basis for overcoming non-use issues in telemedicine.
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Affiliation(s)
| | - Peter Eh Schwarz
- Technische Universität Dresden, Germany; German Center for Diabetes Research (DZD), Germany
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10
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Potzel AL, Gar C, Seissler J, Lechner A. A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach. JMIR Mhealth Uhealth 2021; 9:e26163. [PMID: 33973864 PMCID: PMC8150415 DOI: 10.2196/26163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. OBJECTIVE The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women's expected standards of commercial health apps. METHODS The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app ("TRIANGLE") was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. RESULTS The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features-a challenge system, human coaching, and a library-address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. CONCLUSIONS The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. TRIAL REGISTRATION German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736.
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Affiliation(s)
- Anne Lotte Potzel
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Christina Gar
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Andreas Lechner
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Makama M, Skouteris H, Moran LJ, Lim S. Reducing Postpartum Weight Retention: A Review of the Implementation Challenges of Postpartum Lifestyle Interventions. J Clin Med 2021; 10:1891. [PMID: 33925502 PMCID: PMC8123857 DOI: 10.3390/jcm10091891] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Postpartum weight retention (PPWR) is a strong predictor of obesity in later life with long term health consequences in women. Suboptimal lifestyle behaviours (e.g., diet and physical activity) contribute to PPWR. Postpartum lifestyle interventions are known to be efficacious in reducing PPWR; however, there are challenges to their successful implementation. To inform implementation, this narrative review provides an overview of the factors that contribute to PPWR, the efficacy of existing postpartum lifestyle interventions and key determinants of effective implementation using the Consolidated Framework for Implementation Research (CFIR) across intervention characteristics, implementation process, individual characteristics and outer and inner setting. We then suggest strategies to improve the translation of evidence into large-scale interventions that deliver on health impact in postpartum women. We have identified gaps that need to be addressed to advance postpartum lifestyle research, including the involvement of postpartum women and community members as key stakeholders for optimal reach and engagement, more complete reporting of intervention characteristics to optimize translation of evidence into practice, capacity building of health professionals and guidelines for postpartum lifestyle management.
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Affiliation(s)
- Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia;
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia;
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3168, Australia;
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Seely EW, Celi AC, Chausmer J, Graves C, Kilpatrick S, Nicklas JM, Rosser ML, Rexrode KM, Stuart JJ, Tsigas E, Voelker J, Zelop C, Rich-Edwards JW. Cardiovascular Health After Preeclampsia: Patient and Provider Perspective. J Womens Health (Larchmt) 2021; 30:305-313. [PMID: 32986503 PMCID: PMC8020553 DOI: 10.1089/jwh.2020.8384] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Preeclampsia predicts future cardiovascular disease (CVD) yet few programs exist for post-preeclampsia care. Methods: The Health after Preeclampsia Patient and Provider Engagement Network workshop was convened at the Radcliffe Institute for Advanced Study in June 2018. The workshop sought to identify: 1) patient perspectives on barriers and facilitators to CVD risk reduction; 2) clinical programs specialized in post-preeclampsia care; 3) recommendations by national organizations for risk reduction; and 4) next steps. Stakeholders included the Preeclampsia Foundation, patients, clinicians who had initiated CVD risk reduction programs for women with prior preeclampsia, researchers, and national task force members. Results: Participants agreed there is insufficient awareness and action to prevent CVD after preeclampsia. Patients suggested a clinician checklist to ensure communication of CVD risks, enhanced training for clinicians on the link between preeclampsia and CVD, and a post-delivery appointment with a clinician knowledgeable about this link. Clinical programs primarily served patients in the first postpartum year, bridging obstetrical and primary care. They recommended CVD risk modification with periodic blood pressure, weight, lipid and diabetes screening. Barriers included the paucity of programs designed for this population and gaps in insurance coverage after delivery. The American Heart Association, the American College of Obstetricians and Gynecologists, and the Preeclampsia Foundation have developed guidelines and materials for patients and providers to guide management of women with prior preeclampsia. Conclusions: Integrated efforts of patients, caregivers, researchers, and national organizations are needed to improve CVD prevention after preeclampsia. This meeting's recommendations can serve as a resource and catalyst for this effort.
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Affiliation(s)
- Ellen W. Seely
- Division of Endocrinology, Hypertension & Diabetes, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C. Celi
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaimie Chausmer
- Maternal Heart Health Clinic, Northside Hospital, Atlanta, Georgia, USA
| | - Cornelia Graves
- Collaborative Perinatal Cardiac Center, St. Thomas Health, Nashville, Tennessee, USA
| | - Sarah Kilpatrick
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacinda M. Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary L. Rosser
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Kathryn M. Rexrode
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer J. Stuart
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eleni Tsigas
- The Preeclampsia Foundation, Melbourne, Florida, USA
| | | | - Carolyn Zelop
- The Valley Hospital, Ridgewood, New Jersey, USA
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
| | - Janet W. Rich-Edwards
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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13
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Feasibility of a Digital Intervention to Promote Healthy Weight Management among Postpartum African American/Black Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042178. [PMID: 33672229 PMCID: PMC7927035 DOI: 10.3390/ijerph18042178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
The study aim was to implement and evaluate the feasibility of a culturally informed (“BeFAB”) app for African American/Black women to address postpartum weight. Women (n = 136; mean age = 27.8 ± 5.4; mean BMI = 32.5 ± 4.3) were recruited from postpartum units, and randomly assigned to receive BeFAB (n = 65) or usual care (n = 71) for 12 weeks. App content included didactic lessons delivered via a virtual coach, app-based messages, goal setting and tracking, and edutainment videos. Feasibility outcomes included recruitment, retention and engagement, and self-reported acceptability. Behavioral (i.e., diet, physical activity), psychosocial (i.e., stress, coping, support, self-efficacy) and weight outcomes were also examined. Recruitment goals were met, but attrition was high, with 56% retention at 12 weeks. Approximately half of participants accessed the app and set a goal ≥one time, but <10% reported achieving a nutrition or activity goal. Among study completers, ≥60% found the app content at least somewhat helpful. Within-group changes for BeFAB among completers were found for increased moderate-to-vigorous physical activity and decreased fruit/vegetable intake and weight. Findings indicate initial feasibility of recruiting postpartum women to participate in a digital healthy body weight program but limited use, reflecting low acceptability and challenges in engagement and retention. Future research is needed on strategies to engage and retain participants in postpartum interventions.
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Lim S, Chen M, Makama M, O'Reilly S. Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs. Semin Reprod Med 2021; 38:377-383. [PMID: 33511581 DOI: 10.1055/s-0040-1722315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Sharleen O'Reilly
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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