Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives

Identifying Unmet Needs of Informal Dementia Caregivers in Clinical Practice: User-Centered Development of a Digital Assessment Tool

Background

Despite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective.

Objective

Our study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting.

Methods

The development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angehörige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers' biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically.

Results

Data from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings.

Conclusions

The input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial.

Evaluation of collaborative oral health care planning between older adults and personnel from public dental care and municipal care organizations: a study protocol for a cluster-randomized controlled study in Sweden

BACKGROUND

Patient participation is key in person-centred care, emphasizing individual choices in treatment. Oral health, integral to overall well-being, is sometimes a neglected part of health. This intervention introduces a novel approach to strengthen person-centred care in homecare settings, employing collaborative, interprofessional teamwork and shared documentation across care organizations. This protocol outlines the design of a cluster-randomized controlled trial (RCT) in Sweden, comparing traditional oral assessments with an interorganizational, team-based oral health care planning model facilitated by a shared digital platform for documentation. The overall aim is to evaluate a person-centred interprofessional and interorganizational model for oral health care planning supported by a digital platform to enable healthy ageing.

METHODS/DESIGN

The intervention, co-designed with older adults, academic institutions, healthcare providers in public dental care, and municipal organizations, will undergo ethical approval. The RCT will randomize older adults, dental hygienists (DHs) and nursing assistants (NAs) into two groups. The intervention group will attend a two-day workshop on a person-centred, three-step team-based model, while the control group will continue using standard procedures. Thereafter, the three-step collaborative model will be compared to standard procedures. Primary outcomes will be measured using the Revised Oral Assessment Guide (ROAG) and the General Oral Health Assessment Index (GOHAI). Secondary outcomes include health economic evaluations, participation rates and quality of care assessments. Qualitative studies from theoretical perspectives of change and learning based on interviews with key stakeholders will be conducted in both the test and control groups.

DISCUSSION

Taking a co-produced approach where theory and practice shape the research iteratively, a person-centred health care planning model supported by a shared digital platform for home settings is evaluated. Anticipated outcomes include improved oral assessments and a deeper understanding of effective person-centred care practices. The co-produced approach of the intervention is also expected to further develop knowledge regarding co-production within domains of healthy ageing from an oral health perspective. As such, the intervention shapes and fosters co-produced person-centred care and healthy ageing.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06310798. Registered on 13 March 2024.

Exploring trust dynamics in health information systems: the impact of patients' health conditions on information source preferences

Introduction

Health information systems (HISs) should provide accessible and high-quality information to patients. However, the challenge lies in understanding patients' trust preferences for health information. This study explores how different information sources (e.g., online platforms, interpersonal sources) are trusted under varying health conditions, focusing on symptom intensity and disease type.

Methods

Using a 2 × 2 × 4 between-subject design, 243 participants from a US college were presented with vignettes of acute or chronic diseases with varying symptom intensities and information sources. Participants rated their trust levels, including both cognitive and behavioral trust, in the health information and recommendations provided by one of the information sources, which was randomly assigned. Logistic regression and ANOVA were employed for the statistical analysis.

Results

The analysis results revealed that trust is generally higher for interpersonal sources like doctors and family/friends compared to online sources like WebMD and Wikipedia when patients are making health decisions. Doctors are the most trusted source during health-related decision making. However, there are no significant differences in cognitive trust among interpersonal sources or among online sources. Furthermore, symptom intensity and disease type did not significantly alter trust levels across various information sources. These findings suggest that people prefer professional medical advice regardless of their health conditions.

Discussion

The study highlights the need for HIS to incorporate features that provide "doctor-verified" information and promote interactive engagement to enhance patients' trust in information source. Additionally, it distinguishes between cognitive and behavioral trust, revealing distinct trust patterns that can inform the strategic development of HIS for varied health conditions. Understanding these trust dynamics can inform the design of effective, patient-centered HIS that better support health education, information seeking, and decision-making.

Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study

BACKGROUND

Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs.

OBJECTIVE

This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home.

METHODS

This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework.

RESULTS

The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, "Breathing exercises" and "Picking up from the floor," revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested.

CONCLUSIONS

This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support.

Classifying self-management clusters of patients with mild cognitive impairment associated with diabetes: A cross-sectional study

AIMS AND OBJECTIVES

This study aims to propose a self-management clusters classification method to determine the self-management ability of elderly patients with mild cognitive impairment (MCI) associated with diabetes mellitus (DM).

BACKGROUND

MCI associated with DM is a common chronic disease in old adults. Self-management affects the disease progression of patients to a large extent. However, the comorbidity and patients' self-management ability are heterogeneous.

DESIGN

A cross-sectional study based on cluster analysis is designed in this paper.

METHOD

The study included 235 participants. The diabetes self-management scale is used to evaluate the self-management ability of patients. SPSS 21.0 was used to analyse the data, including descriptive statistics, agglomerative hierarchical clustering with Ward's method before k-means clustering, k-means clustering analysis, analysis of variance and chi-square test.

RESULTS

Three clusters of self-management styles were classified as follows: Disease neglect type, life oriented type and medical dependence type. Among all participants, the percentages of the three clusters above are 9.78%, 32.77% and 57.45%, respectively. The difference between the six dimensions of each cluster is statistically significant.

CONCLUSION(S)

This study classified three groups of self-management styles, and each group has its own self-management characteristics. The characteristics of the three clusters may help to provide personalized self-management strategies and delay the disease progression of MCI associated with DM patients.

RELEVANCE TO CLINICAL PRACTICE

Typological methods can be used to discover the characteristics of patient clusters and provide personalized care to improve the efficiency of patient self-management to delay the progress of the disease.

PATIENT OR PUBLIC CONTRIBUTION

In our study, we invited patients and members of the public to participate in the research survey and conducted data collection.

Identification of required capabilities of digital health ecosystems when preventing and managing non-communicable diseases

Objective

Non-communicable diseases cause annual mortality for 41 million people worldwide. These diseases include coronary heart disease, cancer, stroke, diabetes, and musculoskeletal as well as mental disorders. Innovation ecosystems in healthcare are multifactor networks in which different stakeholders interact together to create socio-economic (patient and cost) value via research, co-creation, and traditional market activities. Although there is much evidence about the impact of digital health interventions and the capabilities needed to support individual actors and specific diseases in non-communicable disease prevention and management, the current understanding of the concept of innovation ecosystems associated with theories is not well understood. There is also a lack of research about innovation ecosystems in the healthcare context. Or understanding of the holistic perspective of the capabilities needed in innovation ecosystems to support future digital health. The objective of this study was to answer this research gap by identifying what capabilities are needed in future digital health ecosystems related to people with non-communicable diseases or at risk of non-communicable diseases. By doing this, the study will help different organisations and policies address this very challenging situation.

Methods

To answer this objective, a qualitative interview-based study including 34 semi-structured interviews was conducted in Finland. Complex adaptive systems theory was used as a theoretical lens to analyse empirical data.

Results and conclusion

Several new capabilities were identified for digital health innovation ecosystems to make organisation managers and policymakers aware of how to deal with future health system demands. From the organisational perspective, capabilities are needed to use non-medical and heterogeneous data to support better treatments and clinical decision-making and provide better and safer data access. From the management perspective, hospitals need capabilities to allow critical experts to participate in innovation work, and overall, all ecosystem actors need capabilities to orchestrate research and innovation actions in the area of digital health.