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Kwok G, Sharma A, Mandato I, Devine KA. Feasibility and Acceptability of a Meditation Mobile App Intervention for Adolescent and Young Adult Survivors of Childhood Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:584. [PMID: 38791797 PMCID: PMC11121627 DOI: 10.3390/ijerph21050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Adolescent and young adult (AYA) survivors of childhood cancer are increasingly recognized as a vulnerable group with unique emotional, social, and practical needs due to the intersection of cancer survivorship and normal developmental processes. Mindfulness meditation has shown early efficacy in improving psychological distress among cancer patients. However, the overall scientific study of app-based mindfulness-based interventions is still in its early stages. The goal of this study was to evaluate the feasibility and acceptability of a commercially available mindfulness mobile app intervention "Ten Percent Happier" among AYA survivors of childhood cancer. METHODS We conducted a single-arm pilot intervention with 25 AYA survivors of childhood cancer ages 18-29 years. RESULTS A total of 108 potentially eligible individuals were initially identified for screening. Of the 45 individuals reached (contact rate = 41.67%), 20 declined to participate; 25 were enrolled in the study and completed the baseline survey (enrollment rate = 55.56%). Twenty-one participants completed the study (retention rate = 84%). Changes in several outcomes were promising, with medium to large effect sizes: Mindfulness (d = 0.74), Negative Emotion (d = 0.48), Perceived Stress (d = 0.52), and Mental Health (d = 0.45). Furthermore, results suggested that participants with consistent app usage showed greater improvement in reported outcomes than those who stopped their usage (e.g., Mindfulness: d = 0.74, Perceived Stress: d = 0.83, Mental Health: d = 0.51; Meaning and Purpose: d = 0.84; and Sleep Disturbance: d = 0.81). Qualitative feedback indicated high satisfaction, but participants suggested adding group or individual peer support to improve their experience with the app. CONCLUSIONS AYA survivors can be difficult to reach, but a mindfulness app was feasible and acceptable to this group. In particular, the robust retention rate and high satisfaction ratings indicate that the meditation mobile app was well received. Preliminary results suggest positive changes in health-related quality of life outcomes, warranting a larger efficacy trial.
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Affiliation(s)
- Gary Kwok
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Archana Sharma
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Ivelisse Mandato
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Katie A. Devine
- Pediatric Population Science, Outcomes, and Disparities Research Section, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
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Minozzi S, Ambrosi L, Saulle R, Uhm SS, Terplan M, Sinclair JM, Agabio R. Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy. Cochrane Database Syst Rev 2024; 4:CD015042. [PMID: 38682758 PMCID: PMC11057221 DOI: 10.1002/14651858.cd015042.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Despite the known harms, alcohol consumption is common in pregnancy. Rates vary between countries, and are estimated to be 10% globally, with up to 25% in Europe. OBJECTIVES To assess the efficacy of psychosocial interventions and medications to reduce or stop alcohol consumption during pregnancy. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO, from inception to 8 January 2024. We also searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). All searches included non-English language literature. We handsearched references of topic-related systematic reviews and included studies. SELECTION CRITERIA We included randomised controlled trials that compared medications or psychosocial interventions, or both, to placebo, no intervention, usual care, or other medications or psychosocial interventions used to reduce or stop alcohol use during pregnancy. Our primary outcomes of interest were abstinence from alcohol, reduction in alcohol consumption, retention in treatment, and women with any adverse event. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included eight studies (1369 participants) in which pregnant women received an intervention to stop or reduce alcohol use during pregnancy. In one study, almost half of participants had a current diagnosis of alcohol use disorder (AUD); in another study, 40% of participants had a lifetime diagnosis of AUD. Six studies took place in the USA, one in Spain, and one in the Netherlands. All included studies evaluated the efficacy of psychosocial interventions; we did not find any study that evaluated the efficacy of medications for the treatment of AUD during pregnancy. Psychosocial interventions were mainly brief interventions ranging from a single session of 10 to 60 minutes to five sessions of 10 minutes each. Pregnant women received the psychosocial intervention approximately at the end of the first trimester of pregnancy, and the outcome of alcohol use was reassessed 8 to 24 weeks after the psychosocial intervention. Women in the control group received treatment as usual (TAU) or similar treatments such as comprehensive assessment of alcohol use and advice to stop drinking during pregnancy. Globally, we found that, compared to TAU, psychosocial interventions may increase the rate of continuously abstinent participants (risk ratio (RR) 1.34, 95% confidence interval (CI) 1.14 to 1.57; I2 =0%; 3 studies; 378 women; low certainty evidence). Psychosocial interventions may have little to no effect on the number of drinks per day, but the evidence is very uncertain (mean difference -0.42, 95% CI -1.13 to 0.28; I2 = 86%; 2 studies; 157 women; very low certainty evidence). Psychosocial interventions probably have little to no effect on the number of women who completed treatment (RR 0.98, 95% CI 0.94 to 1.02; I2 = 0%; 7 studies; 1283 women; moderate certainty evidence). None of the included studies assessed adverse events of treatments. We downgraded the certainty of the evidence due to risk of bias and imprecision of the estimates. AUTHORS' CONCLUSIONS Brief psychosocial interventions may increase the rate of continuous abstinence among pregnant women who report alcohol use during pregnancy. Further studies should be conducted to investigate the efficacy and safety of psychosocial interventions and other treatments (e.g. medications) for women with AUD. These studies should provide detailed information on alcohol use before and during pregnancy using consistent measures such as the number of drinks per drinking day. When heterogeneous populations are recruited, more detailed information on alcohol use during pregnancy should be provided to allow future systematic reviews to be conducted. Other important information that would enhance the usefulness of these studies would be the presence of other comorbid conditions such as anxiety, mood disorders, and the use of other psychoactive substances.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Ludovico Ambrosi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Seilin S Uhm
- School of Medicine, University of Southampton, Southampton, UK
| | - Mishka Terplan
- Friends Research Institute, Baltimore, USA
- Family and Community Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
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Janssen P, Lecke S, Renner R, Zhang W, Vedam S, Norman WV, Bayrampour H, Tough S, Murray J, Muhajarine N, Dennis CL. Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom. BMJ Open 2024; 14:e081730. [PMID: 38238058 PMCID: PMC10806627 DOI: 10.1136/bmjopen-2023-081730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Prenatal education is associated with positive health behaviours, including optimal weight gain, attendance at prenatal care, acceptance of routine screening tests, smoking cessation, decreased alcohol consumption and breast feeding. Adoption of these behaviours has been associated with reduced rates of caesarean birth, preterm birth and low birth weight. Barriers to prenatal class attendance faced by parents in Canada include geography, socioeconomic status, age, education, and, among Indigenous peoples and other equity-deserving groups, stigma. To address the need for easily accessible and reliable information, we created 'SmartMom', Canada's first prenatal education programme delivered by short message service text messaging. SmartMom provides evidence-based information timed to be relevant to each week of pregnancy. The overall goal of SmartMom is to motivate the adoption of positive prenatal health behaviours with the ultimate goal of improving health outcomes among women and their newborns. METHODS AND ANALYSIS We will conduct a two-arm single-blinded randomised controlled trial. Blinding of participants to trial intervention will not be possible as they will be aware of receiving the intervention, but data analysts will be blinded. Our primary research questions are to determine if women experiencing uncomplicated pregnancies randomly assigned to receive SmartMom messages versus messages addressing general topics related to pregnancy but without direction for behaviour change, have higher rates of: (1) weight gain within ranges recommended for prepregnancy body mass index and (2) adherence to Canadian guidelines regarding attendance at prenatal care appointments. ETHICS AND DISSEMINATION The study has been granted a Certificate of Approval, number H22-00603, by the University of British Columbia Research Ethics Board. To disseminate our findings, we are undertaking both integrated and end-of-grant knowledge translation, which will proactively involve potential end-users and stakeholders at every phase of our project. TRIAL REGISTRATION NUMBER NCT05793944.
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Affiliation(s)
- Patricia Janssen
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- SmartMom Mobile Health Education, Vancouver, British Columbia, Canada
| | - Sara Lecke
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wei Zhang
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul's hospital, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Dept of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Public Health, Environments & Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Hamideh Bayrampour
- Family Practice, Midwifery Program, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne Tough
- Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jennifer Murray
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazeem Muhajarine
- Dept of Community Health and Epidemiology, U of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cindy Lee Dennis
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Wada A, Nakamura Y, Kawajiri M, Takeishi Y, Yoshida M, Yoshizawa T. Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study. JMIR Form Res 2023; 7:e48637. [PMID: 37962945 PMCID: PMC10685280 DOI: 10.2196/48637] [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: 07/03/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial. OBJECTIVE This study aims to verify the feasibility and usability of the Job Adjustment mobile app. METHODS A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale. RESULTS The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01). CONCLUSIONS The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas.
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Affiliation(s)
- Aya Wada
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Hachioji, Tokyo, Japan
| | - Yasuka Nakamura
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maiko Kawajiri
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoko Takeishi
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toyoko Yoshizawa
- Health Sciences Department of Nursing, Kansai University of International Studies, Miki, Hyogo, Japan
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Wang J, Wu Z, Choi SW, Sen S, Yan X, Miner JA, Sander AM, Lyden AK, Troost JP, Carlozzi NE. The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study. JMIR Form Res 2023; 7:e43099. [PMID: 37707948 PMCID: PMC10540022 DOI: 10.2196/43099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/28/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood. OBJECTIVE The primary objective of this study is to evaluate the dose-response relationship of a fully automated JITAI-based self-management intervention involving personalized mobile app notifications targeted at decreasing the level of caregiver strain, anxiety, and depression. The secondary objective is to investigate whether the effectiveness of this mobile health intervention was moderated by the caregiver group. We also explored whether the effectiveness of this intervention was moderated by (1) previous HRQOL measures, (2) the number of weeks in the study, (3) step count, and (4) minutes of sleep. METHODS We examined 36 caregivers from 3 disease groups (10 from spinal cord injury, 11 from Huntington disease, and 25 from allogeneic hematopoietic cell transplantation) in the intervention arm of a larger randomized controlled trial (subjects in the other arm received no prompts from the mobile app) designed to examine the acceptability and feasibility of this intensive type of trial design. A series of multivariate linear models implementing a weighted and centered least squares estimator were used to assess the JITAI efficacy and effect. RESULTS We found preliminary support for a positive dose-response relationship between the number of administered JITAI messages and JITAI efficacy in improving caregiver strain, anxiety, and depression; while most of these associations did not meet conventional levels of significance, there was a significant association between high-frequency JITAI and caregiver strain. Specifically, administering 5-6 messages per week as opposed to no messages resulted in a significant decrease in the HRQOL score of caregiver strain with an estimate of -6.31 (95% CI -11.76 to -0.12; P=.046). In addition, we found that the caregiver groups and the participants' levels of depression in the previous week moderated JITAI efficacy. CONCLUSIONS This study provides preliminary evidence to support the effectiveness of the self-management JITAI and offers practical guidance for designing future personalized JITAI strategies for diverse caregiver groups. TRIAL REGISTRATION ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591.
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Affiliation(s)
- Jitao Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Xinghui Yan
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Angelle M Sander
- H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System, Houston, TX, United States
| | - Angela K Lyden
- Clinical Trials Support Office, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan P Troost
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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Raynor P, Corbett C, West D, Johnston D, Eichelberger K, Litwin A, Guille C, Prinz R. Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4457. [PMID: 36901467 PMCID: PMC10002058 DOI: 10.3390/ijerph20054457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD). METHODS Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed. RESULTS A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design. CONCLUSIONS The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.
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Affiliation(s)
- Phyllis Raynor
- College of Nursing, Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, University of South Carolina, Columbia, SC 29208, USA
| | - Cynthia Corbett
- College of Nursing, Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, University of South Carolina, Columbia, SC 29208, USA
| | - Delia West
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - D’Arion Johnston
- College of Education, University of South Carolina, Columbia, SC 29208, USA
| | - Kacey Eichelberger
- Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC 29605, USA
| | - Alain Litwin
- Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC 29605, USA
- School of Health Research, Clemson University, Greenville, SC 29601, USA
| | - Constance Guille
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ron Prinz
- Psychology Department, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA
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Cain CM, Kamdar N, Veldman R, Budhwani S, O'Mahen P. Content Analysis of American Network News Coverage of Prevention Strategies During the Initial Wave of the COVID-19 Pandemic. J Gen Intern Med 2023; 38:1030-1037. [PMID: 36538158 PMCID: PMC9765360 DOI: 10.1007/s11606-022-07954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Broadcast media is a method to communicate health information to the general public and has previously been used in prior public health emergencies. Despite the current ubiquity of social media, traditional news programming retains relatively large audiences, which increased during the COVID-19 pandemic's early days. Viewership of broadcast media networks' evening news skews toward older groups (age 65 and up) which were vulnerable to health complications related to the COVID-19 pandemic. OBJECTIVES The current study explored the trends in American broadcast network news media coverage of prevention during the initial wave of the COVID-19 pandemic. DESIGN Quantitative content analysis using the Public Health Framework for Prevention was used to analyze three major US media networks' evening news content for thematic trends in COVID-19 coverage during the first US pandemic wave from March to May 2020. SUBJECTS A total of 117 episodes of the evening news, 39 from each of the three major US media networks, evenly divided among the first 13 weeks of the pandemic in the US. MAIN MEASURES Outcome variables included average seconds of coverage per episode devoted to prevention strategies, COVID-19 coverage not related to prevention, and non-COVID-19 coverage. KEY RESULTS The proportion of coverage dedicated to COVID-19 sharply increased in the first 2 weeks of March and decreased in the last 2 weeks of May. Networks focused approximately half the COVID-19 coverage time on prevention issues (288 seconds/episode) compared to non-prevention issues (538 seconds/episode). Prevention coverage varied over time. CONCLUSIONS Although coverage included COVID-19 prevention content, more of the coverage was on other pandemic-related issues (e.g., economic impacts). Because public network news outlets have broad reach and accessibility, they could be an effective partner for public health agencies disseminating prevention messaging for current and future disease outbreaks and threats to public health.
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Affiliation(s)
- Cary M Cain
- Division of Public Health Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Nipa Kamdar
- Center for Innovations in Quality, Effectiveness & Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Shahereez Budhwani
- Center for Innovations in Quality, Effectiveness & Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
| | - Patrick O'Mahen
- Center for Innovations in Quality, Effectiveness & Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study. BMC Pregnancy Childbirth 2023; 23:19. [PMID: 36627569 PMCID: PMC9830616 DOI: 10.1186/s12884-022-05320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tobacco smoking and alcohol consumption before and during pregnancy increase the risk of adverse health outcomes for mother and child. Interventions to address smoking and drinking before and during pregnancy have the potential to reduce early-life health inequalities. In the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pilot study we aimed to evaluate the acceptability, feasibility and effectiveness of a complex intervention supporting women in smoking and alcohol cessation before and during pregnancy. METHODS From February 2019 till March 2021, we piloted the SAFER pregnancy intervention among pregnant women and women planning pregnancy in South-West Netherlands in an uncontrolled before-after study. Participants were supported in smoking and alcohol cessation via up to six group sessions and an online platform. In addition, biochemically validated cessation was rewarded with incentives (i.e. shopping vouchers) amounting up to 185 euros. We aimed to include 66 women. The primary outcome was smoking and/or alcohol cessation at 34-38 weeks of gestation (if pregnant) or after six group sessions (if not pregnant). Quantitative data were analysed using descriptive statistics. Focus group interviews among those involved in the study were conducted at the end of the study to explore their experiences. Qualitative data was analysed using thematic analysis. RESULTS Thirty-nine women who smoked were included; no women who consumed alcohol were referred to the study. Unemployment (51%), financial problems (36%) and a smoking partner (72%) were common. Thirteen women (33%) dropped out, often due to other problems impeding smoking cessation or 'being too busy' to participate in the group sessions. Eleven women (28%) had quit smoking at the study's endpoint. The personal and positive approach was highly valued and biochemical validation was felt to be helpful. CONCLUSION The SAFER pregnancy intervention seems appropriate for women in need of extra support for smoking cessation before and during pregnancy. Its impact on alcohol cessation could not be studied due to recruitment issues. Recruitment and prevention of early dropout need attention in further development of this intervention. TRIAL REGISTRATION Netherlands Trial Register: NL7493. Date registered: 04/02/2019.
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Phillips SEK, Celi AC, Wehbe A, Kaduthodil J, Zera CA. Mobilizing the fourth trimester to improve population health: interventions for postpartum transitions of care. Am J Obstet Gynecol 2022:S0002-9378(22)02587-X. [PMID: 36574875 DOI: 10.1016/j.ajog.2022.12.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Birthing people in the United States, particularly those from marginalized communities, experience an unexpectedly high rate of morbidity and mortality. Optimal postpartum care is an opportunity to address immediate maternal health concerns while providing a connection to further high-value primary care. However, postpartum care in the United States is fragmented and incomplete. In response to this failure, the American College of Obstetricians and Gynecologists has called for obstetricians to develop individualized care plans that facilitate transitions from obstetrical to primary care after delivery. In this clinical opinion, we review previous interventions that have aimed to increase postpartum care engagement and bridge gaps in care. Although numerous interventions have been trialed, few have been both successful and scalable. We provide recommendations on ways to reimagine equitable and effective postpartum care interventions with multidisciplinary collaboration.
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Affiliation(s)
- Sara E K Phillips
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA.
| | - Ann C Celi
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA; Divisions of General Medicine and Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alexandra Wehbe
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Jasmine Kaduthodil
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
| | - Chloe A Zera
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Boston, MA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA
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Lu SC, Xu M, Wang M, Hardi A, Cheng AL, Chang SH, Yen PY. Effectiveness and Minimum Effective Dose of App-Based Mobile Health Interventions for Anxiety and Depression Symptom Reduction: Systematic Review and Meta-Analysis. JMIR Ment Health 2022; 9:e39454. [PMID: 36069841 PMCID: PMC9494214 DOI: 10.2196/39454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews support the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long the minimum treatment "dose" is for an mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness. OBJECTIVE Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose effectiveness of app-based mHealth interventions for anxiety and depression symptom reduction. METHODS We conducted a literature search on 7 databases (ie, Ovid MEDLINE, Embase, PsycInfo, Scopus, Cochrane Library (eg, CENTRAL), ScienceDirect, and ClinicalTrials, for publications from January 2012 to April 2020. We included randomized controlled trials (RCTs) evaluating app-based mHealth interventions for anxiety and depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We estimated the pooled effect size using Hedge g and appraised study quality using the revised Cochrane risk-of-bias tool for RCTs. RESULTS We included 15 studies involving 2627 participants for 18 app-based mHealth interventions. Participants in the intervention groups showed a significant effect on anxiety (Hedge g=-.10, 95% CI -0.14 to -0.06, I2=0%) but not on depression (Hedge g=-.08, 95% CI -0.23 to 0.07, I2=4%). Interventions of at least 7 weeks' duration had larger effect sizes on anxiety symptom reduction. CONCLUSIONS There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to nonsignificant effects of the interventions and study quality concerns. The recommended dose of mHealth interventions and the sustainability of intervention effectiveness remain unclear and require further investigation.
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Affiliation(s)
- Sheng-Chieh Lu
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mindy Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, United States
| | - Angela Hardi
- Becker Medical Library, Washington University in St Louis, St Louis, MO, United States
| | - Abby L Cheng
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, United States.,Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, United States
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, United States
| | - Po-Yin Yen
- Institute for Informatics, Washington University in St Louis, St Louis, MO, United States.,Goldfarb School of Nursing, Barnes Jewish College, BJC HealthCare, St Louis, MO, United States
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Benton AD, Nason E, Lewis C, Vinklarek A, Santana A. Dose Matters in Evaluation of a School-Based Adolescent Sexual Health Education Program. THE JOURNAL OF SCHOOL HEALTH 2022; 92:815-821. [PMID: 35246980 PMCID: PMC9543517 DOI: 10.1111/josh.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research on the effects of intervention dose on outcomes within adolescent sexual health education programming is lacking. Existing research on dose typically utilizes the number of sessions as a variable. In a school setting, there are scheduling limitations, student absences, and other logistical barriers that have the potential to affect the number of sessions for an intervention and, in turn, impact the efficacy of programming. METHODS This article evaluates the effectiveness of a school-based, peer-led adolescent comprehensive sexual health education program, with a focus on dose. A repeated measures MANOVA was used to evaluate the effects of individual difference variables and intervention variables on changes in participants' knowledge and attitudes across 2 time points. Additionally, paired t-tests were used to evaluate changes in specific behaviors. RESULTS Results indicated that knowledge improved following the intervention, and specifically larger doses, measured in minutes, of the intervention were associated with larger improvements in knowledge. There were no significant effects related to attitudes or behavioral outcomes. CONCLUSIONS This study adds to the knowledge base by including analysis of how the dose of intervention may impact youth outcomes. Implications for school health practices and research are discussed.
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Affiliation(s)
- Amy D. Benton
- School of Social Work, Texas State University, 601 University DriveSan MarcosTX78666USA
| | - Erica Nason
- School of Social Work, Texas State University, 601 University DriveSan MarcosTX78666USA
| | - Carol Lewis
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto BoulevardAustinTX78712USA
| | - Aubrey Vinklarek
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto BoulevardAustinTX78712USA
| | - Alda Santana
- ETR Associates, 333 University Avenue, Suite 130SacramentoCA95825USA
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12
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Dol J, Aston M, Grant A, McMillan D, Tomblin Murphy G, Campbell-Yeo M. Implementing Essential Coaching for Every Mother during the COVID-19 pandemic: A pre-post intervention study. Birth 2022; 49:273-280. [PMID: 34862659 DOI: 10.1111/birt.12603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective of this project was to evaluate the preliminary impact of Essential Coaching for Every Mother on maternal self-efficacy, social support, postpartum anxiety, and postpartum depression. The secondary objective was to explore the acceptability of the Essential Coaching for Every Mother program provided during the COVID-19 pandemic. METHODS A prospective pre-post study was conducted with first-time mothers in Nova Scotia, Canada, between July 15 and September 19, 2020. Participants completed a self-report survey at enrollment (after birth) and 6 weeks postpartum. Various standardized measures were used, and qualitative feedback on the program was also collected. Paired t tests were carried out to determine changes from baseline to follow-up on psychosocial outcomes, and qualitative feedback was analyzed through thematic analysis. RESULTS A total of 88 women enrolled. Maternal self-efficacy increased between baseline (B) and follow-up (F) (B: 33.33; F: 37.11, P = 0.000), whereas anxiety (STAI) declined (B: 38.49; F: 34.79, P = 0.004). In terms of acceptability, 89% of participants felt that the number of messages was just right, 84.5% felt the messages contained all the information they needed relative to caring for a newborn, and 98.8% indicated they would recommend this program to other new mothers. CONCLUSIONS Essential Coaching for Every Mother may play a role in increasing maternal self-efficacy and decreasing anxiety, although future work with a control group is needed to delineate the true effects of the program. Overall, mothers were satisfied with the Essential Coaching for Every Mother program and would recommend it for other mothers, during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amy Grant
- Maritime SPOR Support Unit, Halifax, Nova Scotia, Canada
| | - Douglas McMillan
- Department of Paediatrics, IWK Health Centre & Dalhousie University, Halifax, Nova Scotia, Canada
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Talmont E, Vitale TR. Telehealth Readiness Assessment of Perinatal Nurses. Nurs Womens Health 2022; 26:86-94. [PMID: 35143778 DOI: 10.1016/j.nwh.2022.01.004] [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: 05/10/2021] [Revised: 09/22/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess telehealth readiness among perinatal nurses in New Jersey. DESIGN Cohort survey study. SETTING/LOCAL PROBLEM New Jersey was one of the hardest hit areas in the early months of the COVID-19 pandemic. Telehealth represented an opportunity to provide continuity of perinatal care at a time when health care was significantly disrupted. PARTICIPANTS Perinatal nurses in New Jersey. INTERVENTION/MEASUREMENTS The intervention was a five-part, 90-question online survey provided via e-mail invitation to New Jersey State Nursing Association members. Data were collected from June 25 to July 9, 2020. Descriptive statistics, frequency analyses, a Mann-Whitney test on nonparametric measures of groups by age, and a one-tailed t test were completed. Results of the Telehealth Readiness Assessment tool were calculated. Open-text responses were organized and used to illustrate the findings. RESULTS Fifty-two perinatal nurses responded to the survey. Twenty-two (42%) completed all 90 questions. Partial answers were accepted. Synchronous live telehealth expanded 66% in the wake of COVID-19. Results showed that 37% (n = 15) of participants used telehealth at work, and 27% (n = 11) used it in getting care for themselves or a family member (M = 2.0, SD = 0.86; one-tailed t test, p = .25). In comparing nervousness in using technology with age, scores for those younger than 45 years (Mdn = 3) and those older than 45 years (Mdn = 2) showed no statistically significant difference, U(n<45years = 15, n≥45 years = 17) = 11, z = -0.02, p < .83. Overall, 46% (n = 26) indicated that telehealth could be extremely helpful or very helpful in reducing health care disparities and improving quality. Overall, telehealth readiness was ranked almost ready. CONCLUSION A telehealth readiness assessment may identify barriers and opportunities that can predict success and failure. Nurses generally accept technology and believe that telehealth could be useful in reducing poor maternal health outcomes and health care disparities.
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Wrobel J, Silvasstar J, Peterson R, Sumbundu K, Kelley A, Stephens D, Craig Rushing S, Bull S. Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns. JMIR Form Res 2022; 6:e32138. [PMID: 35212633 PMCID: PMC8917435 DOI: 10.2196/32138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/01/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. Methods The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. Results Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks. Conclusions This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. Trial Registration ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481
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Affiliation(s)
- Julia Wrobel
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Joshva Silvasstar
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Roger Peterson
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Kanku Sumbundu
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Allyson Kelley
- Allyson Kelley and Associates PLLC, Sisters, OR, United States
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | | | - Sheana Bull
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
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15
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Umaefulam V, Premkumar K, Koole M. Perceptions on mobile health use for health education in an Indigenous population. Digit Health 2022; 8:20552076221092537. [PMID: 35449712 PMCID: PMC9016580 DOI: 10.1177/20552076221092537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Indigenous peoples in Canada face numerous health needs and challenges and
often have poor health status due to inequitable access to care. Providing
culturally appropriate support for health conditions, particularly chronic
conditions that require self-management, can assist in averting
complications and morbidity. Mobile health is a useful medium for delivering
health education across different populations. However, meaningful user
involvement is necessary because mobile health interventions suitable for
one population may not be appropriate for another. Indigenous people’s views
will inform the use of mobile health interventions in Indigenous
communities. Objective The study explored the perception of Indigenous women on using mobile health
as a tool for receiving health information. Methods This was a qualitative study, and participants comprised of 22 Indigenous
women (First Nations and Métis) with or at risk of diabetes, aged 18–69
years in Saskatoon, Canada. After 12 weeks of disseminating diabetic eye
care information via text messaging, data were collected via sharing circle
discussions and analyzed using thematic analysis. Results Participants indicated that the nature of messages such as the use of
Indigenous languages, the message content, frequency of messages, group
activities, and delivery formats such as voice messages, mobile
applications, Internet, two-way messaging, and text messages were essential
considerations in using mobile health as a tool for receiving health
information. Conclusion Different factors need to be considered in using mobile health as a tool for
health education among Indigenous peoples. These factors could be applicable
in implementing mobile health solutions in other populations for the
management of health conditions.
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Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marguerite Koole
- Educational Technology and Design, Department of Curriculum Studies, College of Education, University of Saskatchewan, Saskatoon, SK, Canada
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Psihogios AM, King-Dowling S, O'Hagan B, Darabos K, Maurer L, Young J, Fleisher L, Barakat LP, Szalda D, Hill-Kayser CE, Schwartz LA. Contextual Predictors of Engagement in a Tailored mHealth Intervention for Adolescent and Young Adult Cancer Survivors. Ann Behav Med 2021; 55:1220-1230. [PMID: 33674863 DOI: 10.1093/abm/kaab008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite the promise of mobile health (mHealth), engagement is often too low for durable health behavior change, and little is known regarding why certain individuals abandon mHealth tools. PURPOSE Guided by a mHealth engagement framework, we evaluated contextual predictors of objective engagement with an app for adolescents and young adults (AYA) who survived cancer. METHODS One hundred and ten AYA survivors (M age = 20.5, 43% female, 30% racial/ethnic minority) were randomized to receive a disease self-management app that delivered 1-2 tailored messages/day for 16 weeks, and contained a survivorship care plan (SCP). Demographic, disease, psychosocial, and setting characteristics were examined as predictors of three objective engagement outcomes: (a) % of active app days, (b) % of messages read, and (c) viewed SCP in the app versus not. A subsample (n = 10) completed qualitative interviews to further assess engagement barriers. RESULTS Self-reported uninterrupted app access (β = -0.56, p < .001), iPhone (vs. Android) ownership (β = 0.30, p < .001), and receiving the intervention in the summer (β = -0.20, p = .01) predicted more active days. Lower depressed mood (β = -0.30, p = .047) and uninterrupted app access (β = -0.50, p < .001) predicted more messages read. Qualitatively, technical glitches and competing priorities were described as engagement barriers, whereas certain types of messages (e.g., health goal messages) were perceived as engaging. Among participants who had uninterrupted app access (n = 76), higher baseline motivation to change, better health perceptions, using the app during the summer, and iPhone ownership predicted higher engagement. CONCLUSIONS Findings demonstrate the importance of comprehensively assessing and planning for multi-level ecological determinants of mHealth engagement in future trials. CLINICALTRIALS.GOV IDENTIFIER NCT03363711.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sara King-Dowling
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bridget O'Hagan
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katie Darabos
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jordyn Young
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dava Szalda
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine E Hill-Kayser
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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SEZER A, KADIOĞLU H. Effect of text messages intervention on pregnancy healthcare practices: A three group non-randomized controlled trial. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.883191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mays D, Johnson AC, Phan L, Sanders C, Shoben A, Tercyak KP, Wagener TL, Brinkman MC, Lipkus IM. Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial. Am J Public Health 2021; 111:1686-1695. [PMID: 34436927 PMCID: PMC8589064 DOI: 10.2105/ajph.2021.306389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.
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Affiliation(s)
- Darren Mays
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Johnson
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lilianna Phan
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Camilla Sanders
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Abigail Shoben
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kenneth P Tercyak
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Theodore L Wagener
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marielle C Brinkman
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Isaac M Lipkus
- Darren Mays and Theodore L. Wagener are with the Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus. Andrea C. Johnson is with the Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lilianna Phan is with the National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Camilla Sanders and Isaac M. Lipkus are with the Duke University School of Nursing, Durham, NC. Abigail Shoben and Marielle C. Brinkman are with the College of Public Health, The Ohio State University, Columbus. Kenneth P. Tercyak is with the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Leziak K, Birch E, Jackson J, Strohbach A, Niznik C, Yee LM. Identifying Mobile Health Technology Experiences and Preferences of Low-Income Pregnant Women with Diabetes. J Diabetes Sci Technol 2021; 15:1018-1026. [PMID: 33605158 PMCID: PMC8442194 DOI: 10.1177/1932296821993175] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapid expansion of mobile technology has resulted in the development of many mobile health ("mHealth") platforms for health monitoring and support. However, applicability, desirability, and extent of tailoring of these platforms for pregnant women, particularly in populations who experience the greatest health inequities-such as women with diabetes mellitus (DM) and/or those with greater socioeconomic barriers-remains unknown. The objective is to understand low-income pregnant women's experiences and preferences for mHealth tools to support DM health and improve DM self-management during pregnancy. METHODS Low-income pregnant and postpartum women were included in individual interviews or focus groups; women with type 2 DM, gestational DM, or no DM were included. Analysis was performed with the constant comparison method. RESULTS In this population of 45 (N=37 with DM) low-income, largely minority, pregnant and postpartum women, 100% reported access to smartphones and prior experience with apps. Interest in mHealth to support health and engagement during pregnancy was high. Preferences for general mHealth features included education that reduces uncertainty, support communities, visualizing progress, convenient access to information, and support for better management of pregnancy-related tasks. Preferred design elements included personalization, interactive features, and integrated graphics. Women with DM expressed multiple additional DM-specific needs, including support tools for DM self-management and self-regulation tasks. CONCLUSION Pregnant and postpartum women, especially those with DM, desire mHealth technology to support engagement and to adapt lifestyle guidelines and treatment requirements for a healthy pregnancy. Further work to develop mHealth interventions tailored for target populations remains a key step in reducing health inequities and promoting access to evidence-based perinatal health interventions.
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Affiliation(s)
- Karolina Leziak
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Eleanor Birch
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Jenise Jackson
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Angelina Strohbach
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Charlotte Niznik
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine,
Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA
- Lynn M. Yee, MD, MPH, Department of
Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine,
250 E. Superior Street, #5-2145, Chicago, IL 60611, USA.
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20
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Ekezie W, Dallosso H, Saravanan P, Khunti K, Hadjiconstantinou M. Experiences of using a digital type 2 diabetes prevention application designed to support women with previous gestational diabetes. BMC Health Serv Res 2021; 21:772. [PMID: 34348719 PMCID: PMC8337145 DOI: 10.1186/s12913-021-06791-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM). Prevention strategies focused on lifestyle modification help to reduce long-term complications. Self-management technology-based interventions can support behaviour change and diabetes control. The Baby Steps programme, a randomised controlled trial intervention offering group education and access to a mobile web application, was evaluated to explore user experience of the app and barriers and facilitators to app usability. Methods Ten semi-structured interviews and four focus group discussions were conducted with 23 trial participants between 2018 and 2019. Interviews and focus group discussions were audiotaped, transcribed and independently analysed. The analysis was informed by thematic analysis, with the use of the Nvivo 12 software. Results Themes identified were: (1) GDM and post-pregnancy support from healthcare services; (2) Impact of Baby Steps app on lifestyle changes; (3) Facilitators and barriers to the usability of the Baby Steps app. The Baby Steps app served as a motivator for increasing self-management activities and a tool for monitoring progress. Peer support and increased awareness of GDM and T2DM enhanced engagement with the app, while poor awareness of all the components of the app and low technical skills contributed to low usability. Conclusions This study documents experiences from existing GDM support, user experiences from using the Baby Steps app, and the barriers and facilitators to app usability. The app was both a motivational and a monitoring tool for GDM self-management and T2DM prevention. Peer support was a key trait for enhanced engagement, while barriers were low technical skills and poor awareness of the app components. A digital app, such as the Baby Steps app, could strengthen existing face-to-face support for the prevention of T2DM. The results also have wider implications for digital support technologies for all self-management interventions. Further research on the effect of specific components of apps will be required to better understand the long term impact of apps and digital interventions on self-management behaviours and outcomes. Trial registration ISRCTN, ISRCTN17299860. Registered on 5 April 2017.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) East Midlands, University of Leicester, Leicester, UK
| | - Helen Dallosso
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) East Midlands, University of Leicester, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Ponnusamy Saravanan
- Population, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) East Midlands, University of Leicester, Leicester, UK
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
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21
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Dol J, Aston M, McMillan D, Tomblin Murphy G, Campbell-Yeo M. Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27138. [PMID: 33764309 PMCID: PMC8088838 DOI: 10.2196/27138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum. OBJECTIVE The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program. METHODS This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant's age and the woman's self-selected preference for breastfeeding or formula feeding and tailored with the infant's name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant's date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention. RESULTS Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022. CONCLUSIONS This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program. TRIAL REGISTRATION ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27138.
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Affiliation(s)
- Justine Dol
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Megan Aston
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Douglas McMillan
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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22
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Schindler-Ruwisch J, Palancia Esposito C. "Alexa, Am I pregnant?": A content analysis of a virtual assistant's responses to prenatal health questions during the COVID-19 pandemic. PATIENT EDUCATION AND COUNSELING 2021; 104:460-463. [PMID: 33422368 PMCID: PMC7771908 DOI: 10.1016/j.pec.2020.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To elucidate whether Amazon's virtual assistant, Alexa, provides evidence-based support as a supplement to provider-facilitated prenatal care, during the COVID-19 pandemic. METHODS Using a conceptual content analysis approach, a query of 40 questions, relating to all phases of pregnancy, was collected from Alexa by two independent investigators, using two unique devices, over a one-week period between May 20, 2020 and May 27, 2020. Alexa's responses were matched to the evidence-based content from the American College of Obstetricians and Gynecologists (ACOG) and reviewed by a Certified Nurse Midwife for completeness and currency. RESULTS Of the 40 questions asked of Alexa, it was unable to answer 14 questions (35%). A total of 21 out of the 40 responses (52%) were not evidence-based and three COVID-specific questions (about 1%) were answered incorrectly or insufficiently. Four questions (10%) were answered accurately. CONCLUSION Alexa was largely unable to provide evidence-based answers to commonly asked pregnancy questions and, in many cases, supplied inaccurate, incomplete, or completely unrelated answers that could further confuse health consumers. PRACTICE IMPLICATIONS Ensuring that mobile health (mhealth) tools, such as Amazon Alexa, are evidence-based and credible in answering common prenatal questions has important implications for this pandemic and future consumer needs.
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Affiliation(s)
- Jennifer Schindler-Ruwisch
- Egan School of Nursing and Health Studies, Fairfield University, 1073 North Benson Road, Fairfield, CT, 06824-5195, USA.
| | - Christa Palancia Esposito
- Egan School of Nursing and Health Studies, Fairfield University, 1073 North Benson Road, Fairfield, CT, 06824-5195, USA.
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23
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King-Dowling S, Psihogios AM, Hill-Kayser C, Szalda D, O’Hagan B, Darabos K, Daniel LC, Barakat LP, Fleisher L, Maurer LA, Velázquez-Martin B, Jacobs LA, Hobbie W, Ginsberg JP, Vachani CC, Metz JM, Schwartz LA. Acceptability and feasibility of survivorship care plans and an accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer. Pediatr Blood Cancer 2021; 68:e28884. [PMID: 33416214 PMCID: PMC9639403 DOI: 10.1002/pbc.28884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-management interventions for adolescent and young adult (AYA) survivors of childhood cancer are needed. The present study reports on the acceptability and feasibility of delivering survivorship care plans (SCPs) and an accompanying app to AYA. PROCEDURE AYA (n = 224) ages 15-29 who completed treatment for cancer were randomized and received a digital SCP only or an SCP plus a mobile app intended to enhance self-management. For 16 weeks, the app delivered one to two daily messages complementing information in their SCP and tailored based on age, treatment, and health goal. Data are presented on feasibility, self-reported acceptability (including satisfaction and perceived benefits) and its relationship to app engagement (for those in app group), and feedback from qualitative interviews conducted with 10 AYA. RESULTS The SCP and app proved feasible as evidenced by high recruitment and retention, access to technology, time analysis, moderate app engagement, and minimal technical issues. However, 12% reported never reading the SCP and 8% never used the app. The app and SCP were acceptable to AYA, and SCP acceptability ratings did not differ between groups. For those with the app, acceptability was positively related to message engagement. AYA recommended enhanced individualization and design features of the SCP and app. CONCLUSIONS Results support the use of tailored SCPs and mobile health interventions for most AYA, as well as the need for further refinement and research. Delivery of SCPs and digital interventions are acceptable and feasible to AYA survivors, and may help promote health-related knowledge and survivorship self-management.
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Affiliation(s)
- Sara King-Dowling
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Alexandra M. Psihogios
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine Hill-Kayser
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA,University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Dava Szalda
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Bridget O’Hagan
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Katie Darabos
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | | | - Lamia P. Barakat
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Laurie A. Maurer
- Tennessee Department of Health, HIV/STD/Viral Hepatitis Section, Nashville, TN, USA
| | | | - Linda A. Jacobs
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA,University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Wendy Hobbie
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Jill P. Ginsberg
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
| | - Carolyn C Vachani
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - James M. Metz
- University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA,University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Lisa A. Schwartz
- The Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA,University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA, USA
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24
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Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study: a before-after study protocol. NPJ Prim Care Respir Med 2020; 30:51. [PMID: 33208752 PMCID: PMC7674488 DOI: 10.1038/s41533-020-00209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
Despite existing interventions, tobacco smoking and alcohol consumption during pregnancy are common. The Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy intervention combines monthly group sessions, access to a web-based platform and incentives upon biochemically validated cessation for a maximum duration of 6 months to promote cessation of smoking and alcohol use before and during pregnancy. To inform development of the SAFER pregnancy intervention, two focus groups with the target population were held beforehand, with results reported here alongside the final SAFER pregnancy study protocol. In a before−after study we aim to include 66 women who are pregnant or have a wish to become pregnant and who smoke and/or consume alcohol (i.e. target population of the SAFER pregnancy intervention). The primary outcome measure is cessation of smoking and/or alcohol use at 34−38 weeks of gestation, or after six group sessions if women did not become pregnant during the study period. Secondary outcomes focus on the barriers and facilitators for implementation of the SAFER pregnancy intervention.
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25
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Yee L, Taylor S, Young M, Williams M, Niznik C, Simon M. Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study. JMIR Diabetes 2020; 5:e17794. [PMID: 32773367 PMCID: PMC7445621 DOI: 10.2196/17794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/24/2022] Open
Abstract
Background Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed. Objective This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy. Methods This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes. Results Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations. Conclusions Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.
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Affiliation(s)
- Lynn Yee
- Northwestern University, Chicago, IL, United States
| | | | - Maria Young
- Northwestern University, Chicago, IL, United States
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26
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Alam M, Banwell C, Lokuge K. The Effect of Women's Differential Access to Messages on Their Adoption of Mobile Health Services and Pregnancy Behavior in Bangladesh: Retrospective Cross-Sectional Study. JMIR Mhealth Uhealth 2020; 8:e17665. [PMID: 32706694 PMCID: PMC7399959 DOI: 10.2196/17665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/03/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Text or voice messages have been used as a popular method for improving women's knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women's singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. OBJECTIVE This study aims to evaluate the effect of women's singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. METHODS In 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women's differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. RESULTS In the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P<.001), consuming nutritious food 5 times a day (OR 1.58, 95% CI 1.04-2.40; P=.03), and following the instructions of Aponjon on drinking potable water (OR 1.90, 95% CI 1.17-3.09; P=.01) than women who shared access with family members. Women's differential access to messages did not affect their knowledge of danger signs and preparedness around delivery. Adolescent women and women aged 20-24 years had lower odds of planning safe deliveries than older women (aged≥25 years). Secondary education was statistically significantly associated with women's ability to recall the short code and pregnancy danger signs, plan safe delivery, and select blood donors for emergencies. Higher family income was associated with women's satisfaction, recognition of danger signs, and arrangement of blood donors and nutritious diet. Women who received more than 4 antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs, and consuming nutritious food. CONCLUSIONS The capacity of women to independently access mobile phone messages can improve their adoption of mobile health services and some pregnancy health care practices. A holistic approach and equitable support are required to improve access to resources and knowledge of delivery preparedness among low-literate and younger women in low-income households.
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27
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Rhodes A, Smith AD, Chadwick P, Croker H, Llewellyn CH. Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e18255. [PMID: 32673251 PMCID: PMC7382015 DOI: 10.2196/18255] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. OBJECTIVE This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. METHODS A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. RESULTS In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (-0.28 kg; 95% CI -1.43 to 0.87) or per-protocol data (-0.65 kg; 95% CI -1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. CONCLUSIONS In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.
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Affiliation(s)
| | | | | | - Helen Croker
- University College London, London, United Kingdom
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28
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DeNicola N, Marko K. Connected Health and Mobile Apps in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2020; 47:317-331. [DOI: 10.1016/j.ogc.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Mays D, Phan L, Johnson AC, Tercyak KP, Snow K, Luta G, Rehberg K, Lipkus I. Results of a Single Arm Pilot Study of a Mobile Messaging Intervention for Hookah Tobacco Cessation in Young Adults. Tob Use Insights 2020; 13:1179173X20915200. [PMID: 32440243 PMCID: PMC7225829 DOI: 10.1177/1179173x20915200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation. Objectives This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers. Methods Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants' hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention. Results Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant (P < .05) increases in risk perceptions (d's = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment. Conclusions These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted.
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Affiliation(s)
- Darren Mays
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Lilianna Phan
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kylie Snow
- Department of Human Science, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn Rehberg
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
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Umaefulam V, Premkumar K. Impact of mobile health in diabetic retinopathy awareness and eye care behavior among Indigenous women. Mhealth 2020; 6:14. [PMID: 32270006 PMCID: PMC7136660 DOI: 10.21037/mhealth.2019.12.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/20/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diabetes is increasingly widespread among Indigenous people, and diabetic retinopathy (DR) is a diabetes eye complication and a common cause of vision loss among adults in Canada. Indigenous women have a high risk of diabetes which increases their risk for DR. This study explored utilizing mobile health (mHealth) via text messages to provide DR awareness and improve diabetic-eye care behavior. This study identified the changes in DR awareness and eye care behavior due to a mHealth education intervention among Indigenous women with or at risk of diabetes. METHODS A pre-post study which adopted an embedded concurrent mixed methods approach guided by self-determination theory and the medicine wheel. Study participants were First Nations and Métis women living with or at risk of diabetes in Saskatoon, Canada. Data was collected via sharing circles and a DR knowledge, attitude, and practice survey. Pre-intervention participants' baseline information on DR knowledge and behavior were obtained from participants. After that, participants received daily text messages on diabetes-eye related information for 12 weeks. Post-intervention, the impact of the mHealth intervention on DR awareness and eye care behavior was assessed. RESULTS Following the intervention, the DR knowledge, attitude, and practice scores significantly improved. Individuals living with diabetes had increased DR attitude and practice post-scores compared to those at risk of diabetes. Older women had a lower pre-post change in practice scores compared to younger women. The mHealth intervention provided a holistic approach to support diabetes-eye care and empowered the study participants to eat healthily, take medication as prescribed, and have regular medical and eye check-ups. CONCLUSIONS The mHealth education intervention increased DR awareness and fostered a change in diabetes-eye care behavior. Health information via text messaging can motivate, provide support, and empower individuals as well as prevent and manage chronic conditions and reduce the risk of complications.
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Affiliation(s)
- Valerie Umaefulam
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kalyani Premkumar
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Blackwell TM, Dill LJ, Hoepner LA, Geer LA. Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage. JMIR Mhealth Uhealth 2020; 8:e14737. [PMID: 32053117 PMCID: PMC7055759 DOI: 10.2196/14737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/01/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
Background The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants’ knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants’ knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks’ exposure to the text message–based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants’ perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14% increase in participants reporting their intent to use T4B and a 28% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population.
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Affiliation(s)
- Tenya M Blackwell
- Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States
| | - LeConte J Dill
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, United States
| | - Lori A Hoepner
- Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States
| | - Laura A Geer
- Department of Environmental and Occupational Health Sciences, SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States
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Griauzde DH, Kieffer EC, Domoff SE, Hess K, Feinstein S, Frank A, Pike D, Pesch MH. The influence of social media on child feeding practices and beliefs among Hispanic mothers: A mixed methods study. Eat Behav 2020; 36:101361. [PMID: 31923649 PMCID: PMC8005295 DOI: 10.1016/j.eatbeh.2019.101361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/22/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES (1) To identify factors that influence child feeding practices and beliefs among Hispanic mothers in a low-income community; (2) to describe the use of social media, other internet websites, and text messaging among Hispanic mothers; and (3) to explore mothers' perceptions of social media and/or text messaging interventions to prevent childhood obesity. METHODS Mixed methods descriptive study with a sequential explanatory design. Hispanic mothers (N = 66) from Detroit, Michigan with children between 6 and 36 months of age completed surveys regarding their child feeding practices, the source (s) influencing these practices, and their use of social media, internet, and text messaging. During qualitative interviews (N = 19), we explored mothers' use of social media and internet websites to find child health information as well as mothers' perspectives on social media/internet/text messaging interventions to promote child health. RESULTS Most survey respondents were between the ages of 20 and 39 years. One-third of mothers breastfed their child for >6 months; 68% did not introduce solids until their child was older than 6 months. The majority (96%) owned a cellphone; 75% used social media at least once daily. Few mothers indicated that social media and other internet websites influenced their child feeding decisions. During qualitative interviews (N = 19), almost all mothers expressed interest in social media and/or text messaging as a tool to communicate information regarding child health and feeding. CONCLUSIONS Hispanic mothers had high rates of social media use and most desired social media/internet/text messaging interventions to promote child health.
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Affiliation(s)
- Dina H Griauzde
- Ann Arbor VA Health System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Sarah E Domoff
- Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA
| | - Kristen Hess
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Amy Frank
- Community Health and Social Services (CHASS) Center, Detroit, MI, USA
| | - Denise Pike
- Community Health and Social Services (CHASS) Center, Detroit, MI, USA
| | - Megan H Pesch
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Evans W, Harrington C, Patchen L, Andrews V, Gaminian A, Ellis L, Napolitano M. Design of a novel digital intervention to promote healthy weight management among postpartum African American women. Contemp Clin Trials Commun 2019; 16:100460. [PMID: 31650078 PMCID: PMC6804615 DOI: 10.1016/j.conctc.2019.100460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/21/2019] [Accepted: 09/28/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Excess weight retention among postpartum women is a risk factor for long term obesity, and African American women are at heightened risk. New solutions, including digital technologies and community-based approaches are needed. Digital platforms, like social media, provide opportunity for participant co-creation (i.e., content co-generated by users and investigators) of health messages and may allow for adaptation of evidence-based weight management interventions to reduce participant burden. The BeFAB intervention, a branded, digital weight management program, tests this hypothesis. METHODS BeFAB content comprises culturally-specific nutrition, physical activity, stress management, health information seeking and related weight management messages and content designed for African American women. The intervention is 12 weeks in duration, delivered through a mobile phone app, and is designed to target specific behavioral predictor beliefs and attitudinal measures (e.g., self-efficacy to achieve weight management goals) based on the culturally-specific content. Use of personal, culturally-specific video-based narratives in the app, and through a secret Facebook group, are included to help model HEAL behaviors and brand BeFAB. Intervention development consisted of iterative formative research steps to engage African American women. The program will be evaluated in a small randomized trial among patients recruited at a clinical facility. CONCLUSIONS BeFAB applies evidence-based content using a promising digital approach. It is novel in its use of branding, culturally-tailored content, and digital technology for behavior change.Evaluation of BeFAB will contribute to the growing literature on digital health behavior change interventions for weight management.
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Affiliation(s)
- W.D. Evans
- The George Washington University, United States
| | | | - L. Patchen
- Medstar Health Research Institute, United States
| | - V. Andrews
- The George Washington University, United States
| | - A. Gaminian
- The George Washington University, United States
| | - L.P. Ellis
- Medstar Health Research Institute, United States
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Hai AH, Hammock K, Velasquez MM. The Efficacy of Technology-Based Interventions for Alcohol and Illicit Drug Use Among Women of Childbearing Age: A Systematic Review and Meta-Analysis. Alcohol Clin Exp Res 2019; 43:2464-2479. [PMID: 31557336 DOI: 10.1111/acer.14203] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alcohol and illicit drug use is prevalent among women of childbearing age and may lead to higher risk for substance-exposed pregnancy and related health consequences for both women and their offspring. Technology-based interventions (TBIs) are increasingly used to prevent or reduce substance use among women of childbearing age. The efficacy of these approaches, however, is unclear. This review critically reviewed existing research evidence from randomized controlled trials (RCTs) on the efficacy of TBIs in preventing and reducing alcohol and illicit drug use among childbearing-aged women. METHODS Seven electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Robust variance estimation in meta-regression was used to estimate effect sizes and conduct moderator analyses. RESULTS Fifteen RCTs including 3,488 participants were included in the systematic review. Meta-analysis results based on 13 RCTs suggest that TBIs were efficacious relative to control conditions in preventing and reducing substance use among women of childbearing age (d = 0.19, 95% CI = 0.02, 0.35). Preliminary moderator analysis results suggest that the efficacy of TBIs might not vary by participant age, race/ethnicity, the type of technology used, or whether a virtual health assistant was used. TBIs' efficacy in terms of specific substance use types (alcohol use and illicit drug use) or control types (inactive control and active controls) was inconclusive, due to the limited number of studies in each category. CONCLUSIONS This systematic review and meta-analysis found evidence of TBIs' efficacy in reducing alcohol and illicit drug use among women of childbearing age. Implications for future research and practice are discussed.
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van Beukering M, Velu A, van den Berg L, Kok M, Mol BW, Frings-Dresen M, de Leeuw R, van der Post J, Peute L. Usability and Usefulness of a Mobile Health App for Pregnancy-Related Work Advice: Mixed-Methods Approach. JMIR Mhealth Uhealth 2019; 7:e11442. [PMID: 31094353 PMCID: PMC6532337 DOI: 10.2196/11442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/14/2018] [Accepted: 12/27/2018] [Indexed: 01/19/2023] Open
Abstract
Background Pregnant women are often unaware of the potential risks that working conditions can cause to them and their unborn child. A mobile health (mHealth) app, the Pregnancy and Work (P and W) app, developed by a multidisciplinary team and based on an evidence-based guideline for occupational physicians, aims to provide advice on work adjustment during pregnancy. Objective This study evaluates the usability of the mHealth P and W app and the perceived usefulness of the work advice, the main goal of the app, by potential end users. Methods A total of 12 working pregnant women participated in think aloud usability sessions and performed 9 tasks. All think aloud sessions were recorded, transcribed, and coanalyzed. The usability problems were rated for their severity in accordance with Nielsen severity scale. The completion rates and time taken for completion of tasks were registered. In addition, participants were questioned on demographics and user characteristics and were asked to evaluate the value of the app by filling in the Intrinsic Motivation Inventory (IMI) score and the System Usability Scale (SUS) questionnaire. Results In total, 82 usability problems with a severity ≥1 were identified, of which 40 had severity ≥3. The main usability problems concerned the interpretation of terminology used in the app’s questionnaires and difficulties in finding and understanding the work advice. Furthermore, 10 out of 12 participants were able to open the work advice page in the app. Only 7 out of these 10 participants understood and intended to follow the work advice. The overall mean IMI score was relatively high (5 out of 7), indicating that the participants did indeed value the use of the app. This IMI score corresponded to the overall mean SUS score (68 out of 100) and the mean grade given to the P and W app (7 out of 10). Conclusions This think aloud usability study showed that the information provided in the P and W app was considered valuable by the end users, working pregnant women, and it meets their needs; however, usability issues severely impacted the perceived usefulness of the work advice given in the app.
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Affiliation(s)
- Monique van Beukering
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Adeline Velu
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Liesbeth van den Berg
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Monique Frings-Dresen
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert de Leeuw
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joris van der Post
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Peute
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Balci AS, Kadioglu H. Text Messages Based Interventions for Pregnant Women’s Health: Systematic Review. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/marusbed.546694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Marcelle ET, Nolting L, Hinshaw SP, Aguilera A. Effectiveness of a Multimodal Digital Psychotherapy Platform for Adult Depression: A Naturalistic Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e10948. [PMID: 30674448 PMCID: PMC6364202 DOI: 10.2196/10948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/08/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
Background Although psychotherapy is one of the most efficacious and effective treatments for depression, limited accessibility to trained providers markedly limits access to care. In an attempt to overcome this obstacle, several platforms seeking to provide these services using digital modalities (eg, video, text, and chat) have been developed. However, the use of these modalities individually poses barriers to intervention access and acceptability. Multimodal platforms, comprising those that allow users to select from a number of available modalities, may be able to provide a solution to these concerns. Objective We aimed to investigate the preliminary effectiveness of providing psychotherapy through a multimodal digital psychotherapy platform. In addition, we aimed to examine differential responses to intervention by gender, self-reported physical health status, and self-reported financial status, as well as how prior exposure to traditional face-to-face psychotherapy affected the effectiveness of a multimodal digital psychotherapy intervention. Finally, we aimed to examine the dose-response effect. Methods Data were collected from a total of 318 active users of BetterHelp, a multimodal digital psychotherapy platform. Data on physical health status, financial status, and prior exposure to psychotherapy were obtained using self-report measures. Effectiveness was determined by the extent of symptom severity change, which was measured using the Patient Health Questionnaire at Time 1 (time of enrollment) and Time 2 (3 months after enrollment). Intervention dosage was measured as the sum of individual therapist-user interactions across modalities. Results Depression symptom severity was significantly reduced after the use of the multimodal digital psychotherapy intervention (P<.001). Individuals without prior traditional psychotherapy experience revealed increased improvement after intervention (P=.006). We found no significant dose-response effect of therapy, nor significant differences in outcomes across gender, self-reported financial status, and self-reported physical health status. Conclusions Users of BetterHelp experienced significantly reduced depression symptom severity after engaging with the platform. Study findings suggest that this intervention is equally effective across gender, self-reported financial status, and self-reported physical health status and particularly effective for individuals without a history of psychotherapy. Overall, study results suggest that multimodal digital psychotherapy is a potentially effective treatment for adult depression; nevertheless, experimental trials are needed. We discuss directions for future research.
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Affiliation(s)
- Enitan T Marcelle
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Laura Nolting
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francsco, CA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.,Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
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McClure C, Cunningham M, Bull S, Berman S, Allison MA. Using Mobile Health to Promote Early Language Development: A Narrative Review. Acad Pediatr 2018; 18:850-854. [PMID: 30098442 DOI: 10.1016/j.acap.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/13/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
In this narrative review, we first present a brief overview of known disparities in children's language development based on socioeconomic status and efforts in the primary care setting to promote children's language development. Next, we define mobile health (m-health) and review the limited, published literature regarding the effectiveness of m-health interventions in promoting children's health, in general, and language development, in particular. Finally, we discuss the potential role of smartphone applications to increase parental behaviors that promote their children's language development, as well as challenges that should be addressed as the field of m-health continues to grow.
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Affiliation(s)
- Catherine McClure
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora
| | - Maureen Cunningham
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora; Center for Global Health , Colorado School of Public Health, Aurora
| | - Sheana Bull
- Department of Community and Behavioral Health , Colorado School of Public Health, Aurora; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (M Allison), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Stephen Berman
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora; Center for Global Health , Colorado School of Public Health, Aurora
| | - Mandy A Allison
- Department of Pediatrics , University of Colorado Anschutz Medical Campus, Aurora.
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Endehabtu B, Weldeab A, Were M, Lester R, Worku A, Tilahun B. Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study. JMIR Pediatr Parent 2018; 1:e9. [PMID: 31518334 PMCID: PMC6715064 DOI: 10.2196/pediatrics.9618] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/14/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. OBJECTIVE The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)-based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. METHODS A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message-based mHealth intervention. RESULTS A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718). CONCLUSIONS A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message-based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message-based mHealth interventions.
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Affiliation(s)
- Berhanu Endehabtu
- eHealthLab Ethiopia, Department of Health Informatics, University of Gondar, Gondar, Ethiopia
| | - Adane Weldeab
- Health Education and Behavioral Sciences Unit, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt University, Vanderbilt, IN, United States
| | - Richard Lester
- Division of infectious disease, Faculty of Medicine, University of the British Columbia, Vancouver, BC, Canada
| | - Abebaw Worku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Binyam Tilahun
- eHealthLab Ethiopia, Department of Health Informatics, University of Gondar, Gondar, Ethiopia
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Overdijkink SB, Velu AV, Rosman AN, van Beukering MD, Kok M, Steegers-Theunissen RP. The Usability and Effectiveness of Mobile Health Technology-Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e109. [PMID: 29691216 PMCID: PMC5941088 DOI: 10.2196/mhealth.8834] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/17/2018] [Accepted: 02/16/2018] [Indexed: 01/18/2023] Open
Abstract
Background A growing number of mobile health (mHealth) technology–based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods We performed a systematic review searching the following electronic databases for studies on mHealth technology–based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. Conclusions Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care.
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Affiliation(s)
- Sanne B Overdijkink
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Adeline V Velu
- Academic Medical Center, Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam, Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Monique Dm van Beukering
- Academic Medical Center, Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam, Netherlands
| | - Marjolein Kok
- Academic Medical Center, Department of Obstetrics and Gynecology, University of Amsterdam, Amsterdam, Netherlands
| | - Regine Pm Steegers-Theunissen
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, Netherlands
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Momplaisir FM, Storm DS, Nkwihoreze H, Jayeola O, Jemmott JB. Improving postpartum retention in care for women living with HIV in the United States. AIDS 2018; 32:133-142. [PMID: 29194122 PMCID: PMC5757672 DOI: 10.1097/qad.0000000000001707] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 02/06/2023]
Abstract
: Research findings have consistently demonstrated that women living with HIV in the United States and globally experience declines in medication adherence and retention in care after giving birth. A number of studies have identified factors associated with postpartum retention in care, but the evidence base for interventions to address the problem and close this gap in the HIV care continuum is limited. Furthermore, the majority of studies have been conducted in low-resource or moderate-resource countries and may be less applicable or require adaptation for use in high resource countries. In the United States, up to two-thirds of women drop out of care after delivery and are unable to maintain or achieve viral suppression postpartum, at a time when maternal and pediatric health are closely linked. We conducted a critical review of the literature to identify existing gaps regarding maternal retention in the United States and conceptualize the problem through the lens of the integrated and ecological models of health behavior. This review describes existing barriers and facilitators to retention in HIV care postpartum from published studies and suggests steps that can be taken, using a multilevel approach, to improve maternal retention. We propose five core action steps related to increasing awareness of the problem of poor postpartum retention, addressing needs for improved care coordination and case management, and using novel approaches to adapt and implement peer support and technology-based interventions to improve postpartum retention and clinical outcomes of women living with HIV.
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Affiliation(s)
- Florence M. Momplaisir
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Deborah S. Storm
- Fairfield, California, (formerly François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Hervette Nkwihoreze
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Olakunle Jayeola
- Department of Environmental and Occupational Health, Dornsife School of Public Health at Drexel University
| | - John B. Jemmott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Justvig SP, Li J, Caravella G, Chen M, Wang H, Benz Scott LA, Pati S. Improving Adherence to Care Recommendations Using a Community Health Worker (CHW) Intervention with the Pediatric Medical Home. J Community Health 2018; 42:444-452. [PMID: 27743336 DOI: 10.1007/s10900-016-0275-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While CHW interventions improve health outcomes, evidence identifying specific domains of CHW-delivered support resulting in positive outcomes is limited. Our goals were to identify domains of CHW-delivered support that assist families with adhering to recommended pediatric care; and, to identify predictors of successful completion of an enriched medical home intervention (EMHI) using trained CHWs making home visits to provide health education and support positive health behaviors. We performed a prospective descriptive study of 88 families participating in a protocol-based EMHI. Completers (N = 46) finished the program with mutual agreement that the family can independently adhere to recommended clinical care. Non-completers (N = 42) were lost to follow-up or dropped out of the program before reaching this milestone. Using Grounded Theory, two trained coders evaluated CHW tasks recorded in an electronic database and classified these tasks across 17 domains. We assessed predictors of EMHI completion using logistic regression. The 88 EMHI participants were primarily <24 months of age (80 %), Hispanic (56 %), and Medicaid enrollees (67 %). Hispanic families (OR = 2.76, p = 0.04) and those with self-reported program goals to 'facilitate family's creation of a system to keep track of child's medical information' (OR = 3.11, p = 0.02) or a 'newborn-specific goal' (OR = 3.21, p = 0.04), such as feeding and safety tips, were more likely to complete the EMHI compared to their counterparts. The most consistent CHW tasks were supporting medical appointments, medication maintenance, and providing health education. CHW interventions designed to improve health behavior outcomes of 'at-risk' families, including Medicaid enrollees, may benefit from support in goal-setting and strategies to systematically manage their child's medical care.
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Affiliation(s)
- Sarah P Justvig
- School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Justine Li
- College of Arts and Sciences, Stony Brook University, Stony Brook, NY, USA
| | | | - Minqin Chen
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Hua Wang
- Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA
| | - Lisa A Benz Scott
- Program in Public Health, and School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA
| | - Susmita Pati
- School of Medicine, Stony Brook University, Stony Brook, NY, USA. .,Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA.
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Bhat A, Mao J, Unutzer J, Reed S, Unger J. Text messaging to support a perinatal collaborative care model for depression: A multi-methods inquiry. Gen Hosp Psychiatry 2018; 52:14-20. [PMID: 29494854 PMCID: PMC5936469 DOI: 10.1016/j.genhosppsych.2018.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mental health care integrated into obstetric settings improves access to perinatal depression treatments. Digital interactions such as text messaging between patient and provider can further improve access. We describe the use of text messaging within a perinatal Collaborative Care (CC) program, and explore the association of text messaging content with perinatal depression outcomes. METHODS We analyzed data from an open treatment trial of perinatal CC in a rural obstetric clinic. Twenty five women with Patient Health Questionnaire-9 score of ≥10 enrolled in CC, and used text messaging to communicate with their Care Manager(CM). We used surveys and focus groups to assessacceptability of text messaging with surveys and focus groups. We calculated the number of text messages exchanged, and analyzed content to understand usage patterns. We explored association between text messaging content and depression outcomes. RESULTS CMs initiated 85.4% messages, and patients responded to 86.9% messages. CMs used text messaging for appointment reminders, and patients used it to obtain obstetric and parenting information. CMs had concerns about the likelihood of boundary violations. Patients appreciated the asynchronous nature of text messaging. CONCLUSION Text messaging is feasible and acceptable within a perinatal CC program. We need further research into the effectiveness of text messaging content, and response protocols.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
| | - Johnny Mao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Susan Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jennifer Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA,Department of Global Health, University of Washington, Seattle, WA
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Abroms LC, Johnson PR, Leavitt LE, Cleary SD, Bushar J, Brandon TH, Chiang SC. A Randomized Trial of Text Messaging for Smoking Cessation in Pregnant Women. Am J Prev Med 2017; 53:781-790. [PMID: 28982527 PMCID: PMC5696101 DOI: 10.1016/j.amepre.2017.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/29/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is a need for innovation in both the enrollment of pregnant smokers in smoking cessation treatment programs and in the types of treatments offered. The study tests whether an interactive and intensive text messaging program, Quit4baby, can promote smoking cessation for pregnant women already enrolled in a health text messaging program, Text4baby. METHODS Between July 2015 and February 2016, a total of 35,957 recruitment text messages were sent to Text4baby subscribers. Eligible pregnant smokers were enrolled and randomized to receive Text4baby (control) or Text4baby and Quit4baby (intervention; N=497). Participants were surveyed at 1 month, 3 months, and 6 months post-enrollment, and saliva samples were collected at 3 months for biochemical verification of smoking status. Data were collected from 2015 to 2016 and analyzed in 2016. RESULTS Using an intention-to-treat analysis, 28.80% of the intervention group and 15.79% of the control group reported not smoking in the past 7 days at 1 month (p<0.01), and 35.20% of the intervention group and 22.67% of the control group reported not smoking in the past 7 days at 3 months (p<0.01). Biochemical verification of smoking status at 3 months indicated no significant differences between groups (15.60% in the intervention group and 10.93% in the control group [p=0.13]), although significant differences favoring the intervention were found for older smokers (p<0.05) and for those who enrolled in their second or third trimester of pregnancy (p<0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (p<0.001, p<0.01). No significant differences were observed at the 6-month follow-up or in the postpartum period. CONCLUSIONS Results provide limited support of the efficacy of the Quit4baby text messaging program in the short term and late in pregnancy, but not in the postpartum period.
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Affiliation(s)
- Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
| | | | - Leah E Leavitt
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Sean D Cleary
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | | | | | - Shawn C Chiang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56:e105-e122. [PMID: 28925418 PMCID: PMC6291822 DOI: 10.3414/me17-05-0003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care. OBJECTIVES The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs. METHODS Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles. RESULTS 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence. CONCLUSIONS SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
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Affiliation(s)
- Haitham Abaza
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
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Huberty JL, Buman MP, Leiferman JA, Bushar J, Hekler EB, Adams MA. Dose and timing of text messages for increasing physical activity among pregnant women: a randomized controlled trial. Transl Behav Med 2017; 7:212-223. [PMID: 27800565 PMCID: PMC5526801 DOI: 10.1007/s13142-016-0445-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Text4baby (T4b), a free nation-wide mobile health information service, delivers health-related text messages (SMS) to pregnant women. The objective of this study was to determine the effectiveness of physical activity (PA) specific SMS to improve PA in pregnant women (vs standard T4b) and the most effective dose/timing of PA-specific SMS to improve PA. Pregnant women (N = 80) were randomized to one of four groups that differed in frequency and time of SMS. The Fitbit™ Flex measured PA. Data were analyzed using mixed model analyses. There were no increases in PA regardless of frequency or time. Those that received six PA SMS/week had greater decreases in activity and greater increases in sedentary time. SMS may not be a "potent" enough strategy to improve PA. Future studies should explore a modified focus on behavior change (e.g., decrease sedentary activity, increase light activity) and incorporate SMS as part of a multi-level approach with other evidence-based strategies.
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Affiliation(s)
- Jennifer L Huberty
- Exercise Science and Health Promotion, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, USA.
| | - Matthew P Buman
- Exercise Science and Health Promotion, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, USA
| | - Jenn A Leiferman
- Department of Community and Behavioral Health Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | | | - Eric B Hekler
- Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | - Marc A Adams
- Exercise Science and Health Promotion, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, USA
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Bahanshal S, Coughlin S, Liu B. For You and Your Baby (4YYB): Adapting the Centers for Disease Control and Prevention's Text4Baby Program for Saudi Arabia. JMIR Res Protoc 2017; 6:e23. [PMID: 28246065 PMCID: PMC5350457 DOI: 10.2196/resprot.5818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/21/2016] [Accepted: 12/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Poor birth outcomes in the Kingdom of Saudi Arabia (KSA) have been found to be partially due to missed prenatal appointments as well as lack of knowledge of healthy pregnancy behaviors. OBJECTIVE The objectives are to summarize birth outcomes and the antenatal care system in KSA, summarize research related to the US Text4Baby mobile health program, and outline the development of an Arabic version of the Text4baby app, For You and Your Baby (4YYB). METHODS First, birth outcomes, health care access, and smartphone usage among Saudi Arabian women are reviewed. Next, the current evidence behind Text4Baby is described. Finally, a plan to develop and test 4YYB is proposed. In the plan, studies will need to be conducted to determine the effectiveness of 4YYB in educating pregnant Saudi women on healthy knowledge and behaviors. This will create an evidence base behind 4YYB before it is launched as a full-scale public health effort in KSA. RESULTS The KSA offers public medical services but remaining challenges include poor birth outcomes and health care access barriers. An estimated 73% to 84% of Saudi women of child-bearing age use smartphone social media apps. A total of 13 published articles on Text4Baby were identified and reviewed. Due to design limitations, the studies provide only limited evidence about the effectiveness of the program in increasing healthy pregnancy knowledge and behaviors. To be useful for Saudi women, the educational messages in 4YYB will need to be translated from English to Arabic and tailored for cultural norms. CONCLUSIONS Developing the 4YYB Arabic-language app for use by pregnant Saudi Arabian women based on Text4Baby is a viable approach, but a rigorous study design is needed to determine its effectiveness in improving healthy pregnancy knowledge and behaviors.
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Affiliation(s)
- Soha Bahanshal
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States
| | - Steven Coughlin
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Benyuan Liu
- Department of Computer Science, University of Massachusetts Lowell, Lowell, MA, United States
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Munro S, Hui A, Salmons V, Solomon C, Gemmell E, Torabi N, Janssen PA. SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions. JMIR Public Health Surveill 2017; 3:e7. [PMID: 28174149 DOI: 10.2196/publichealth.6949] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. OBJECTIVE To explore women's preferences for a prenatal education program by text messaging. METHODS We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women's perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. RESULTS A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages "all the time" (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. CONCLUSIONS This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes.
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Affiliation(s)
- Sarah Munro
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Amber Hui
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Salmons
- Maternal, Infant, Child and Youth, Public Health, Northern Health Authority, Quesnel, BC, Canada
| | - Carolyn Solomon
- Maternal and Women's Health, Public Health Services Branch, Population and Public Health Division, British Columbia Ministry of Health, Victoria, BC, Canada
| | - Emily Gemmell
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nahal Torabi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Patricia A Janssen
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Evans WD, Mays D. Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study. JMIR Mhealth Uhealth 2016; 4:e137. [PMID: 28007691 PMCID: PMC5216257 DOI: 10.2196/mhealth.6493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/19/2016] [Accepted: 12/15/2016] [Indexed: 01/05/2023] Open
Abstract
Background Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages. Objective The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs. Methods We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline. Results Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t6=–2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t20=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol. Conclusions This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages.
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Affiliation(s)
- William D Evans
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Georgetown University, Washington, DC, United States
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50
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Examining pregnancy-specific smartphone applications: what are patients being told? J Perinatol 2016; 36:802-7. [PMID: 27195980 DOI: 10.1038/jp.2016.77] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/18/2016] [Accepted: 04/04/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the informative content of two free, pregnancy-specific smartphone applications and their accuracy and adherence to prenatal care guidelines. STUDY DESIGN This is a qualitative analysis of the information delivered through two free, pregnancy-specific smartphone applications (apps): Text4Baby (T4B) and Baby Center's 'My Pregnancy Today' (BC). All information from conception through 2 weeks postpartum were transcribed and coded independently by two physician researchers. Content was analyzed and assigned thematic codes. The proportion of content each app delivered per theme was then calculated and the χ(2)-test was used to compare thematic frequency between apps. RESULTS A total of 609 pieces of daily content were transcribed; 698 message themes were coded and analyzed. Most information delivered by T4B was about fetal development (23.8%) or prenatal care (16.6%); most content from BC was about normal pregnancy symptoms (20.1%) or maternal well-being (21.1%); the differences between apps for each of these themes were statistically significant (P<0.05). A total of four messages contained incomplete or ambiguous content; neither app delivered overtly incorrect medical information. T4B and BC had a similar proportion of information that was in-line with the American College of Obstetrics and Gynecology Guidelines for Prenatal Care. Neither app delivered any messages about contraception. CONCLUSION T4B and BC are free, pregnancy-specific apps with different focuses. Neither app delivers comprehensive prenatal information, as evidenced by the absence of information about postpartum contraception. More information is needed to determine the role of such apps in prenatal care.
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