1
|
Johnson CM, D'Eramo Melkus G, Reagan L, Pan W, Amarasekara S, Pereira K, Hassell N, Nowlin S, Vorderstrasse A. Learning in a Virtual Environment to Improve Type 2 Diabetes Outcomes: Randomized Controlled Trial. JMIR Form Res 2023; 7:e40359. [PMID: 36962700 PMCID: PMC10160930 DOI: 10.2196/40359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/17/2022] [Accepted: 03/23/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Given the importance of self-management in type 2 diabetes mellitus (T2DM), a major aspect of health is providing diabetes self-management education and support. Known barriers include access, availability, and the lack of follow through on referral to education programs. Virtual education and support have increased in use over the last few years. OBJECTIVE The purpose of the Diabetes Learning in a Virtual Environment (LIVE) study was to compare the effects of the LIVE intervention (educational 3D world) to a diabetes self-management education and support control website on diet and physical activity behaviors and behavioral and metabolic outcomes in adults with T2DM over 12 months. METHODS The LIVE study was a 52-week multisite randomized controlled trial with longitudinal repeated measures. Participants were randomized to LIVE (n=102) or a control website (n=109). Both contained the same educational materials, but the virtual environment was synchronous and interactive, whereas the control was a flat website. Data were collected at baseline and 3, 6, and 12 months using surveys and clinical, laboratory, and Fitbit measures. Descriptive statistics included baseline characteristics and demographics. The effects of the intervention were initially examined by comparing the means and SDs of the outcomes across the 4 time points between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months. RESULTS This trial included 211 participants who consented. The mean age was 58.85 (SD 10.1) years, and a majority were White (127/211, 60.2%), non-Hispanic (198/211, 93.8%), married (107/190, 56.3%), and female (125/211, 59.2%). Mean hemoglobin A1c (HbA1c) level at baseline was 7.64% (SD 1.79%) and mean BMI was 33.51 (SD 7.25). We examined weight loss status versus randomized group, where data with no weight change were eliminated, and the LIVE group experienced significantly more weight loss than the control group (P=.04). There were no significant differences between groups in changes in physical activity and dietary outcomes (all P>.05), but each group showed an increase in physical activity. Both groups experienced a decrease in mean HbA1c level, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline HbA1c level was 8.6% or higher. CONCLUSIONS This study confirmed that there were minor positive changes on glycemic targets in both groups over the 12-month study period; however, the majority of the participants began with optimal HbA1c levels. We did find clinically relevant metabolic changes in those who began with an HbA1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT02040038; https://clinicaltrials.gov/ct2/show/NCT02040038.
Collapse
Affiliation(s)
- Constance M Johnson
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
- School of Nursing, Duke University, Durham, NC, United States
| | - Gail D'Eramo Melkus
- Rory Myers College of Nursing, New York University, New York, NY, United States
| | - Louise Reagan
- Rory Myers College of Nursing, New York University, New York, NY, United States
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Wei Pan
- School of Nursing, Duke University, Durham, NC, United States
| | | | | | - Nancy Hassell
- School of Nursing, Duke University, Durham, NC, United States
| | - Sarah Nowlin
- Rory Myers College of Nursing, New York University, New York, NY, United States
- Department of Nursing, Mount Sinai Hospital, New York, NY, United States
| | - Allison Vorderstrasse
- School of Nursing, Duke University, Durham, NC, United States
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| |
Collapse
|
2
|
Ramos SR, Johnson C, Melkus G, Kershaw T, Gwadz M, Reynolds H, Vorderstrasse A. Cardiovascular Disease Prevention Education Using a Virtual Environment in Sexual-Minority Men of Color With HIV: Protocol for a Sequential, Mixed Method, Waitlist Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38348. [PMID: 35579928 PMCID: PMC9157319 DOI: 10.2196/38348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is estimated that 70% of all deaths each year in the United States are due to chronic conditions. Cardiovascular disease (CVD), a chronic condition, is the leading cause of death in ethnic and racial minority males. It has been identified as the second most common cause of death in persons with HIV. By the year 2030, it is estimated that 78% of persons with HIV will be diagnosed with CVD. OBJECTIVE We propose the first technology-based virtual environment intervention to address behavioral, modifiable risk factors associated with cardiovascular and metabolic comorbidities in sexual-minority men of color with HIV. METHODS This study will be guided using social cognitive theory and the Technology Acceptance Model. A sequential, mixed method, waitlist controlled randomized control feasibility trial will be conducted. Aim 1 is to qualitatively explore perceptions of cardiovascular risk in 15 participants. Aim 2 is to conduct a waitlist controlled comparison to test if a virtual environment is feasible and acceptable for CVD prevention, based on web-based, self-assessed, behavioral, and psychosocial outcomes in 80 sexual-minority men of color with HIV. RESULTS The study was approved by the New York University Institutional Review Board in 2019, University of Texas Health Science Center at Houston in 2020, and by the Yale University Institutional Review Board in February 2022. As of April 2022, aim 1 data collection is 87% completed. We expect to complete data collection for aim 1 by April 30, 2022. Recruitment for aim 2 will begin mid-May 2022. CONCLUSIONS This study will be the first online virtual environment intervention for CVD prevention in sexual-minority men of color with HIV. We anticipate that the intervention will be beneficial for CVD prevention education and building peer social supports, resulting in change or modification over time in risk behaviors for CVD. TRIAL REGISTRATION ClinicalTrials.gov NCT05242952; https://clinicaltrials.gov/ct2/show/NCT05242952. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38348.
Collapse
Affiliation(s)
- S Raquel Ramos
- School of Nursing, Yale University, Orange, CT, United States
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
- The Center for Drug Use and HIV Research, New York University, New York, NY, United States
| | - Constance Johnson
- Cizik School of Nursing, University of Texas Houston, Houston, TX, United States
- School of Biomedical Informatics, University of Texas Houston, Houston, TX, United States
| | - Gail Melkus
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States
| | - Marya Gwadz
- The Center for Drug Use and HIV Research, New York University, New York, NY, United States
- Silver School of Social Work, New York University, New York, NY, United States
| | - Harmony Reynolds
- Department of Medicine, Grossman School of Medicine, New York University, New York, NY, United States
- NYU Langone Health, New York, NY, United States
| | - Allison Vorderstrasse
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| |
Collapse
|
3
|
Amdie FZ, Luctkar-Flude M, Snelgrove-Clarke E, Sawhney M, Alemu S, Woo K. Feasibility of Virtual Simulation-Based Diabetes Foot Care Education in Patients with Diabetes in Ethiopia: Protocol for a Randomized Controlled Trial. Diabetes Metab Syndr Obes 2022; 15:995-1009. [PMID: 35386589 PMCID: PMC8979753 DOI: 10.2147/dmso.s345722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a rapidly growing global public health problem; the number of adults with diabetes is expected to increase from 424.9 million in 2017 to 628.6 million in 2045. Approximately 80% of diabetic patients live in low- and middle-income countries where access to care may be limited. For example, in Ethiopia, diabetes care is often rudimentary, and formal, structured diabetes education is almost non-existent. One potential solution to the lack of diabetes management education for patients could be virtual simulation-based diabetes education incorporating the contextual realities of patients in Ethiopia. Despite its great potential to improve glycemic control, delay diabetes-related complications and reduce mortality associated with diabetes, the feasibility of virtual simulation-based diabetes self-management education has not been studied in low- and middle-income settings. OBJECTIVE The purpose of the current study is to evaluate the feasibility of a virtual simulation-based Diabetes Foot Care Education (DFCE) program among adult patients with diabetes in Ethiopia. METHODS A randomized controlled feasibility study including participants from University of Gondar Referral Hospital (UoGRH) will be conducted. A sample of 40 participants will be recruited, of which 20 participants will receive the virtual simulation-based education program, and the other 20 participants will continue with their usual diabetes care. After the education program, a questionnaire and structured interview will be used to explore the feasibility (acceptability, practicality) and the potential impact of virtual simulation-based DFCE intervention in patients with diabetes. Data will be analyzed using SPSS version 25 using descriptive statistics, independent t-tests, paired sample t-test, and factorial ANOVA at significance levels of less than 0.05. DISCUSSION Our study seeks to understand the perceived usefullness and usability of virtual simulation-based diabetes foot care education on behavioural (diabetes foot-care knowledge, foot self-care practices, and foot self-care efficacy). Furthermore, the study will provide insight to assist in the development of technologically assisted and contextually designed DFCE programs. TRIAL REGISTRATION NUMBER NCT04841291 (ClinicalTrials.gov Identifier).
Collapse
Affiliation(s)
- Fisseha Zewdu Amdie
- School of Nursing, University of Gondar, Gondar, Ethiopia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Correspondence: Fisseha Zewdu Amdie, Email
| | | | | | - Monakshi Sawhney
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Shitaye Alemu
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
4
|
Zisis G, Carrington MJ, Oldenburg B, Whitmore K, Lay M, Huynh Q, Neil C, Ball J, Marwick TH. An m-Health intervention to improve education, self-management, and outcomes in patients admitted for acute decompensated heart failure: barriers to effective implementation. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:649-657. [PMID: 36713108 PMCID: PMC9707948 DOI: 10.1093/ehjdh/ztab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/30/2021] [Indexed: 02/01/2023]
Abstract
Aims Effective and efficient education and patient engagement are fundamental to improve health outcomes in heart failure (HF). The use of artificial intelligence (AI) to enable more effective delivery of education is becoming more widespread for a range of chronic conditions. We sought to determine whether an avatar-based HF-app could improve outcomes by enhancing HF knowledge and improving patient quality of life and self-care behaviour. Methods and results In a randomized controlled trial of patients admitted for acute decompensated HF (ADHF), patients at high risk (≥33%) for 30-day hospital readmission and/or death were randomized to usual care or training with the HF-app. From August 2019 up until December 2020, 200 patients admitted to the hospital for ADHF were enrolled in the Risk-HF study. Of the 72 at high-risk, 36 (25 men; median age 81.5 years; 9.5 years of education; 15 in NYHA Class III at discharge) were randomized into the intervention arm and were offered education involving an HF-app. Whilst 26 (72%) could not use the HF-app, younger patients [odds ratio (OR) 0.89, 95% confidence interval (CI) 0.82-0.97; P < 0.01] and those with a higher education level (OR 1.58, 95% CI 1.09-2.28; P = 0.03) were more likely to enrol. Of those enrolled, only 2 of 10 patients engaged and completed ≥70% of the program, and 6 of the remaining 8 who did not engage were readmitted. Conclusions Although AI-based education is promising in chronic conditions, our study provides a note of caution about the barriers to enrolment in critically ill, post-acute, and elderly patients.
Collapse
Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia,Menzies Institute for Medical Research, University of Tasmania, Australia,Corresponding author. Tel: +61 3 8532 1550. Trial registration: Australia New Zealand Clinical Trials Registry (ACTRN): ACTRN12618001273279
| |
Collapse
|
5
|
Pérez-Aldana CA, Lewinski AA, Johnson CM, Vorderstrasse AA, Myneni S. Exchanges in a Virtual Environment for Diabetes Self-Management Education and Support: Social Network Analysis. JMIR Diabetes 2021; 6:e21611. [PMID: 33492236 PMCID: PMC7870352 DOI: 10.2196/21611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes remains a major health problem in the United States, affecting an estimated 10.5% of the population. Diabetes self-management interventions improve diabetes knowledge, self-management behaviors, and clinical outcomes. Widespread internet connectivity facilitates the use of eHealth interventions, which positively impacts knowledge, social support, and clinical and behavioral outcomes. In particular, diabetes interventions based on virtual environments have the potential to improve diabetes self-efficacy and support, while being highly feasible and usable. However, little is known about the patterns of social interactions and support taking place within type 2 diabetes-specific virtual communities. OBJECTIVE The objective of this study was to examine social support exchanges from a type 2 diabetes self-management education and support intervention that was delivered via a virtual environment. METHODS Data comprised virtual environment-mediated synchronous interactions among participants and between participants and providers from an intervention for type 2 diabetes self-management education and support. Network data derived from such social interactions were used to create networks to analyze patterns of social support exchange with the lens of social network analysis. Additionally, network correlations were used to explore associations between social support networks. RESULTS The findings revealed structural differences between support networks, as well as key network characteristics of supportive interactions facilitated by the intervention. Emotional and appraisal support networks are the larger, most centralized, and most active networks, suggesting that virtual communities can be good sources for these types of support. In addition, appraisal and instrumental support networks are more connected, suggesting that members of virtual communities are more likely to engage in larger group interactions where these types of support can be exchanged. Lastly, network correlations suggest that participants who exchange emotional support are likely to exchange appraisal or instrumental support, and participants who exchange appraisal support are likely to exchange instrumental support. CONCLUSIONS Social interaction patterns from disease-specific virtual environments can be studied using a social network analysis approach to better understand the exchange of social support. Network data can provide valuable insights into the design of novel and effective eHealth interventions given the unique opportunity virtual environments have facilitating realistic environments that are effective and sustainable, where social interactions can be leveraged to achieve diverse health goals.
Collapse
Affiliation(s)
- Carlos A Pérez-Aldana
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Allison A Lewinski
- Durham Veterans Affairs Medical Center, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Duke University School of Nursing, Durham, NC, United States
| | - Constance M Johnson
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Sahiti Myneni
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
6
|
Ramos SR, Warren R, Shedlin M, Melkus G, Kershaw T, Vorderstrasse A. A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions. Behav Med 2019; 45:166-176. [PMID: 31343963 PMCID: PMC6793989 DOI: 10.1080/08964289.2019.1570074] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 10/26/2022]
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.
Collapse
Affiliation(s)
| | - Rueben Warren
- b Tuskegee University National Center for Bioethics in Research and Health Care
| | | | - Gail Melkus
- a New York University Rory Meyers College of Nursing
| | | | | |
Collapse
|
7
|
Lewinski AA, Anderson RA, Vorderstrasse AA, Johnson CM. Developing Methods That Facilitate Coding and Analysis of Synchronous Conversations via Virtual Environments. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2019; 18:10.1177/1609406919842443. [PMID: 31130832 PMCID: PMC6534273 DOI: 10.1177/1609406919842443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Programs via the Internet are uniquely positioned to capture qualitative data. One reason is because the Internet facilitates the creation of a community of similar individuals who can exchange information and support related to living with a chronic illness. Synchronous conversations via the Internet can provide insight into real-time social interaction and the exchange of social support. One way to analyze interactions among individuals is by using qualitative methods such as content, conversation, or discourse analysis. This manuscript describes how we used content analysis with aspects from conversation and discourse analysis to analyze synchronous conversations via the Internet to describe what individuals talk about and how individuals talk in an Internet-mediated interaction. With the increase in Internet interventions that facilitate collection of real-time conversational data, this article provides insight into how combining qualitative methods can facilitate the coding and analysis of these complex data.
Collapse
Affiliation(s)
- Allison A. Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Ruth A. Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Constance M. Johnson
- School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
8
|
Wonggom P, Du H, Clark RA. Evaluation of the effectiveness of an interactive avatar-based education application for improving heart failure patients' knowledge and self-care behaviours: A pragmatic randomized controlled trial protocol. J Adv Nurs 2018; 74:2667-2676. [PMID: 29920745 DOI: 10.1111/jan.13768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to evaluate the effectiveness of an avatar-based education application for improving knowledge and self-care behaviour in patients with heart failure (HF). BACKGROUND Avatar-based technologies for supporting education are an innovative approach for patients with low literacy, low health literacy and English as a second language. The use of avatar technologies for patient education has shown benefits in improving knowledge, self-care behaviours and quality of life in chronic diseases such as cancer, diabetes and depression. Research has demonstrated positive outcomes in clinical practice. However, the effectiveness of this technology has not been evaluated among patients with HF. DESIGN A multi-centred, non-blinded randomized, two-armed parallel pragmatic, controlled trial. METHOD Eighty-eight participants will be recruited from the HF clinics at three public hospitals and randomized into either control or intervention groups. The intervention group will receive the avatar-based education plus usual care. The control group will receive usual care. The primary outcome is HF knowledge, secondary outcomes include; improved self-care behaviours, readmission and satisfaction. Data will be collected at the baseline and at 1- and 3-month follow-ups. DISCUSSION This study will measure the effectiveness of avatar-based education on patients' knowledge and self-care behaviours following HF. The evidence will be evaluated in terms of the reduction in patients' readmission.
Collapse
Affiliation(s)
- Parichat Wonggom
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Huiyun Du
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
9
|
Creating a sustainable collaborative consumer health application for chronic disease self-management. J Biomed Inform 2017; 71:198-206. [PMID: 28600025 DOI: 10.1016/j.jbi.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/15/2017] [Accepted: 06/04/2017] [Indexed: 11/20/2022]
Abstract
As the prevalence of chronic diseases increase, there is a need for consumer-centric health informatics applications that assist individuals with disease self-management skills. However, due to the cost of development of these applications, there is also a need to build a disease agnostic architecture so that they could be reused for any chronic disease. This paper describes the architecture of a collaborative virtual environment (VE) platform, LIVE©, that was developed to teach self-management skills and provide social support to those individuals with type 2 diabetes. However, a backend database allows for the application to be easily reused for any chronic disease. We tested its usability in the context of a larger randomized controlled trial of its efficacy. The usability was scored as 'good' by half of the participants in the evaluation. Common errors in the testing and solutions to address initial usability issues are discussed. Overall, LIVE© represents a usable and generalizable platform that will be adapted to other chronic diseases and health needs in future research and applications.
Collapse
|
10
|
Lewinski AA, Anderson RA, Vorderstrasse AA, Fisher EB, Pan W, Johnson CM. Analyzing Unstructured Communication in a Computer-Mediated Environment for Adults With Type 2 Diabetes: A Research Protocol. JMIR Res Protoc 2017; 6:e65. [PMID: 28438726 PMCID: PMC5422658 DOI: 10.2196/resprot.7442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 01/07/2023] Open
Abstract
Background Individuals with type 2 diabetes have an increased risk for comorbidities such as heart disease, lower limb amputations, stroke, and renal failure. Multiple factors influence development of complications in a person living with type 2 diabetes; however, an individual’s self-management behaviors may delay the onset of, or lessen the severity of, these complications. Social support provides personal, informal advice and knowledge that helps individuals initiate and sustain self-management and adherence. Objective Our aim was to gain an understanding of type 2 diabetes social interaction in a virtual environment, one type of computer-mediated environment (CME), and the social support characteristics that increase and sustain self-management in adults living with chronic illness. Methods This study is a secondary analysis of longitudinal data collected in a CME study, Second Life Impacts Diabetes Education & Self-Management (1R21-LM010727-01). This virtual environment replicated a real-life community where 6 months of naturalistic synchronous voice conversations, emails, and text chats were recorded among participants and providers. This analysis uses a mixed-methods approach to explore and compare qualitative and quantitative findings. This analysis is guided by two theories: Strong/Weak Ties Theory and Social Penetration Theory. Qualitative data will be analyzed using content analysis, and we will complete descriptive statistics on the quantified variables (eg, average number of ties). Institutional review board approval was obtained in June 2016. Results This study is in progress. Conclusions Interventions provided through virtual environments are a promising solution to increasing self-management practices. However, little is known of the depth, breadth, and quality of social support that is exchanged and how interaction supports self-management and relates to health outcomes. This study will provide knowledge that will help guide clinical practice and policy to enhance social support for chronic illness via the Internet.
Collapse
Affiliation(s)
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, United States
| | - Constance M Johnson
- School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
11
|
Cook N, Winkler SL. Acceptance, Usability and Health Applications of Virtual Worlds by Older Adults: A Feasibility Study. JMIR Res Protoc 2016; 5:e81. [PMID: 27256457 PMCID: PMC4911513 DOI: 10.2196/resprot.5423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/06/2016] [Accepted: 02/04/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Virtual worlds allow users to communicate and interact across various environments, scenarios, and platforms. Virtual worlds present opportunities in health care to reduce the burden of illness and disability by supporting education, rehabilitation, self-management, and social networking. The application of virtual worlds to older adults who bear the burden and cost of health conditions associated with age has not been evaluated. OBJECTIVE The aim of this study is to explore the usability, ease of use, and enjoyment of a virtual world by older adults, the types of virtual world activities that older adults may engage in, and the perceptions of older adults regarding the application of virtual worlds in health care. METHODS This quasi-experimental pre-post design research was guided by the Technology Acceptance Model (TAM). Participants were recruited from a Lifelong Learning Institute (LLI) program at Nova Southeastern University. Participants attended four training sessions over a 5-week period in the Second Life (SL) virtual world. Subjects were surveyed before and after the training on perceived ease of use, attitudes towards technology, behavioral intention to use the system, facilitating conditions, effort expectancy, and self-efficacy. RESULTS Older adults (N=19) completed the informed consent and attended the first training session, and 11 participants (58%, 11/19) completed the full training and the post survey. Completers (82%, 9/11) were more likely than non-completers (37%, 3/8) to consider themselves technologically savvy (P=.048), and to express confidence in being able to use the virtual world (100%, 11/11 vs 37%, 3/8; P=.002). All completers (100%, 11/11) perceived that SL has application in health behaviors and disease and reducing social isolation among people who are homebound. Of the completers, 10 (91%, 10/11) responded that they enjoyed learning how to use SL. Completers suggested that future trainings include more assistants and smaller groups. CONCLUSIONS This pilot study suggests that virtual worlds can be both a feasible and an applicable method to promote health among some seniors. Future research on virtual worlds with older populations should consider using state-of-the art technology including large monitors, providing a minimum of one trainer for every two to three participants, and distributing a comprehensive training manual at the start of the training to support organization and recall.
Collapse
Affiliation(s)
- Nicole Cook
- Master of Public Health program, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States.
| | | |
Collapse
|
12
|
Johnson C, Feinglos M, Pereira K, Hassell N, Blascovich J, Nicollerat J, Beresford HF, Levy J, Vorderstrasse A. Feasibility and preliminary effects of a virtual environment for adults with type 2 diabetes: pilot study. JMIR Res Protoc 2014; 3:e23. [PMID: 24713420 PMCID: PMC4004161 DOI: 10.2196/resprot.3045] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/03/2014] [Accepted: 03/13/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Innovative interventions that empower patients in diabetes self-management (DSM) are needed to provide accessible, sustainable, cost-effective patient education and support that surpass current noninteractive interventions. Skills acquired in digital virtual environments (VEs) affect behaviors in the physical world. Some VEs are programmed as real-time three-dimensional representations of various settings via the Internet. For this research, a theoretically grounded VE that facilitates DSM was developed and pilot tested. It offered weekly synchronous DSM education classes, group meetings, and social networking in a community in which participants practiced real world skills such as grocery shopping, exercising, and dining out, allowing for interactive knowledge application. The VE was available 24/7 on the Internet, minimizing access barriers. OBJECTIVE The objective of this study was to evaluate the feasibility and efficacy of participation in a VE for DSM education and support. METHODS This study utilized a single group, pre-mid-post measure design. At 0, 3, and 6 months, we assessed participants' perceived VE usability and usefulness, self-efficacy, diabetes self-management behaviors, perceived social support, and diabetes knowledge using validated survey measures; and we recorded metabolic indicators (HbA1c, BP, BMI). Process data were continuously collected in the VE (log-ins, voice recordings, locations visited, objects interacted with, and movement). Data analysis included descriptive statistics, t tests to evaluate changes in mediators and outcomes over time, and depiction of utilization and movement data. RESULTS We enrolled 20 participants (13/20, 65% white, 7/20, 35% black), with an age range of 39-72 years (mean age, 54 years) and diabetes duration from 3 months to 25 years. At baseline, 95% (18/19) and 79% (15/19) of participants rated usefulness and ease of use as high on validated surveys with no significant changes at 3 or 6 months. Participants logged into the site a mean of 2.5 hours/week over the course of 6 months. High DSM class attendance was reflected by the largest percentage of time spent in the classroom (48.6%). Self-efficacy, social support, and foot care showed significant improvement (P<.05). There were improvement trends in clinical outcomes that were clinically meaningful but did not reach statistical significance given the small sample size. CONCLUSIONS Because relatively little is known about usability, acceptability, and efficacy of health interventions in VEs, this study constitutes an important, innovative first step in exploring the potential of VEs for facilitating DSM. The preliminary data suggest that VEs provide a feasible and useful platform for patients and educators that affects self-management and related mediators. Flexible access to both synchronous and asynchronous diabetes education, skill building activities, and support from a home computer remove barriers to attending clinic-based meetings. This program has potential for improving DSM in an easily disseminated alternative model.
Collapse
|
13
|
Vorderstrasse A, Shaw RJ, Blascovich J, Johnson CM. A theoretical framework for a virtual diabetes self-management community intervention. West J Nurs Res 2014; 36:1222-37. [PMID: 24451083 DOI: 10.1177/0193945913518993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Due to its high prevalence, chronic nature, potential complications, and self-management challenges for patients, diabetes presents significant health education and support issues. We developed and pilot-tested a virtual community for adults with type 2 diabetes to promote self-management education and provide social support. Although digital-based programs such as virtual environments can address significant barriers to reaching patients (i.e., child care, transportation, location), they must be strongly grounded in a theoretical basis to be well-developed and effective. In this article, we discuss how we synthesized behavioral and virtual environment theoretical frameworks to guide the development of SLIDES (Second Life Impacts Diabetes Education and Support).
Collapse
Affiliation(s)
| | - Ryan J Shaw
- Duke University School of Nursing, Durham, NC, USA
| | | | | |
Collapse
|