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Klooster IT, Kip H, van Gemert-Pijnen L, Crutzen R, Kelders S. A systematic review on eHealth technology personalization approaches. iScience 2024; 27:110771. [PMID: 39290843 PMCID: PMC11406103 DOI: 10.1016/j.isci.2024.110771] [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: 11/02/2023] [Revised: 03/05/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.
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Affiliation(s)
- Iris Ten Klooster
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Department of Research, Stichting Transfore, Deventer, the Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Saskia Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
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Abdelmalak N, Burns J, Suhlrie L, Laxy M, Stephan AJ. Consideration of inequalities in effectiveness trials of mHealth applications - a systematic assessment of studies from an umbrella review. Int J Equity Health 2024; 23:181. [PMID: 39261871 PMCID: PMC11389088 DOI: 10.1186/s12939-024-02267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness. METHODS We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool. RESULTS We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation. CONCLUSIONS Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems. REGISTRATION https://osf.io/89dhy/ .
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Affiliation(s)
- Nancy Abdelmalak
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Jacob Burns
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Laura Suhlrie
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Michael Laxy
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Anna-Janina Stephan
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Kengne AP, Brière JB, Gudiña IA, Jiang X, Kodjamanova P, Bennetts L, Khan ZM. The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:807-816. [PMID: 38366854 DOI: 10.1080/14737167.2024.2319598] [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: 07/19/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia. METHODS We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2. RESULTS Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence. CONCLUSIONS Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.
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Affiliation(s)
| | | | | | - Xiaobin Jiang
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Liga Bennetts
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
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Miao Y, Luo Y, Zhao Y, Liu M, Wang H, Wu Y. Effectiveness of eHealth Interventions in Improving Medication Adherence Among Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e58013. [PMID: 39008845 PMCID: PMC11287104 DOI: 10.2196/58013] [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: 03/03/2024] [Revised: 04/02/2024] [Accepted: 05/30/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Nonadherence to medication among patients with cardiovascular diseases undermines the desired therapeutic outcomes. eHealth interventions emerge as promising strategies to effectively tackle this issue. OBJECTIVE The aim of this study was to conduct a network meta-analysis (NMA) to compare and rank the efficacy of various eHealth interventions in improving medication adherence among patients with cardiovascular diseases (CVDs). METHODS A systematic search strategy was conducted in PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure Library (CNKI), China Science and Technology Journal Database (Weipu), and WanFang databases to search for randomized controlled trials (RCTs) published from their inception on January 15, 2024. We carried out a frequentist NMA to compare the efficacy of various eHealth interventions. The quality of the literature was assessed using the risk of bias tool from the Cochrane Handbook (version 2.0), and extracted data were analyzed using Stata16.0 (StataCorp LLC) and RevMan5.4 software (Cochrane Collaboration). The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS A total of 21 RCTs involving 3904 patients were enrolled. The NMA revealed that combined interventions (standardized mean difference [SMD] 0.89, 95% CI 0.22-1.57), telephone support (SMD 0.68, 95% CI 0.02-1.33), telemonitoring interventions (SMD 0.70, 95% CI 0.02-1.39), and mobile phone app interventions (SMD 0.65, 95% CI 0.01-1.30) were statistically superior to usual care. However, SMS compared to usual care showed no statistical difference. Notably, the combined intervention, with a surface under the cumulative ranking curve of 79.3%, appeared to be the most effective option for patients with CVDs. Regarding systolic blood pressure and diastolic blood pressure outcomes, the combined intervention also had the highest probability of being the best intervention. CONCLUSIONS The research indicates that the combined intervention (SMS text messaging and telephone support) has the greatest likelihood of being the most effective eHealth intervention to improve medication adherence in patients with CVDs, followed by telemonitoring, telephone support, and app interventions. The results of these network meta-analyses can provide crucial evidence-based support for health care providers to enhance patients' medication adherence. Given the differences in the design and implementation of eHealth interventions, further large-scale, well-designed multicenter trials are needed. TRIAL REGISTRATION INPLASY 2023120063; https://inplasy.com/inplasy-2023-12-0063/.
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Affiliation(s)
- Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuan Luo
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuhan Zhao
- School of Nursing, Capital Medical University, Beijing, China
| | - Mingxuan Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Huiying Wang
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Whitley MD, Perez LG, Castro G, Larson A, Derose KP. Modifying Text Messages from a Faith-Based Physical Activity Intervention with Latino Adults in Response to the COVID-19 Pandemic. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:399-407. [PMID: 36651265 PMCID: PMC9852972 DOI: 10.1177/2752535x221150009] [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] [Indexed: 01/19/2023]
Abstract
BACKGROUND Text messages are useful for health promotion and can be modified during public health emergencies. PURPOSE Describe how we developed and implemented a physical activity (PA) text messaging component within a faith-based intervention, modified the text message content in response to the COVID-19 pandemic and evaluated participants' perceptions of the modified text messages. RESEARCH DESIGN AND STUDY SAMPLE PA promotion text messages were delivered to predominately Spanish-speaking, churchgoing Latino adults (n = 284) in Los Angeles, California. In 2020, we modified the messages to disseminate COVID-19-related information and support and share virtual PA resources. DATA COLLECTION AND ANALYSIS We analyzed quantitative and qualitative survey data to gauge participants' experiences with the text messages. RESULTS COVID-19 related text messages were a feasible, acceptable addition to a PA intervention for a sample of Latinos. CONCLUSIONS Throughout the pandemic, the messages enabled continued communication and support for PA and protection from COVID-19 in a population at high-risk of health inequities.
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Affiliation(s)
- Margaret D Whitley
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
| | - Lilian G Perez
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
| | - Gabriela Castro
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
| | - Anne Larson
- California State University, Los Angeles, Los Angeles, CA, USA
| | - Kathryn P Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
- Department of Health Promotion & Policy, University of Massachusetts Amherst, Amherst, MA, USA
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Hartch CE, Dietrich MS, Lancaster BJ, Stolldorf DP, Mulvaney SA. Effects of a medication adherence app among medically underserved adults with chronic illness: a randomized controlled trial. J Behav Med 2024; 47:389-404. [PMID: 38127174 PMCID: PMC11026187 DOI: 10.1007/s10865-023-00446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
For individuals living with a chronic illness who require use of long-term medications, adherence is a vital aspect of successful symptom management and outcomes. This study investigated the effect of a smartphone app on adherence, self-efficacy, knowledge, and medication social support in a medically underserved adult population with various chronic illnesses. Participants were randomized to a group who used the app for one month or a control group provided with a printed medication list. Compared to the control group, participants receiving the intervention had significantly greater medication adherence (Cohen's d = -0.52, p = .014) and medication self-efficacy (Cohen's d = 0.43, p = .035). No significant effects were observed related to knowledge or social support. The findings suggest use of the app could positively impact chronic disease management in a medically underserved population in the United States.
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Affiliation(s)
- Christa E Hartch
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA.
- School of Nursing and Health Sciences, Manhattanville College, 2900 Purchase Street, Purchase, NY, 10577, USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
| | - B Jeanette Lancaster
- Sadie Heath Cabiness Professor and Dean Emerita, School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Deonni P Stolldorf
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
| | - Shelagh A Mulvaney
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, #1475, Nashville, TN, 37203, USA
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Ferreira PD, Simoes JA, Velho DC. Adherence to Antihypertensive Therapy and Its Determinants: A Systematic Review. Cureus 2024; 16:e59532. [PMID: 38826951 PMCID: PMC11144025 DOI: 10.7759/cureus.59532] [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] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Hypertension is a globally prevalent condition, and low adherence to antihypertensive therapy is considered one of the main causes of poor blood pressure (BP) control. Non-adherence to antihypertensive treatment is a complex issue that can arise from various factors; however, gaining an understanding of this provides key targets for intervention strategies. This study aimed to provide an overview of the current status and recent developments regarding our understanding of the determinants of patients' adherence to antihypertensives. A systematic review was performed using the electronic databases MEDLINE/PubMed, Web of Science, Scientific Electronic Library Online (SciELO), and "Índex das Revistas Médicas Portuguesas", which included studies published between 2017 and 2021 following the PICOS model: (P) Adult patients with the diagnosis of primary hypertension, using at least one antihypertensive agent; (I) all interventions on both pharmacological and non-pharmacological level; (C) patient's adherence against their non-adherence; (O) changes in adherence to the therapeutic plan; and (S) any study design (except review articles) written in English, French, Spanish or Portuguese. Articles were reviewed by two researchers and their quality was assessed. Subsequently, determinants were classified according to their consistent or inconsistent association with adherence or non-adherence. Only 45 of the 635 reports identified met the inclusion criteria. Adherence was consistently associated with patient satisfaction with communication, patient-provider relationship, their treatment, and use of eHealth and mHealth strategies; a patient's mental and physical health, including depression, cognitive impairment, frailty, and disability, previous hospitalization, occurrence of vital events; drug treatment type and appearance; and unwillingness due to health literacy, self-efficacy, and both implicit and explicit attitudes towards treatment. There were discrepancies regarding the association of other factors to adherence, but these inconsistent factors should also be taken into account. In conclusion, the barriers to adherence are varied and often interconnected between socioeconomic, patient, therapy, condition, and healthcare system levels. Healthcare teams should invest in studying patients' non-adherence motives and tailoring interventions to individual levels, by using a multifaceted approach to assess adherence. Further research is needed to analyze the impact of implicit attitudes, the use of new technological approaches, and the influence of factors that are inconsistently associated with non-adherence, to understand their potential in implementing adherence strategies.
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Affiliation(s)
| | - Jose A Simoes
- Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, PRT
| | - Denise C Velho
- Family Medicine, ULS de Leiria, USF Santiago, Leiria, PRT
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Sun T, Xu X, Ding Z, Xie H, Ma L, Zhang J, Xia Y, Zhang G, Ma Z. Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e53006. [PMID: 38578692 PMCID: PMC11031705 DOI: 10.2196/53006] [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: 09/22/2023] [Revised: 12/22/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with "adherence" playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. OBJECTIVE The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. METHODS A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. RESULTS The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (-7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. CONCLUSIONS The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/46883.
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Affiliation(s)
- Ting Sun
- Graduate School, University of Science and Technology of China, Hefei, China
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Xuejie Xu
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Zenghui Ding
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Hui Xie
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Linlin Ma
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Jing Zhang
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Yuxin Xia
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Guoli Zhang
- School of Nursing, Bengbu Medical University, Bengbu, China
| | - Zuchang Ma
- Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
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Acharya S, Neupane G, Seals A, KC M, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Self-Measured Blood Pressure-Guided Pharmacotherapy: A Systematic Review and Meta-Analysis of United States-Based Telemedicine Trials. Hypertension 2024; 81:648-657. [PMID: 38189139 PMCID: PMC11213974 DOI: 10.1161/hypertensionaha.123.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The optimal approach to implementing telemedicine hypertension management in the United States is unknown. METHODS We examined telemedicine hypertension management versus the effect of usual clinic-based care on blood pressure (BP) and patient/clinician-related heterogeneity in a systematic review/meta-analysis. We searched United States-based randomized trials from Medline, Embase, CENTRAL, CINAHL, PsycINFO, Compendex, Web of Science Core Collection, Scopus, and 2 trial registries. We used trial-level differences in BP and its control rate at ≥6 months using random-effects models. We examined heterogeneity in univariable metaregression and in prespecified subgroups (clinicians leading pharmacotherapy [physician/nonphysician], self-management support [pharmacist/nurse], White versus non-White patient predominant trials [>50% patients/trial], diabetes predominant trials [≥25% patients/trial], and White patient predominant but not diabetes predominant trials versus both non-White and diabetes patient predominant trials]. RESULTS Thirteen, 11, and 7 trials were eligible for systolic and diastolic BP difference and BP control, respectively. Differences in systolic and diastolic BP and BP control rate were -7.3 mm Hg (95% CI, -9.4 to -5.2), -2.7 mm Hg (-4.0 to -1.5), and 10.1% (0.4%-19.9%), respectively, favoring telemedicine. Greater BP reduction occurred in trials where nonphysicians led pharmacotherapy, pharmacists provided self-management support, White patient predominant trials, and White patient predominant but not diabetes predominant trials, with no difference by diabetes predominant trials. CONCLUSIONS Telemedicine hypertension management is more effective than clinic-based care in the United States, particularly when nonphysicians lead pharmacotherapy and pharmacists provide self-management support. Non-White patient predominant trials achieved less BP reduction. Equity-conscious, locally informed adaptation of telemedicine interventions is needed before wider implementation.
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Affiliation(s)
- Sameer Acharya
- Department of Internal Medicine, Cayuga Medical Center, Ithaca, New York, USA
| | - Gagan Neupane
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Austin Seals
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Madhav KC
- Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Dean Giustini
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharan Sharma
- SCL Heart and Vascular Institute, Brighton, Colorado, USA
| | - Yhenneko J. Taylor
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Deepak Palakshappa
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Jeff D. Williamson
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Hayden B. Bosworth
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Yashashwi Pokharel
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
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Katz ME, Mszar R, Grimshaw AA, Gunderson CG, Onuma OK, Lu Y, Spatz ES. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356070. [PMID: 38353950 PMCID: PMC10867699 DOI: 10.1001/jamanetworkopen.2023.56070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. Objective To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. Data Sources In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Study Selection Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data Extraction and Synthesis Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Main Outcomes and Measures Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. Results A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. Conclusions and Relevance In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.
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Affiliation(s)
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G. Gunderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Oyere K. Onuma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Yuan Lu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Erica S. Spatz
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
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11
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Hartch CE, Dietrich MS, Stolldorf DP. Effect of a Medication Adherence Mobile Phone App on Medically Underserved Patients with Chronic Illness: Preliminary Efficacy Study. JMIR Form Res 2023; 7:e50579. [PMID: 38079192 PMCID: PMC10750237 DOI: 10.2196/50579] [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: 07/05/2023] [Revised: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Medication adherence is vital in the treatment of patients with chronic illness who require long-term medication therapies to maintain optimal health. Medication adherence, a complex and widespread problem, has been difficult to solve. Additionally, lower-income, medically underserved communities have been found to have higher rates of inadequate adherence to oral medications. Even so, this population has been underrepresented in studies using mobile medication adherence app interventions. Federally qualified health centers provide care for medically underserved populations, defined as communities and populations where there is a demonstrable unmet need for health services. These centers have been reporting an increase in a more complex chronic disease population. Including medically underserved individuals in mobile health studies provides opportunities to support this disproportionately affected group, work toward reducing health disparities in access to health care, and understand barriers to mobile health uptake. OBJECTIVE The aim of this preliminary efficacy study was to evaluate the effects and feasibility of a commercially available medication adherence app, Medisafe, in a medically underserved adult population with various chronic illnesses seeking care in a federally qualified health center. METHODS Participants in this single-arm pre-post intervention preliminary efficacy study (N=10) completed a baseline survey, used the app for 2 weeks, and completed an end-of-study survey. The primary outcome measures were medication adherence and medication self-efficacy. Feedback on the use of the app was also gathered. RESULTS A statistically significant median increase of 8 points on the self-efficacy for adherence to medications scale was observed (P=.03, Cohen d=0.69). Though not significant, the adherence to refills and medications scale demonstrated a median change of 2.5 points in the direction of increased medication adherence (P=.21, Cohen d=0.41). Feedback about the app was positive. CONCLUSIONS Use of the Medisafe app is a viable option to improve medication self-efficacy and medication adherence in medically underserved patients in an outpatient setting with a variety of chronic illnesses.
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Affiliation(s)
- Christa E Hartch
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- School of Nursing and Health Sciences, Manhattanville College, Purchase, NY, United States
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
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Arnold ML, Sanchez VA, Carrasco DN, Martinez D, Dhar S, Stickel A, Perreira KM, Athanasios T, Lee DJ. Risk factors associated with occupational noise-induced hearing loss in the Hispanic community health study/study of Latinos: A cross-sectional epidemiologic investigation. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:586-597. [PMID: 37615410 DOI: 10.1080/15459624.2023.2250403] [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] [Indexed: 08/25/2023]
Abstract
The purpose of this study was to estimate the prevalence of occupational noise exposure and risk factors of occupational noise-induced hearing loss (NIHL) in Hispanic/Latino adults included in the baseline wave of the Hispanic Community Health Study/Study of Latinos collected from 2008 to 2011. Sequential multiple linear regression modeled the relationship between occupational NIHL (defined as a 3-, 4-, 6-kHz pure-tone average [PTA]) and occupation type, self-reported noise exposure, cardiovascular disease (CVD) risk score, and hearing protective device (HPD) use. The final model controlled for sex, age, and recreational noise exposure. Among 12,851 included participants, approximately 40% (n = 5036) reported occupational noise exposure "Sometimes" (up to 50% of the time) or "Frequently" (75-100% of the time). In the final fitted model, longest-held occupation and CVD risk were associated with poorer hearing. Specifically, those in non-skilled, service, skilled, and military/police/other job categories had between 2.07- and 3.29-dB worse PTA than professional/office workers. Additionally, a shift in the CVD risk score category from low to medium was associated with a 2.25- and 8.20-dB worse PTA for medium and high CVD risk, respectively. Age and sex were also significantly associated with poorer hearing, such that men presented with 6.08 dB worse PTA than women, and for every one-year increase in age, PTA increased by 0.62 dB (ps < .001). No interactions were seen between noise*sometimes or frequent exposure to other ototoxic agents and PTA (ps = .33 & .92, respectively). The prevalence of occupational noise exposure was high in this cross-sectional investigation of adults from Hispanic/Latino backgrounds. Findings contribute to the extant literature by demonstrating that risk factors for occupational NIHL in adults from varying Hispanic/Latino backgrounds are consistent with those of other previously studied groups.
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Affiliation(s)
- Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida
| | - Victoria A Sanchez
- Department of Otolaryngology - Head and Neck Surgery, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | | | - Diane Martinez
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida
| | - Sumitrajit Dhar
- School of Communication, Northwestern University, Evanston, Illinois
| | - Ariana Stickel
- Department of Psychology, San Diego State University, San Diego, California
| | - Krista M Perreira
- Department of Health Policy, and Management, University of North Carolina, Chapel Hill, North Carolina
| | - Tsalatsanis Athanasios
- Biostatistics Core, University of South Florida - Morsani College of Medicine, Tampa, Florida
| | - David J Lee
- Miller School of Medicine, University of Miami, Coral Gables, Florida
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Piskorz D, Alcocer L, López Santi R, Puente Barragán A, Múnera A, Molina DI, Galván Oseguera H, Barroso WS, Palomo S, Díaz-Díaz E, Cardona-Muñoz E, Wyss F, Ponte Negretti C, Rosas Peralta M, Chávez Mendoza A, Alvares López H, Patiño EP, Guerra López A, Escudero X, Enciso JM. Blood pressure telemonitoring and telemedicine, a Latin America perspective. Blood Press 2023; 32:2251586. [PMID: 37635629 DOI: 10.1080/08037051.2023.2251586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To share a Latin-American perspective of the use of telemedicine, together with blood pressure measurements outside the medical office, as a potential contribution to improving access to the health system, diagnosis, adherence, and persistence in hypertension treatment. MATERIAL AND METHODS A document settled by a Writing Group of Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Epidemiology and Cardiovascular Prevention Council of the Interamerican Society of Cardiology, and National Cardiologist Association of Mexico. RESULTS In almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality. Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension. The clinical practitioner has seen increased evidence that the use of out-of-office blood pressure (BP) measurement and telemedicine are helpful tools to keep patients and physicians in contact and promote better pharmacological adherence and BP control. A survey carried out by medical and scientific institutions showed that practitioners are up-to-date with telemedicine, had internet access, and had hardware availability. CONCLUSIONS A transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension.
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Affiliation(s)
| | - Luis Alcocer
- Mexico Institute of Cardiovascular Health, Mexico City, Mexico
| | | | | | - Ana Múnera
- Rosario Tesoro Clinic-Cardioestudio, Medellin, Colombia
| | | | | | | | - Silvia Palomo
- Group of Mexico Hypertension Experts Group, Mexico City, Mexico
| | | | | | - Fernando Wyss
- Cardiovascular Services and Technology of Guatemala, Guatemala, Guatemala
| | | | | | - Adolfo Chávez Mendoza
- Cardiology Hospital, National Medical Center XXI Century, Mexico Institute of Social Security, Mexico City, Mexico
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Bakema R, Smirnova D, Biri D, Kocks JWH, Postma MJ, de Jong LA. The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review. J Med Internet Res 2023; 25:e42474. [PMID: 37751232 PMCID: PMC10565624 DOI: 10.2196/42474] [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: 09/05/2022] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. METHODS We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. RESULTS Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.
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Affiliation(s)
- Robbert Bakema
- Nederlandse Service Apotheek Beheer BV, 's-Hertogenbosch, Netherlands
| | - Daria Smirnova
- Asc Academics, Groningen, Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Despina Biri
- Asc Academics, Groningen, Netherlands
- Victoria Hospital, Kirkcaldy, United Kingdom
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, Netherlands
- Groningen Research Institute Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Lisa A de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Acharya S, Neupane G, Seals A, Madhav KC, Giustini D, Sharma S, Taylor YJ, Palakshappa D, Williamson JD, Moore JB, Bosworth HB, Pokharel Y. Heterogeneity of the Effect of Telemedicine Hypertension Management Approach on Blood Pressure: A Systematic Review and Meta-analysis of US-based Clinical Trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.14.23295587. [PMID: 37745417 PMCID: PMC10516092 DOI: 10.1101/2023.09.14.23295587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Telemedicine management of hypertension (TM-HTN) uses home blood pressure (BP) to guide pharmacotherapy and telemedicine-based self-management support (SMS). Optimal approach to implementing TM-HTN in the US is unknown. Methods We conducted a systematic review and a meta-analysis to examine the effect of TM-HTN vs. usual clinic-based care on BP and assessed heterogeneity by patient- and clinician-related factors. We searched US-based randomized clinical trials among adults from Medline, Embase, CENTRAL, CINAHL, PsycInfo, and Compendex, Web of Science Core Collection, Scopus, and two trial registries to 7/7/2023. Two authors extracted, and a third author confirmed data. We used trial-level differences in systolic BP (SBP), diastolic BP (DBP) and BP control rate at ≥6 months using random-effects models. We examined heterogeneity of effect in univariable meta-regression and in pre-specified subgroups [clinicians leading pharmacotherapy (physician vs. non-physician), SMS (pharmacist vs. nurse), White vs. non-White patient predominant trials (>50% patients/trial), diabetes predominant trials (≥25% patients/trial) and in trials that have majority of both non-White patients and patients with diabetes vs. White patient predominant but not diabetes predominant trials. Results Thirteen, 11 and 7 trials were eligible for SBP, DBP and BP control, respectively. Differences in SBP, DBP and BP control rate were -7.3 mmHg (95% CI: - 9.4, -5.2), -2.7 mmHg (-4.0, -1.5) and 10.1% (0.4%, 19.9%), respectively, favoring TM-HTN. More BP reduction occurred in trials with non-physician vs. physician led pharmacotherapy (9.3/4.0 mmHg vs. 4.9/1.1 mmHg, P<0.01 for both SBP/DBP), pharmacist vs. nurses provided SMS (9.3/4.1 mmHg vs. 5.6/1.0 mmHg, P=0.01 for SBP, P<0.01 for DBP), and White vs. non-White patient predominant trials (9.3/4.0 mmHg vs. 4.4/1.1 mmHg, P<0.01 for both SBP/DBP), with no difference by diabetes predominant trials. Lower BP reduction occurred in both diabetes and non-White patient predominant trials vs. White patient predominant but not diabetes predominant trials (4.5/0.9 mmHg vs. 9.5/4.2 mmHg, P<0.01 for both SBP/DBP). Conclusions TM-HTN is more effective than clinic-based care in the US, particularly when non-physician led pharmacotherapy and pharmacist provided SMS. Non-White patient predominant trials seemed to achieve lesser BP reduction. Equity conscious, locally informed adaptation of TM-HTN is needed before wider implementation. Clinical Perspective What Is New?: In this systematic review and meta-analysis of US-based clinical trials, we found that telemedicine management of hypertension (TM-HTN) was more effective in reducing and controlling blood pressure (BP) compared with clinic based hypertension (HTN) care.The BP reduction was more evident when pharmacotherapy was led by non-physician compared with physicians and HTN self-management support was provided by clinical pharmacists compared with nurses,Non-White patient predominant trials achieved lesser BP reductions than White patient predominant trials.What Are the Clinical Implications?: Before wider implementation of TM-HTN intervention in the US, locally informed adaptation, such as optimizing the team-based HTN care approach, can provide more effective BP control.Without equity focused tailoring, TM-HTN intervention implemented as such can exacerbate inequities in BP control among non-White patients in the US.
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Wang C, Fang B, Regmi A, Yamaguchi Y, Yang L, Cai Y. Text mining online disinformation about antihypertensive agents ACEI/ARB and COVID-19 on Sina Weibo. J Glob Health 2023; 13:06028. [PMID: 37593954 PMCID: PMC10436343 DOI: 10.7189/jogh.13.06028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background The global COVID-19 pandemic outbreak has caused a significant social and economic burden, with over 4.7 million confirmed cases and thousands of casualties. Moreover, pandemic-related misinformation and disinformation on social media platforms have led to intense psychosocial issues. We investigated online disinformation about angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blocker (ARB) drugs and their relationship to COVID-19 on Sina Weibo. Methods We searched for posts related to the pandemic from its beginning in December 2019 to 19 January 2021. We used text mining to identify content related to "antihypertensive agents ACEI/ARB can increase COVID-19". Results We found 82 posts spreading disinformation and 44 posts dispelling disinformation. The former had 535 clicks and concerns and 31 comments, and was forwarded 98 times. Of the 82 posts spreading disinformation, 15.9% (n = 13) contained pseudo-scientific information, 24.4% (n = 20) contained authoritative releases, and 75.6% (n = 62) contained normal personal releases. Most disinformation posts (n = 61 (74.3%)) were published from 16 February 2020 to 16 March 2020, and 12.2% (n = 10) were published from 1 February 2021 to 16 March 2021. Among the 44 dispelling disinformation posts, approximately 57.1% of the comments were in support, and 42.9% were opposed or invalid. Nearly half of the users were confused or superstitious about the disinformation. Conclusions The disinformation about ACEI/ARB increasing the opportunity for COVID-19 infection during the pandemic was based on clinical mechanisms and scientific evidence intended for hypertensive patients taking long-term medication. It was packaged in a pseudo-scientific shell, leading to confusion and panic among patients. This disinformation harmed COVID-19 prevention efforts, damaged mental health, and possibly led to harmful behaviours. In future crises, the spread of rumours should be stopped quickly and effectively.
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Affiliation(s)
- Chunli Wang
- Department of Geriatrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Fang
- Department of Information Management, School of Management, Shanghai University, Shanghai, China
| | - Aksara Regmi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yoshifumi Yamaguchi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Yang
- Department of Geriatrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Geriatrics, Shanghai Fourth People’s Hospital affiliated to Tongji University, Shanghai, China
| | - Yuyang Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai, China
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Kim KK, McGrath SP, Solorza JL, Lindeman D. The ACTIVATE Digital Health Pilot Program for Diabetes and Hypertension in an Underserved and Rural Community. Appl Clin Inform 2023; 14:644-653. [PMID: 37201542 PMCID: PMC10431973 DOI: 10.1055/a-2096-0326] [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: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic. OBJECTIVES The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community. METHODS ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension. RESULTS Participants were adult patients with uncontrolled diabetes and/or hypertension (n = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80). CONCLUSION The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.
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Affiliation(s)
- Katherine K. Kim
- MITRE Corporation, Health Innovation Center, McLean, Virginia, United States
- Department of Public Health Sciences, Division of Health Informatics, University of California Davis, School of Medicine, Sacramento, California, United States
| | - Scott P. McGrath
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
| | - Juan L. Solorza
- Livingston Community Health, Livingston, California, United States
| | - David Lindeman
- CITRIS and the Banatao Institute, University of California Berkeley, Berkeley, California, United States
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Poblete JY, Vawter NL, Lewis SV, Felisme EM, Mohn PA, Shea J, Northrup AW, Liu J, Al-Rousan T, Godino JG. Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study. JMIR Hum Factors 2023; 10:e46313. [PMID: 37486745 PMCID: PMC10407769 DOI: 10.2196/46313] [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: 03/09/2023] [Revised: 05/27/2023] [Accepted: 06/17/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. OBJECTIVE We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). METHODS Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. RESULTS A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. CONCLUSIONS Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.
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Affiliation(s)
- Jacqueline Yareli Poblete
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Natalie Lauren Vawter
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Sydney Virginia Lewis
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Earl Marc Felisme
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Paloma Adriana Mohn
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Jennifer Shea
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Adam William Northrup
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Jie Liu
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, La Jolla, CA, United States
| | - Job Gideon Godino
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, La Jolla, CA, United States
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Culhane-Pera KA, Vang KB, Ortega LM, Xiong T, Northuis CA, de la Parra P, Lakshminarayan K. Mobile health technology for hypertension management with Hmong and Latino adults: mixed-methods community-based participatory research. ETHNICITY & HEALTH 2023; 28:413-430. [PMID: 35387531 PMCID: PMC9535036 DOI: 10.1080/13557858.2022.2059451] [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: 05/11/2021] [Accepted: 03/23/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To identify Hmong and Latino adults' perspectives about a mHealth-based care model for hypertension (HTN) management involving blood pressure (BP) self-monitoring, electronic transmission of BP readings, and responsive HTN medication adjustment by a provider team. DESIGN We conducted a mixed-methods formative study with 25 Hmong and 25 Latino participants with HTN at an urban federally-qualified health center. We used a tool to assess HTN knowledge and conducted open-ended interviews to identify perspectives about mHealth-based care model. RESULTS While most participants agreed that lowering high blood pressure decreased the risk of strokes, heart attacks, and kidney failure, there were gaps in medical knowledge. Three major themes emerged about the mHealth-based care model: (1) Using mHealth technology could be useful, especially if assistance was available to patients with technological challenges; (2) Knowing blood pressures could be helpful, especially to patients who agreed with doctors' medical diagnosis and prescribed treatment; (3) Transmitting blood pressures to the clinic and their responsive actions could feel empowering, and the sense of increased surveillance could feel entrapping. Some people may feel empowered since it could increase patient-provider communication without burden of clinic visits and could increase involvement in BP control for those who agree with the medical model of HTN. However, some people may feel entrapped as it could breach patient privacy, interfere with patients' lifestyle choices, and curtail patient autonomy. CONCLUSIONS In general, Hmong and Latino adults responded positively to the empowering aspects of the mHealth-based care model, but expressed caution for those who had limited technological knowledge, who did not agree with the medical model and who may feel entrapped. In a shared decision-making approach with patients and possibly their family members, health care systems and clinicians should explore barriers and potential issues of empowerment and entrapment when offering a mHealth care model in practice.
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Affiliation(s)
| | | | | | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Carin A Northuis
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pilar de la Parra
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Siopis G, Moschonis G, Eweka E, Jung J, Kwasnicka D, Asare BYA, Kodithuwakku V, Willems R, Verhaeghe N, Annemans L, Vedanthan R, Oldenburg B, Manios Y. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health 2023; 5:e144-e159. [PMID: 36828607 DOI: 10.1016/s2589-7500(23)00002-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. FINDINGS Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. INTERPRETATION SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility. FUNDING European Union's Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- George Siopis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Evette Eweka
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Vimarsha Kodithuwakku
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium; Research Institute for Work and Society, HIVA KU Leuven, Leuven, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC, Australia; NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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21
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Rodriguez JA, Seiglie JA, Caballero AE. What Does a New Health Technology Landscape Mean for Hispanic/Latino People With Diabetes? Clin Diabetes 2023; 41:289-291. [PMID: 37092153 PMCID: PMC10115760 DOI: 10.2337/cd22-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Jorge A. Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jacqueline Anne Seiglie
- Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Augusto Enrique Caballero
- Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
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22
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Yan S, Luo S, Yang X, He L, Chen X, Que G. Effectiveness of online caries management platform in children's caries prevention: A randomized controlled trial. Front Public Health 2023; 11:1102503. [PMID: 36844857 PMCID: PMC9947237 DOI: 10.3389/fpubh.2023.1102503] [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: 11/19/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Purpose To construct an online caries management platform and evaluate its efficacy in children's caries prevention based on caries risk. Methods The study participants were second-grade pupils. The caries risk assessment tool (CAT) was used to grade caries risk for all participants, who were randomly divided into the experimental (114 pupils) and control (111 pupils) groups. The experimental group used the Internet for caries management, while the control group was managed by traditional lecturing in classroom. The caries status of each surface of the first permanent molars was recorded. The basic information and oral health knowledge, attitude, and behaviors of participants were collected by questionnaire. One year later, outcome data were collected. Pearson's chi-squared test was used to analyze the caries risk assessment items and oral health behaviors. The Mann-Whitney U-test was used to analyze the decayed-missing-filled surfaces (DMFS) index, plaque index, and scores of oral health knowledge and attitude. P < 0.05 was considered statistically significant. This study was available on the website of Chinese Clinical Trials Register (No: MR-44-22-012947). Results After 1 year, the oral health knowledge score was improved by 20.58% (P < 0.001) in the experimental group and 6.02% in the control group. The plaque index was improved by 49.60% (P < 0.001) in the experimental group and 21.01% in the control group. The DMFS index increased in both groups but there were no significant differences (P = 0.608). The experimental group had a better improvement effect in caries risk assessment items than the control group, including "whether the frequency of eating sugary snacks or drinks between meals is more than 3 times/day" (P = 0.033) and the use of fluoridated toothpaste (P = 0.020). The experimental group was better than the control group in reported oral health behaviors, including frequency of eating sweets before sleep (P = 0.032), brushing time (P = 0.001), and the filled rate (proportion of FS in DMFS) of first permanent molars (P = 0.003). Conclusions The online caries management platform showed more advantages than traditional lecturing in improving oral health knowledge and behaviors (oral hygiene practice, sugar consumption behavior, and medical treatment behavior). This platform provides a reliable implementation path for the occurrence and continuous improvement of oral health-related behaviors.
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Affiliation(s)
- Siqi Yan
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Song Luo
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoxia Yang
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Lidan He
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Xinyi Chen
- Stomatological Hospital, Southern Medical University, Guangzhou, China
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23
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Christon LM, Chandler J, Benfield K, Pairet S, Hoffman M, Treiber F, James WE. Perceptions of the Fatigue Experience and a Breathing Awareness Meditation-Integrated mHealth App for Fatigue and Stress in Patients with Sarcoidosis. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2022; 11:14-34. [PMID: 37982097 PMCID: PMC10655927 DOI: 10.1080/21641846.2022.2154499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
Objective Sarcoidosis-associated fatigue is a debilitating consequence of sarcoidosis, a multi-system inflammatory disease, and may be related to increased stress associated with sarcoidosis. Breathing awareness meditation has potential as an intervention for managing stress and fatigue for sarcoidosis patients (SPs). This project's aim was to obtain feedback from key informants to design and tailor a patient-centered Sarcoidosis Patient Resource and Companion (SPARC) mHealth App developed for SPs to manage fatigue and stress at home using breathing awareness meditation. Methods We used a mixed-method patient/user-centered design with triangulation to understand SPs experiences of sarcoidosis-associated fatigue and stress (n = 13), and obtain feedback on the SPARC App-prototype integrating breathing awareness meditation from these SPs and health care team members (HCTMs; n = 5). Using deductive content analysis, transcribed interviews were coded for themes and subthemes. Results We report on findings from qualitative interviews and assessment of SPs' experiences including themes describing fatigue/stress interactions. Themes indicated that SPs find fatigue to be a profoundly difficult experience affecting multiple domains of functioning for which they perceive few effective strategies to cope. SPs and HCTMs shared feedback on the SPARC App-prototype after a test session; it was reported to be user friendly and to have potential for improving fatigue/stress, and key points for tailoring the App to SPs were shared. Conclusion Sarcoidosis-associated fatigue poses a significant burden for SPs. The SPARC App-prototype with breathing awareness meditation was acceptable and feasible to use and was well-received by SPs and HCTMs. Future iterations of the SPARC App to test the effect of breathing awareness meditation on fatigue will need to incorporate recommendations for tailoring for SPs.
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Affiliation(s)
- Lillian M Christon
- Medical University of South Carolina (MUSC), College of Medicine, Department of Psychiatry & Behavioral Sciences
| | - Jessica Chandler
- MUSC, College of Nursing, Department of Nursing, Technology Applications Center for Healthful Lifestyles
| | - Katie Benfield
- MUSC, College of Medicine, Department of Medicine, Susan Pearlstine Sarcoidosis Center of Excellence
| | - Samantha Pairet
- MUSC, College of Nursing, Department of Nursing, Technology Applications Center for Healthful Lifestyles
| | - Maria Hoffman
- MUSC, College of Medicine, Department of Medicine, Susan Pearlstine Sarcoidosis Center of Excellence
| | - Frank Treiber
- MUSC, College of Nursing, Department of Nursing, Technology Applications Center for Healthful Lifestyles
| | - W Ennis James
- MUSC, College of Medicine, Department of Medicine, Susan Pearlstine Sarcoidosis Center of Excellence
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Bhatt G, Goel S, Grover S, Medhi B, Singh G, Gill SS, Swasticharan L, Singh RJ. Development of a multi-component tobacco cessation training package utilizing multiple approaches of intervention development for health care providers and patients attending non-communicable disease clinics of Punjab, India. Front Public Health 2022; 10:1053428. [PMID: 36530680 PMCID: PMC9755677 DOI: 10.3389/fpubh.2022.1053428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Providing patients with personalized tobacco cessation counseling that is culturally sensitive, and disease-specific from healthcare providers (HCPs) as part of their routine consultations is an approach that could be incorporated, using existing healthcare systems such as the Non-Communicable Disease (NCD) clinics. This paper describes the development of a multi-component culturally tailored, patient-centric, disease-specific tobacco cessation package utilizing multiple approaches of intervention development for healthcare providers and patients attending these clinics in Punjab, India, along with a proposed framework for implementation. Methods The proposed intervention package was developed in 6 stages. These included a review of literature for identifying successful cessation interventions for ethnic minority groups, co-production of the package with all stakeholders involved via a series of consultative meetings and workshops, understanding contextual factors of the state and 'factor-in' these in the package, pre-test of the package among HCPs and tobacco users using in-depth interviews, micro detailing and expansion of the package by drawing on existing theories of the Cascade Model and Trans-Theoretical Model and developing an evolving analysis plan through real-world implementation at two pilot districts by undertaking a randomized controlled trial, assessing implementer's experiences using a mixed-method with a primary focus on qualitative and economic evaluation of intervention package. Results A multi-component package consisting of a booklet (for HCPs), disease-specific pamphlets and short text messages (for patients; bilingual), and an implementation framework was developed using the 6-step process. A major finding from the in-depth interviews was the need for a specific capacity-building training program on tobacco cessation. Therefore, using this as an opportunity, we trained the in-service human resource and associated program managers at the state and district-level training workshops. Based on the feedback, training objectives were set and supported with copies of intervention package components. In addition, the role and function of each stakeholder were defined in the proposed framework. Conclusion Consideration of tobacco users' socio-cultural and patient-centric approach makes a robust strategy while developing and implementing an intervention providing an enlarged scope to improve care services for diversified socio-cultural communities.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,Public Health Master's Program, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, Ireland,Faculty of Human and Health Sciences, Swansea University, Swansea, United Kingdom,*Correspondence: Sonu Goel
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurmandeep Singh
- National Health Mission, Department of Health and Family Welfare Government of Punjab, Chandigarh, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Leimapokpam Swasticharan
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Rana J. Singh
- Department of Tobacco and NCD Control, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
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Onakomaiya D, Cooper C, Barber A, Roberts T, Gyamfi J, Zanowiak J, Islam N, Ogedegbe G, Schoenthaler A. Strategies to Improve Medication Adherence and Blood Pressure Among Racial/Ethnic Minority Populations: A Scoping Review of the Literature from 2017 to 2021. Curr Hypertens Rep 2022; 24:639-654. [PMID: 36136215 PMCID: PMC9712277 DOI: 10.1007/s11906-022-01224-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To identify intervention strategies that were effective in promoting medication adherence and HTN control among racial/ethnic minority groups in the US. RECENT FINDINGS Twelve articles were included in this review and 4 categories of intervention strategies were identified as counseling by trained personnel, mHealth tools, mHealth tools in combination with counseling by trained personnel, and quality improvement. The findings show that interventions delivered by trained personnel are effective in lowering BP and improving medication adherence, particularly for those delivered by health educators, CHWs, medical assistants, and pharmacists. Additionally, the combination of mHealth tools with counseling by trained personnel has the potential to be more effective than either mHealth or counseling alone and report beneficial effects on medication adherence and BP control. This review provides potential next steps for future research to examine the effectiveness of mHealth interventions in combination with support from trained health personnel and its effects on racial disparities in HTN outcomes.
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Affiliation(s)
- Deborah Onakomaiya
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Vilcek Institute of Graduate Biomedical Sciences, New York, USA
| | - Claire Cooper
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Aigna Barber
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Timothy Roberts
- Health Science Library, New York University Grossman School of Medicine, New York, NY, USA
| | - Joyce Gyamfi
- New York University School of Global Public Health, New York, NY, USA
| | - Jennifer Zanowiak
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Antoinette Schoenthaler
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
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Alzahrani SA, Bin Muammar MF, Bin Muammar AF, Alolah A, Almutawa M. The Adoption and Acceptance of mHealth Interventions for Self-Management of Hypertension Among Adult Patients: A Systematic Review. Cureus 2022; 14:e31584. [DOI: 10.7759/cureus.31584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
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Khoong EC, Commodore-Mensah Y, Lyles CR, Fontil V. Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity. Curr Hypertens Rep 2022; 24:599-613. [PMID: 36001268 PMCID: PMC9399977 DOI: 10.1007/s11906-022-01218-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To evaluate how self-measured blood pressure (SMBP) monitoring interventions impact hypertension equity. RECENT FINDINGS While a growing number of studies have recruited participants from safety-net settings, racial/ethnic minority groups, rural areas, or lower socio-economic backgrounds, few have reported on clinical outcomes with many choosing to evaluate only patient-reported outcomes (e.g., satisfaction, engagement). The studies with clinical outcomes demonstrate that SMBP monitoring (a) can be successfully adopted by historically excluded patient populations and safety-net settings and (b) improves outcomes when paired with clinical support. There are few studies that explicitly evaluate how SMBP monitoring impacts hypertension disparities and among rural, low-income, and some racial/ethnic minority populations. Researchers need to design SMBP monitoring studies that include disparity reduction outcomes and recruit from broader populations that experience worse hypertension outcomes. In addition to assessing effectiveness, studies must also evaluate how to mitigate multi-level barriers to real-world implementation of SMBP monitoring programs.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine at Zuckerberg, Department of Medicine, San Francisco General Hospital, UCSF, Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, USA.
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Courtney R Lyles
- Division of General Internal Medicine at Zuckerberg, Department of Medicine, San Francisco General Hospital, UCSF, Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Valy Fontil
- Division of General Internal Medicine at Zuckerberg, Department of Medicine, San Francisco General Hospital, UCSF, Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, USA
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Aguiar M, Trujillo M, Chaves D, Álvarez R, Epelde G. mHealth Apps Using Behavior Change Techniques to Self-report Data: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33247. [PMID: 36083606 PMCID: PMC9508675 DOI: 10.2196/33247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/15/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management. Objective This review aimed to identify behavior change techniques (BCTs) commonly used in mHealth, assess their effectiveness based on the evidence reported in interventions and reviews to highlight the most appropriate techniques to design an optimal strategy to improve adherence to data reporting, and provide recommendations for future interventions and research. Methods We performed a systematic review of studies published between 2010 and 2021 in relevant scientific databases to identify and analyze mHealth interventions using BCTs that evaluated their effectiveness in terms of user adherence. Search terms included a mix of general (eg, data, information, and adherence), computer science (eg, mHealth and BCTs), and medicine (eg, personalized medicine) terms. Results This systematic review included 24 studies and revealed that the most frequently used BCTs in the studies were feedback and monitoring (n=20), goals and planning (n=14), associations (n=14), shaping knowledge (n=12), and personalization (n=7). However, we found mixed effectiveness of the techniques in mHealth outcomes, having more effective than ineffective outcomes in the evaluation of apps implementing techniques from the feedback and monitoring, goals and planning, associations, and personalization categories, but we could not infer causality with the results and suggest that there is still a need to improve the use of these and many common BCTs for better outcomes. Conclusions Personalization, associations, and goals and planning techniques were the most used BCTs in effective trials regarding adherence to mHealth apps. However, they are not necessarily the most effective since there are studies that use these techniques and do not report significant results in the proposed objectives; there is a notable overlap of BCTs within implemented app components, suggesting a need to better understand best practices for applying (a combination of) such techniques and to obtain details on the specific BCTs used in mHealth interventions. Future research should focus on studies with longer follow-up periods to determine the effectiveness of mHealth interventions on behavior change to overcome the limited evidence in the current literature, which has mostly small-sized and single-arm experiments with a short follow-up period.
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Affiliation(s)
- Maria Aguiar
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
- Multimedia and Computer Vision Group, Universidad del Valle, Cali, Colombia
| | - Maria Trujillo
- Multimedia and Computer Vision Group, Universidad del Valle, Cali, Colombia
| | - Deisy Chaves
- Multimedia and Computer Vision Group, Universidad del Valle, Cali, Colombia
- Department of Electrical, Systems and Automation, Universidad de León, León, Spain
| | - Roberto Álvarez
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
- Biodonostia Health Research Institute, eHealth Group, Donostia-San Sebastián, Spain
| | - Gorka Epelde
- Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain
- Biodonostia Health Research Institute, eHealth Group, Donostia-San Sebastián, Spain
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Zhang Y, Tao Y, Zhong Y, Thompson J, Rahmani J, Bhagavathula AS, Xu X, Luo J. Feedback based on health advice via tracing bracelet and smartphone in the management of blood pressure among hypertensive patients: A community-based RCT trial in Chongqing, China. Medicine (Baltimore) 2022; 101:e29346. [PMID: 35839004 PMCID: PMC11132405 DOI: 10.1097/md.0000000000029346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Lifestyle interventions have been recognized as a line of treatment for noncommunicable diseases. This study aimed to evaluate a bespoke mHealth approach to deliver personalized feedback to improve blood pressure and weight for hypertensive patients in community settings. METHODS A total of 307 participants, 50 from each community, were expected to be in the intervention or control group. A professional health facilitator was assigned for each of the 6 communities. The primary outcomes of the study are the reduction in blood pressure and weight at baseline and postintervention. RESULTS Of 307 recruited, 192 participants (62.5%) completed the study (intervention: 104 and control: 88). There was no difference in attrition rates between the 2 groups (33.5% vs 41.9%, P = .291). After 6 month of intensive feedback intervention through the mHealth approach, patients had better blood pressure (133.4 ± 15.3 vs 139.7 ± 16.0) compared with control. CONCLUSIONS People who were adherent to the intervention demonstrated a clinical benefit in weight and blood pressure.
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Affiliation(s)
- Yong Zhang
- School of Public Health and Health Management, Chongqing Medical University, Chongqing, China
| | - Yang Tao
- Nan’an District Center of Disease Control, Chongqing, China
| | - Yun Zhong
- Nan’an District Center of Disease Control, Chongqing, China
| | - Jacqueline Thompson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy at Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Xiaoyang Xu
- Physical Examination Center of the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Luo
- Yangtze Normal University, Chongqing, China
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Kassavou A, Wang M, Mirzaei V, Shpendi S, Hasan R. The Association Between Smartphone App-Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e34767. [PMID: 35819830 PMCID: PMC9328789 DOI: 10.2196/34767] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/05/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. OBJECTIVE This systematic literature review evaluates the extent to which smartphone app-based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. METHODS A systematic search of 7 databases was conducted in August 2021. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. The search strategy was developed using keywords from previous reviews and relevant literature. Trials involving adults, published after the year 2000, and in the English language were considered for inclusion. The random-effects meta-analysis method was used to account for the distribution of the effect across the studies. RESULTS We identified 4638 articles, of which 227 were included for full-text screening. A total of 15 randomized controlled trials were included in the review. In total, 7415 patients with hypertension were included in the meta-analysis. The results indicate that app-based behavioral self-monitoring interventions had a small but significant effect in reducing systolic blood pressure (SBP), on average, by 1.64 mmHg (95% CI 2.73-0.55, n=7301; odds ratio [OR] 1.60, 95% CI 0.74-3.42, n=114) and in improving changes in medication adherence behavior (standardized mean difference [SMD] 0.78, 95% CI 0.22-1.34) compared to usual care or minimal intervention. The review found the intervention had a small effect on supporting improvements in healthy diet by changing habits related to high sodium food (SMD -0.44, 95% CI -0.79 to -0.08) and a trend, although insignificant, toward supporting smoking cessation, low alcohol consumption, and better physical activity behaviors. A subgroup analysis found that behavioral self-monitoring interventions combined with tailored advice resulted in higher and significant changes in both SBP and diastolic blood pressure (DBP) in comparison to those not providing tailored advice (SBP: -2.92 mmHg, 95% CI -3.94 to -1.90, n=3102 vs -0.72 mmHg, 95% CI -1.67 to 0.23, n=4199, χ2=9.65, P=.002; DBP: -2.05 mmHg, 95% CI -3.10 to -1.01, n=968 vs 1.54 mmHg, 95% CI -0.53 to 3.61, n=400, χ2=9.19, P=.002). CONCLUSIONS Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has a modest but potentially clinically significant effect on blood pressure reduction. Future studies could use rigorous methods to explore its effects on supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision. TRIAL REGISTRATION PROSPERO CRD42019136158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136158.
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Affiliation(s)
- Aikaterini Kassavou
- The Primary Care Unit, Department of Public Health and Primary Care, The University of Cambridge, Cambridge, United Kingdom
| | - Michael Wang
- The Primary Care Unit, Department of Public Health and Primary Care, The University of Cambridge, Cambridge, United Kingdom
| | - Venus Mirzaei
- The Primary Care Unit, Department of Public Health and Primary Care, The University of Cambridge, Cambridge, United Kingdom
| | - Sonia Shpendi
- The Primary Care Unit, Department of Public Health and Primary Care, The University of Cambridge, Cambridge, United Kingdom
| | - Rana Hasan
- The Primary Care Unit, Department of Public Health and Primary Care, The University of Cambridge, Cambridge, United Kingdom
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Brown SA, Hudson C, Hamid A, Berman G, Echefu G, Lee K, Lamberg M, Olson J. The pursuit of health equity in digital transformation, health informatics, and the cardiovascular learning healthcare system. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100160. [PMID: 38559893 PMCID: PMC10978355 DOI: 10.1016/j.ahjo.2022.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 04/04/2024]
Abstract
African Americans have a higher rate of cardiovascular morbidity and mortality and a lower rate of specialty consultation and treatment than Caucasians. These disparities also exist in the care and treatment of chemotherapy-related cardiovascular complications. African Americans suffer from cardiotoxicity at a higher rate than Caucasians and are underrepresented in clinical trials aimed at preventing cardiovascular injury associated with cancer therapies. To eliminate racial and ethnic disparities in the prevention of cardiotoxicity, an interdisciplinary and innovative approach will be required. Diverse forms of digital transformation leveraging health informatics have the potential to contribute to health equity if they are implemented carefully and thoughtfully in collaboration with minority communities. A learning healthcare system can serve as a model for developing, deploying, and disseminating interventions to minimize health inequities and maximize beneficial impact.
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Affiliation(s)
- Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Gift Echefu
- Baton Rouge General Medical Center, Department of Internal Medicine, Baton Rouge, LA, USA
| | - Kyla Lee
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Morgan Lamberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica Olson
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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Govier DJ, Cohen-Cline H, Marsi K, Roth SE. Differences in access to virtual and in-person primary care by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. BMC Health Serv Res 2022; 22:511. [PMID: 35428257 PMCID: PMC9012053 DOI: 10.1186/s12913-022-07858-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
Background Research exploring telehealth expansion during the COVID-19 pandemic has demonstrated that groups disproportionately impacted by COVID-19 also experience worse access to telehealth. However, this research has been cross-sectional or short in duration; geographically limited; has not accounted for pre-existing access disparities; and has not examined COVID-19 patients. We examined virtual primary care use by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. We also assessed use of in-person primary care to understand whether disparities in virtual access may have been offset by improved in-person access. Methods Using a cohort design, electronic health records, and Centers for Disease Control and Prevention Social Vulnerability Index, we compared changes in virtual and in-person primary care use by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our study population included 11,326 adult patients diagnosed with COVID-19 between March and July 2020. We estimated logistic regression models to examine likelihood of primary care use. In all regression models we computed robust standard errors; in adjusted models we controlled for demographic and health characteristics of patients. Results In a patient population of primarily Hispanic/Latino and non-Hispanic White individuals, and in which over half lived in socially vulnerable areas, likelihood of virtual primary care use increased from the year before to the year after COVID-19 diagnosis (3.6 to 10.3%); while in-person use remained stable (21.0 to 20.7%). In unadjusted and adjusted regression models, compared with White patients, Hispanic/Latino and other race/ethnicity patients were significantly less likely to use virtual care before and after COVID-19 diagnosis; Hispanic/Latino, Native Hawaiian/Pacific Islander, and other race/ethnicity patients, and patients living in socially vulnerable areas were also significantly less likely to use in-person care during these time periods. Conclusions Newly expanded virtual primary care has not equitably benefited individuals from racialized groups diagnosed with COVID-19, and virtual access disparities have not been offset by improved in-person access. Health systems should employ evidence-based strategies to equitably provide care, including representative provider networks; targeted, empowering outreach; co-developed culturally and linguistically appropriate tools and technologies; and provision of enabling resources and services.
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Mikulski BS, Bellei EA, Biduski D, De Marchi ACB. Mobile Health Applications and Medication Adherence of Patients With Hypertension: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 62:626-634. [PMID: 34963562 DOI: 10.1016/j.amepre.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Current evidence has revealed the beneficial effects of mobile health applications on systolic and diastolic blood pressure. However, there is still no solid evidence of the underlying factors for these outcomes, and hypertension treatment is performed mainly by medication intake. This study aims to analyze the impacts of health applications on medication adherence of patients with hypertension and understand the underlying factors. METHODS A systematic review and meta-analysis were conducted considering controlled clinical trials published, without year filter, through July 2020. The searches were performed in the electronic databases of Scopus, MEDLINE, and BVSalud. Study characteristics were extracted for qualitative synthesis. The meta-analysis examined medication-taking behavior outcomes using the generic inverse-variance method to combine multiple variables. RESULTS A total of 1,199 records were identified, of which 10 studies met the inclusion criteria for qualitative synthesis, and 9 met the criteria for meta-analysis with 1,495 participants. The analysis of mean changes revealed significant improvements in medication adherence (standardized mean difference=0.41, 95% CI=0.02, 0.79, I2=82%, p=0.04) as well as the analysis of the values measured after follow-up (standardized mean difference=0.60, 95% CI=0.30, 0.90, I2=77%, p<0.0001). Ancillary improvements were also identified, such as patients' perceived confidence, treatment self-efficacy and self-monitoring, acceptance of technology, and knowledge about the condition and how to deal with health issues. DISCUSSION There is evidence that mobile health applications can improve medication adherence in patients with hypertension, with broad heterogeneity between studies on the topic. The use of mobile health applications conceivably leads to ancillary improvements inherent to better medication adherence.
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Affiliation(s)
- Bruna Spiller Mikulski
- From the Faculty of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil
| | - Ericles Andrei Bellei
- and the Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil.
| | - Daiana Biduski
- and the Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil
| | - Ana Carolina Bertoletti De Marchi
- From the Faculty of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil; and the Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil
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Cao W, Milks MW, Liu X, Gregory ME, Addison D, Zhang P, Li L. mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring. JMIR Mhealth Uhealth 2022; 10:e29415. [PMID: 35234655 PMCID: PMC8928043 DOI: 10.2196/29415] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/01/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown. OBJECTIVE This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented. METHODS A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review. RESULTS The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs. CONCLUSIONS Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology.
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Affiliation(s)
- Weidan Cao
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - M Wesley Milks
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Xiaofu Liu
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Megan E Gregory
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel Addison
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ping Zhang
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Lang Li
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
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DeLaughter KL, Fix GM, McDannold SE, Pope C, Bokhour BG, Shimada SL, Calloway R, Gordon HS, Long JA, Miano DA, Cutrona SL. Incorporating African American Veterans' Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol. JMIR Res Protoc 2021; 10:e29423. [PMID: 34855617 PMCID: PMC8686408 DOI: 10.2196/29423] [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: 04/07/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives. Objective In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID) DERR1-10.2196/29423
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Affiliation(s)
- Kathryn L DeLaughter
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Boston University School of Medicine, Boston, MA, United States
| | - Sarah E McDannold
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Charlene Pope
- Nursing, Ralph H Johnson VA Medical Center, Charleston, SC, United States.,College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Rodney Calloway
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, United States.,Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Judith A Long
- Corporal Michael J Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia, PA, United States.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle A Miano
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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Dougherty EC, Burse N, Butzner M, Wu H, Stuckey HL, Allison JJ, Cuffee YL. Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study. Pilot Feasibility Stud 2021; 7:209. [PMID: 34809710 PMCID: PMC8607626 DOI: 10.1186/s40814-021-00930-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension. Methods In this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data. Results Black and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure. Conclusion This study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources.
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Affiliation(s)
- Emily C Dougherty
- General Academic Pediatrics, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Natasha Burse
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Michael Butzner
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Hongke Wu
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Heather L Stuckey
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Hershey, PA, 17033, USA
| | - Jeroan J Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, MA, 01655, USA
| | - Yendelela L Cuffee
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, DE, USA.
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Sockolow PS, Buck HG, Shadmi E. An integrative review of chronic illness mHealth self-care interventions: Mapping technology features to patient outcomes. Health Informatics J 2021; 27:14604582211043914. [PMID: 34488478 DOI: 10.1177/14604582211043914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mobile health (mHealth)-hand-held technologies to address health priorities-has significant potential to answer the growing need for patient chronic illness self-care interventions. Previous reviews examined mHealth effect on patient outcomes. None have a detailed examination and mapping of specific technology features to targeted health outcomes. Examine recent chronic illness mHealth self-care interventions; map the study descriptors, mHealth technology features, and study outcomes. (1) Information extracted from PubMed, CINAHL, and Web of Science databases for clinical outcomes studies published 2010-January 2020; and (2) realist synthesis techniques for within and across case analysis. From 652 records, 32 studies were examined. Median study duration was 19.5 weeks. Median sample size was 62 participants. About 47% of interventions used solely patient input versus digital input; 50% sent tailored messages versus generic messages; 22% augmented the intervention with human interaction. Studies with positive clinical outcomes had higher use of digital input. Software descriptions were lacking. Most studies built interventions: only two incorporated target audience participation in development. We recommend researchers provide sufficient system description detail. Future research includes: data input characteristics; impact of augmentation with human interaction on outcomes; and development decisions.
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Joo JY, Liu MF. Culturally tailored interventions for ethnic minorities: A scoping review. Nurs Open 2021; 8:2078-2090. [PMID: 34388862 PMCID: PMC8363345 DOI: 10.1002/nop2.733] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 01/22/2023] Open
Abstract
AIM This scoping review identifies strengths and weakness of culturally tailored interventions for ethnic minorities' care in the United States. It reviews recently published studies to improve understanding of these interventions for future research and practice. DESIGN Scoping review. METHODS By searching five electronic databases-CINAHL, PubMed, Ovid, Scopus and Web of Science, this review located 58 empirical studies published between 2015-2019. This review was guided by the PRISMA statements. RESULTS The review identified four weaknesses and five strengths of culturally tailored interventions. Weaknesses included unclear guidelines, low attention and retention rates, failure to measure processes and inadequate training for healthcare providers. The intervention strengths were culturally respectful and patient-centred care, healthy lifestyle promotion, increased family and community supports, technology use for efficient and timely care and increased knowledge of disease by participants.
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Affiliation(s)
| | - Megan F. Liu
- School of Gerontology Health ManagementCollege of NursingTaipei Medical UniversityTaipeiTaiwan
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Thomas Craig KJ, Morgan LC, Chen CH, Michie S, Fusco N, Snowdon JL, Scheufele E, Gagliardi T, Sill S. Systematic review of context-aware digital behavior change interventions to improve health. Transl Behav Med 2021; 11:1037-1048. [PMID: 33085767 PMCID: PMC8158169 DOI: 10.1093/tbm/ibaa099] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health risk behaviors are leading contributors to morbidity, premature mortality associated with chronic diseases, and escalating health costs. However, traditional interventions to change health behaviors often have modest effects, and limited applicability and scale. To better support health improvement goals across the care continuum, new approaches incorporating various smart technologies are being utilized to create more individualized digital behavior change interventions (DBCIs). The purpose of this study is to identify context-aware DBCIs that provide individualized interventions to improve health. A systematic review of published literature (2013-2020) was conducted from multiple databases and manual searches. All included DBCIs were context-aware, automated digital health technologies, whereby user input, activity, or location influenced the intervention. Included studies addressed explicit health behaviors and reported data of behavior change outcomes. Data extracted from studies included study design, type of intervention, including its functions and technologies used, behavior change techniques, and target health behavior and outcomes data. Thirty-three articles were included, comprising mobile health (mHealth) applications, Internet of Things wearables/sensors, and internet-based web applications. The most frequently adopted behavior change techniques were in the groupings of feedback and monitoring, shaping knowledge, associations, and goals and planning. Technologies used to apply these in a context-aware, automated fashion included analytic and artificial intelligence (e.g., machine learning and symbolic reasoning) methods requiring various degrees of access to data. Studies demonstrated improvements in physical activity, dietary behaviors, medication adherence, and sun protection practices. Context-aware DBCIs effectively supported behavior change to improve users' health behaviors.
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Affiliation(s)
| | - Laura C Morgan
- Oncology, Imaging, and Life Sciences, IBM Watson Health, Cambridge, MA, USA
| | - Ching-Hua Chen
- Computational Health Behavior and Decision Sciences, IBM Research, Yorktown Heights, NY, USA
| | - Susan Michie
- Centre for Behavior Change, University College London, London, UK
| | - Nicole Fusco
- Oncology, Imaging, and Life Sciences, IBM Watson Health, Cambridge, MA, USA
| | - Jane L Snowdon
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, MA, USA
| | - Elisabeth Scheufele
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, MA, USA
| | - Thomas Gagliardi
- Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, MA, USA
| | - Stewart Sill
- Oncology, Imaging, and Life Sciences, IBM Watson Health, Cambridge, MA, USA
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Dietary and Lifestyle Modification for the Prevention and Treatment of Hypertension. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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42
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Yue J, Yang X, Wang B, Hu H, Fu H, Gao Y, Sun G. Home blood pressure telemonitoring for improving blood pressure control in middle-aged and elderly patients with hypertension. J Clin Hypertens (Greenwich) 2021; 23:1744-1751. [PMID: 34350677 PMCID: PMC8678721 DOI: 10.1111/jch.14341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023]
Abstract
The blood pressure (BP) control rate among treated hypertensives in China remains low at 37.5%. The relationship between home blood pressure telemonitoring (HBPT) and BP control is controversial. The authors aimed to investigate the relationship between HBPT and BP control in middle‐aged and elderly hypertensives. In total, 252 hypertension patients aged between 60 and 79 years were enrolled. The patients were given either HBPT through interactive platforms between physicians and patients (telemonitoring group, n = 126) or conventional management (routine management group, n = 126). All patients were followed‐up for 15 months. BP control was defined as home systolic blood pressure < 135 mm Hg and home diastolic blood pressure < 85 mm Hg. At baseline, there were no significant differences in the baseline BP control rate (p = .083). However, after 15 months, the BP control rate improved in both groups, and the telemonitoring group (71.3%) had a significantly higher BP control than the routine management group (49.8%) (p < .001). The change of BP control rate from baseline in the routine management group increased by 26.1%, and that of the telemonitoring group increased by 35.4%. The results of the fully adjusted binary logistic regression showed that HBPT was positively associated with BP control after adjusting for confounders (OR = 4.15, 95% CI 2.05–8.39). Similar results were observed after 3, 9, and 12 months. The association of HBPT with BP control was similar in subgroups. In conclusions, HBPT is recommended for BP control in middle‐aged and elderly hypertensives in the community setting.
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Affiliation(s)
- Jianwei Yue
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China.,Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
| | - Xiaomin Yang
- Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
| | - Bin Wang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Han Hu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Haiming Fu
- Department of Clinical Laboratory, Baotou Maternal and Child Health Center, Baotou, Inner Mongolia Autonomous Region, P.R. China
| | - Yuxia Gao
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Gang Sun
- Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
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Uribe ALM, Rudt HG, Leak TM. Stakeholders' Views on Mobile Applications to Deliver Infant and Toddler Feeding Education to Latina Mothers of Low Socioeconomic Status. Nutrients 2021; 13:2569. [PMID: 34444738 PMCID: PMC8398137 DOI: 10.3390/nu13082569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 12/02/2022] Open
Abstract
Infant- and toddler-feeding (ITF) practices are critical to long-term health and chronic disease prevention. Using mobile applications (apps) to promote desirable ITF practices shows promise for overcoming challenges of in-person education. However, the viability of ITF apps for Latina mothers of low-socioeconomic status (SES) remains unclear. The objective of this study was to characterize stakeholders' views on Latina mothers' capability, motivation, and barriers to using ITF apps. New York City-based health professionals who frequently engage with Latina mothers of low SES completed in-depth interviews. Directed content analysis was used to identify themes through theoretical and inductive codes. Participants included dietitians, nutrition educators, and physicians (n = 17). The following themes were identified: (1) Most Latina mothers of low-SES are tech-savvy (i.e., high capability and experience using smartphones and apps); (2) Apps are an appealing way to deliver ITF education; (3) There are challenges to using apps that must be carefully considered for ITF education development. Overall, ITF apps are a viable option as skills and use appear high among Latina mothers. Key considerations for app development include targeted app promotion; detailed instructions for obtaining and using app; more visuals, less text for low literacy and multiple dialects; making key features available offline.
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Affiliation(s)
- Alexandra L. MacMillan Uribe
- Division of Nutritional Sciences, Cornell University, 244 Garden Avenue, Ithaca, NY 14853, USA; (H.G.R.); (T.M.L.)
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Al-Arkee S, Mason J, Lane DA, Fabritz L, Chua W, Haque MS, Jalal Z. Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e24190. [PMID: 34032583 PMCID: PMC8188316 DOI: 10.2196/24190] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 01/07/2023] Open
Abstract
Background Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57%, and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps’ functionality and usability and the involvement of health care professionals in their use. Methods Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=121385
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Affiliation(s)
- Shahd Al-Arkee
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Julie Mason
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - M Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Zahraa Jalal
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
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Gonzalez C, Early J, Gordon-Dseagu V, Mata T, Nieto C. Promoting Culturally Tailored mHealth: A Scoping Review of Mobile Health Interventions in Latinx Communities. J Immigr Minor Health 2021; 23:1065-1077. [PMID: 33988789 PMCID: PMC8120499 DOI: 10.1007/s10903-021-01209-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
This scoping review of mHealth research focuses on intervention studies that utilize mobile technologies to promote behavior change and improve health outcomes in U.S. Latinx communities. 342 mHealth articles were reviewed using PRIMSA protocols; most did not include a majority Latinx study population or did not report on an intervention. The final sample resulted in 23 articles published between 2012 and 2020. Reviewed interventions focused on conditions such as: diabetes, depression, substance abuse, obesity, hypertension, maternal health, and farmworker safety. About one-third of mHealth interventions included mobile applications, the rest were limited to texting programs. Text message reminders can help improve medication adherence and care access, especially when coupled with support from community health workers. Bi-directional text message interventions with feedback loops and personalized treatment options can build user agency. Additionally, multi-modal applications that combine texting with self-guided interactive content show promise for culturally tailored mHealth.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Communications Building 101, Seattle, WA, 98195, USA.
| | - Jody Early
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, USA
| | - Vanessa Gordon-Dseagu
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, USA
| | - Teresa Mata
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Carolina Nieto
- Department of Communication, University of Washington, Communications Building 101, Seattle, WA, 98195, USA
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Chunara R, Zhao Y, Chen J, Lawrence K, Testa PA, Nov O, Mann DM. Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. J Am Med Inform Assoc 2021; 28:33-41. [PMID: 32866264 PMCID: PMC7499631 DOI: 10.1093/jamia/ocaa217] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19. MATERIALS AND METHODS Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results. RESULTS Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. DISCUSSION There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use. CONCLUSION Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection-many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.
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Affiliation(s)
- Rumi Chunara
- NYU Tandon School of Engineering, Department of Computer Science and Engineering, Brooklyn, New York, USA.,NYU School of Global Public Health, Department of Biostatistics, New York, New York, USA
| | - Yuan Zhao
- NYU School of Global Public Health, Department of Epidemiology, New York, New York, USA
| | - Ji Chen
- NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA
| | - Katharine Lawrence
- NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA.,Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Paul A Testa
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Oded Nov
- Department of Technology Management & Innovation, NYU Tandon School of Engineering, Brooklyn, New York, USA
| | - Devin M Mann
- NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA.,Medical Center Information Technology, NYU Langone Health, New York, New York, USA
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Implementing Hypertension Management Interventions in Immigrant Communities in the U.S.: a Narrative Review of Recent Developments and Suggestions for Programmatic Efforts. Curr Hypertens Rep 2021; 23:5. [PMID: 33483867 PMCID: PMC7821846 DOI: 10.1007/s11906-020-01121-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To outline intervention efforts focused on reducing hypertension disparities in immigrant communities in the U.S. and to identify areas in the design, implementation, and evaluation of these interventions that warrant further exploration guided by an implementation science framework. RECENT FINDINGS Studies examined (n = 11) included immigrant populations of African, Hispanic, and Asian origin. Men were underrepresented in most studies. Culturally tailored group-based educational sessions in religious or community spaces were common. Intervention agents included research assistants, registered nurses, community health workers, and faith-based organization volunteers. Community stakeholders were engaged in most studies, although most commonly for recruitment efforts. Surveys/interviews were used for intervention evaluation, and documentation of intervention activities and trainings was used to assess fidelity. Identified pathways for further intervention innovation included gender or migration-status-based targeting, diversifying intervention agents, enhancing mixed-method process evaluations, and tailoring to emerging needs during the COVID-19 pandemic.
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Ford D, Harvey JB, McElligott J, King K, Simpson KN, Valenta S, Warr EH, Walsh T, Debenham E, Teasdale C, Meystre S, Obeid JS, Metts C, Lenert LA. Leveraging health system telehealth and informatics infrastructure to create a continuum of services for COVID-19 screening, testing, and treatment. J Am Med Inform Assoc 2020; 27:1871-1877. [PMID: 32602884 PMCID: PMC7337763 DOI: 10.1093/jamia/ocaa157] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/26/2020] [Indexed: 01/31/2023] Open
Abstract
Objectives We describe our approach in using health information technology to provide a continuum of services during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 challenges and needs required health systems to rapidly redesign the delivery of care. Materials and Methods Our health system deployed 4 COVID-19 telehealth programs and 4 biomedical informatics innovations to screen and care for COVID-19 patients. Using programmatic and electronic health record data, we describe the implementation and initial utilization. Results Through collaboration across multidisciplinary teams and strategic planning, 4 telehealth program initiatives have been deployed in response to COVID-19: virtual urgent care screening, remote patient monitoring for COVID-19–positive patients, continuous virtual monitoring to reduce workforce risk and utilization of personal protective equipment, and the transition of outpatient care to telehealth. Biomedical informatics was integral to our institutional response in supporting clinical care through new and reconfigured technologies. Through linking the telehealth systems and the electronic health record, we have the ability to monitor and track patients through a continuum of COVID-19 services. Discussion COVID-19 has facilitated the rapid expansion and utilization of telehealth and health informatics services. We anticipate that patients and providers will view enhanced telehealth services as an essential aspect of the healthcare system. Continuation of telehealth payment models at the federal and private levels will be a key factor in whether this new uptake is sustained. Conclusions There are substantial benefits in utilizing telehealth during the COVID-19, including the ability to rapidly scale the number of patients being screened and providing continuity of care.
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Affiliation(s)
- Dee Ford
- Department of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jillian B Harvey
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James McElligott
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn King
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kit N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shawn Valenta
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily H Warr
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tasia Walsh
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ellen Debenham
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carla Teasdale
- Information Solutions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephane Meystre
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jihad S Obeid
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Leslie A Lenert
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Makris E, Hu L, Jones GB, Wright JM. Moving the Dial on Heart Failure Patient Adherence Rates. Patient Prefer Adherence 2020; 14:2407-2418. [PMID: 33324042 PMCID: PMC7733338 DOI: 10.2147/ppa.s283277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Heart failure remains a substantive contributor to patient morbidity and mortality rates worldwide and represents a significant burden on the healthcare ecosystem. Faced with persistent physical symptoms and debilitating social consequences, patients follow complex treatment regimens and often have difficulty adhering to them. PURPOSE In this manuscript, we review factors which contribute to low adherence rates and advance potential single- and multi-factor-based interventions. It is hoped that these observations can lead to improvements in managed care of this vulnerable population of patients. METHODS A narrative review of the primary literature was performed on contributing factors with primary focus on the period 2015-2020 using available databases and search engines. Adherence pain points identified were mapped against a series of potential solutions which are presented. RESULTS Enhancement of treatment adherence relies on two approaches viz. single-factor and multi-factor solutions. Single factors identified include electronic reminders, enhanced health education, financial incentives, gamification strategies, community drivers, persona-based modeling, and burden relief of poly pharmacy. Multi-factor solutions combine two or more of the seven approaches offering the potential for flexible interventions tailored to the individual. DISCUSSION AND CONCLUSION Heart failure patients with poor adherence have increased mortality, hospitalization needs, and healthcare costs. This review highlights current single-factor and multi-factor adherence methods. Against a backdrop of diversity of approaches, multi-factor solutions cast the widest net for positively influencing adherent behaviors. A key enabler lies in the development and leveraging of patient personas in the synthesis of successful intervention methods. Deployable solutions can also be envisioned in clinical trials where adherence tracking represents an essential component.
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Affiliation(s)
- Eleanna Makris
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Lucy Hu
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Graham B Jones
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
- Clinical and Translational Science Institute, Tufts University Medical Center, Boston, MA02111, USA
| | - Justin M Wright
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
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50
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Alsaqabi YS, Rabbani U. Medication Adherence and Its Association With Quality of Life Among Hypertensive Patients Attending Primary Health Care Centers in Saudi Arabia. Cureus 2020; 12:e11853. [PMID: 33282607 PMCID: PMC7714734 DOI: 10.7759/cureus.11853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Chronic diseases require long-term medication and adherence to medication is important for the control of disease as well as prevention of complications. Non-compliance may lead to worsening of the disease, which may affect patients' quality of life. This study aimed to assess the level of medication adherence and its association with quality of life (QOL) among hypertensive patients in Buraidah, Saudi Arabia. Methods A cross-sectional study was carried out in which 299 hypertensive patients were recruited from the randomly selected primary health care centers. Medication adherence was assessed by Hill-Bone Medication Adherence Scale, and quality of life was assessed by the World Health Organization's Quality of Life (WHOQOL)-BREF. Multivariate linear regression was used to assess the association of medication adherence with quality of life. Data was analyzed using SPSS version 21.0 (IBM Inc., Armonk, USA). Results The prevalence of poor adherence was found to be 38.8%. We did not find a significant association of medication adherence with any of the four (physical, psychological, social relationship, and environmental) domains of WHOQOL-BREF. However, poor medication adherence was associated with poor perceived overall QOL adjusted β=-0.012 (95% confidence interval [CI]: -0.021 to -0.002; p=0.018) and health adjusted β=-0.013 (95% CI: -0.025 to -0.002; p<0.018). Conclusion We found a high prevalence of non-adherence among hypertensive patients. This calls for developing interventions to improve compliance with medications to prevent complications of hypertension. Our study could not find a significant association of medication adherence with any of the domains of QOL, while poor adherence was associated with lower overall perceived QOL and health. Nonetheless, worsening of disease due to non-adherence may affect the QOL of patients. We recommend large scale prospective studies to explore the relationship between medication adherence and QOL.
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Affiliation(s)
| | - Unaib Rabbani
- Family Medicine Academy, Qassim Health Cluster, Buraidah, SAU
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