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Fakes K, Waller A, Carey M, Czerenkowski J, Nolan E, Leigh L, Pollack M, Henskens F, Sanson-Fisher R. Discharge intervention to improve outcomes and web-based portal engagement after stroke and transient ischaemic attack: A randomised controlled trial. J Stroke Cerebrovasc Dis 2024:107771. [PMID: 38788985 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107771] [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: 03/01/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES Web-based interventions may assist in post-discharge stroke care. However, strategies for maximising uptake and engagement are needed. AIMS To determine the: (1) effectiveness of a discharge support intervention (EnableMe web-based portal and strategies to encourage use) in improving quality of life and reducing depression (primary outcome); anxiety and unmet needs of survivors of stroke and transient ischemic attack (TIA); and (2) EnableMe use and acceptability. MATERIALS AND METHODS An open, parallel-group, multi-centre randomised controlled trial (RCT) of the intervention compared to usual care for survivors of stroke/TIA and their support persons. Participants recruited from eight hospitals completed questionnaires at baseline, 3 and 6 months. Outcomes included quality of life, depression, anxiety and unmet needs. RESULTS 98 survivors (n=52 intervention, n=47 control) and 30 support persons (n=11 intervention, n=19 control) enrolled in the RCT. Bayesian analyses showed substantial evidence of an intervention effect on survivors' quality of life scores at 3 months. There was moderate-to-strong evidence of a treatment effect on depression scores and strong evidence that intervention participants had fewer unmet needs at 3 and 6 months. 45% of intervention group survivors and 63% of support persons self-reported using EnableMe. 64% of survivors and 84% of support persons found it helpful. CONCLUSION Substantial evidence for the discharge support intervention was found, with a difference between groups in survivor quality of life, depression, and unmet needs. Acceptability was demonstrated with largely positive attitudes towards EnableMe. Future research should explore different engagement strategies to improve uptake of online stroke resources.
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Affiliation(s)
- Kristy Fakes
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Amy Waller
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Mariko Carey
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia; Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.
| | | | - Erin Nolan
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia; HMRI Data Sciences, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia; HMRI Data Sciences, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Michael Pollack
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia; Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia.
| | - Frans Henskens
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
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Schult TM, Mohr DC, Greenfield RH, Reddy KP. The Impact of Involvement in Whole Health System for Veterans or Participating in It for Oneself on Job Attitudes in VA Employees. J Occup Environ Med 2024; 66:e131-e136. [PMID: 38588074 DOI: 10.1097/jom.0000000000003062] [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: 04/10/2024]
Abstract
OBJECTIVE The aim of the study is to examine how involvement in the Whole Health System of care, clinically and personally (through employee-focused activities), would affect employee satisfaction, engagement, burnout, and turnover intent in the Veterans Health Administration. METHODS Multivariate logistic regression analysis of cross-sectional survey from Veterans Health Administration employees was used to determine the influence of Whole Health System involvement and Employee Whole Health participation on job attitudes. RESULTS Whole Health System involvement was associated higher job satisfaction, higher levels of engagement, lower burnout, and lower turnover intent. A similar pattern of results was identified when looking specifically at Employee Whole Health participation and associated job attitudes. CONCLUSIONS Employees who are either directly involved in delivering Whole Health services to veterans or who have participated in Whole Health programming for their own benefit may experience a meaningful positive impact on their well-being and how they experience the workplace.
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Affiliation(s)
- Tamara M Schult
- From the Veterans Health Administration, Office of Patient Centered Care and Cultural Transformation, Washington, DC (T.M.S., R.H.G., K.P.R.); Veterans Health Administration, National Center for Organization Development, Cincinnati, Ohio (D.C.M.); and Washington University School of Medicine, St Louis, Missouri (K.P.R.)
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van der Meer HA, Doomen A, Visscher CM, Engelbert RHH, Nijhuis-van der Sanden MWG, Speksnijder CM. The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients. Disabil Rehabil Assist Technol 2024; 19:433-445. [PMID: 35960692 DOI: 10.1080/17483107.2022.2094000] [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: 09/14/2021] [Accepted: 06/17/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). MATERIALS AND METHODS A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients. RESULTS Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference). CONCLUSION OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).
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Affiliation(s)
- Hedwig A van der Meer
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Annet Doomen
- Physiotherapy Private Practice 'De Molen', Houten, The Netherlands
- Institute of Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
| | | | - Caroline M Speksnijder
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
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te Braake E, Grünloh C, Tabak M. Shifting Responsibilities: Developing a Pan-European Service Model for an eHealth Technology Supporting Self-Management of People with Chronic Obstructive Pulmonary Disease and Comorbidities. Int J Chron Obstruct Pulmon Dis 2024; 19:175-192. [PMID: 38249825 PMCID: PMC10800113 DOI: 10.2147/copd.s432568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Active participation of patients in their care via self-management is an important pillar to manage chronic conditions. Self-management education and continuous support are needed to improve patients' confidence to take such active role. One way to do this is through eHealth technologies. However, those technologies can only be successful when actively used in daily practice and when integrated in overall care. Therefore, this study investigated how a self-management eHealth technology could be implemented that emphasises the active role of patients in their care. Methods The service modelling method was utilized as implementation strategy. The design process consisted of five phases with salient stakeholders and consortium members of a European project to develop the service model. Studies with salient stakeholders were carried out in three different countries (Italy, Estonia, the Netherlands). A combination between face-to-face and online methods facilitated the participatory design process. Results Due to the pan-European context, different stakeholders in the three countries were identified. Research nurses and case managers were not yet established in practice but once implemented, expected to contribute to optimal implementation. During service modelling, a crucial step was revealed: providing self-management training before technology use to let patient familiarise with the concept of taking an active role. As HCPs felt that they were not necessarily equipped to guide patients in terms of self-management, they also should have access to such self-management training. Conclusion By demonstrating a way for implementation while emphasising patients' active role, we also showed the complexity of the method in two ways. First, by demonstrating the fine line between the descriptive and prescriptive model. Thus, showcasing the need to recognize that prescriptive models may be hampered by the delay in changing work practices. Second, by highlighting the importance of identifying country-specific differences in the pan-European context, revealing that service modelling is not a one-size-fits-all approach.
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Affiliation(s)
- Eline te Braake
- Roessingh Research and Development, Enschede, the Netherlands
- University of Twente, Biomedical Signals and System Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Enschede, the Netherlands
| | - Christiane Grünloh
- Roessingh Research and Development, Enschede, the Netherlands
- University of Twente, Biomedical Signals and System Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Enschede, the Netherlands
| | - Monique Tabak
- University of Twente, Biomedical Signals and System Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Enschede, the Netherlands
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Enthoven P, Menning L, Öberg B, Schröder K, Fors M, Lindbäck Y, Abbott A. Physiotherapists' experiences of implementation of the BetterBack model of care for low back pain in primary care - a focus group interview study. Physiother Theory Pract 2024:1-13. [PMID: 38189338 DOI: 10.1080/09593985.2023.2301436] [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: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION The BetterBack model of care (MoC), a best practice physiotherapy MoC for low back pain (LBP), was implemented in Swedish primary care to improve management of patients with LBP and provide patients with support tools to better self-manage episodes of LBP. PURPOSE The objective was to describe how physiotherapists in primary care experienced the implementation of the BetterBack MoC for LBP. METHODS Focus group interviews were conducted with physiotherapists in 2018-2019, 14-18 months after the introduction of the BetterBack MoC. Data were analyzed using qualitative content analysis. RESULTS Five focus group interviews with 23 (15 female and 8 male) physiotherapists, age range 24-61 years were analyzed. A supportive organization and adaptation to the local culture, combined with health care professionals' attitudes and collaboration between physiotherapists emerged as important factors for a successful implementation and for long-term sustainability of the MoC. Physiotherapists had differing opinions if the implementation led to change in clinical practice. Improved confidence in how to manage patients with LBP was expressed by physiotherapists. CONCLUSIONS Several barriers and facilitators influence the implementation of a best practice physiotherapy MoC for LBP in primary care, which need to be considered in future implementation and sustainability processes.
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Affiliation(s)
- Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Linnea Menning
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Maria Fors
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Yvonne Lindbäck
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden
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Zhu EM, Buljac-Samardžić M, Ahaus K, Sevdalis N, Huijsman R. Implementation and dissemination of home- and community-based interventions for informal caregivers of people living with dementia: a systematic scoping review. Implement Sci 2023; 18:60. [PMID: 37940960 PMCID: PMC10631024 DOI: 10.1186/s13012-023-01314-y] [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: 10/07/2022] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life. Implementation science knowledge is needed to optimize the real-world outcomes of evidence-based interventions (EBIs) for informal caregivers. This scoping review aims to systematically synthesize the literature that reports implementation strategies employed to deliver home- and community-based EBIs for informal caregivers of PwD, implementation outcomes, and the barriers and facilitators to implementation of these EBIs. METHODS Embase, MEDLINE, Web of Science, and Cochrane Library were searched from inception to March 2021; included studies focused on "implementation science," "home- and community-based interventions," and "informal caregivers of people with dementia." Titles and abstracts were screened using ASReview (an innovative AI-based tool for evidence reviews), and data extraction was guided by the ERIC taxonomy, the Implementation Outcome Framework, and the Consolidated Framework for Implementation Science Research; each framework was used to examine a unique element of implementation. RESULTS Sixty-seven studies were included in the review. Multicomponent (26.9%) and eHealth (22.3%) interventions were most commonly reported, and 31.3% of included studies were guided by an implementation science framework. Training and education-related strategies and provision of interactive assistance were the implementation strategy clusters of the ERIC taxonomy where most implementation strategies were reported across the reviewed studies. Acceptability (82.1%), penetration (77.6%), and appropriateness (73.1%) were the most frequently reported implementation outcomes. Design quality and packaging (intervention component suitability) and cosmopolitanism (partnerships) constructs, and patient's needs and resources and available resources (infrastructure) constructs as per the CFIR framework, reflected the most frequently reported barriers and facilitators to implementation. CONCLUSION Included studies focused largely on intervention outcomes rather than implementation outcomes and lacked detailed insights on inner and outer setting determinants of implementation success or failure. Recent publications suggest implementation science in dementia research is developing but remains in nascent stages, requiring future studies to apply implementation science knowledge to obtain more contextually relevant findings and to structurally examine the mechanisms through which implementation partners can strategically leverage existing resources and regional networks to streamline local implementation. Mapping local evidence ecosystems will facilitate structured implementation planning and support implementation-focused theory building. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Eden Meng Zhu
- Erasmus School of Health Policy & Management, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | | | - Kees Ahaus
- Erasmus School of Health Policy & Management, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Nick Sevdalis
- Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore, Singapore
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Pearce L, Costa N, Sherrington C, Hassett L. Implementation of digital health interventions in rehabilitation: A scoping review. Clin Rehabil 2023; 37:1533-1551. [PMID: 37132030 DOI: 10.1177/02692155231172299] [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] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Digital health interventions have potential to enhance rehabilitation services by increasing accessibility, affordability and scalability. However, implementation of digital interventions in rehabilitation is poorly understood. This scoping review aims to map current strategies, research designs, frameworks, outcomes and determinants used to support and evaluate the implementation of digital interventions in rehabilitation. DATA SOURCES Comprehensive searches from inception until October 2022 of MEDLINE, CINAHL, PsycINFO, PEDro, SpeechBITE, NeuroBITE, REHABDATA, WHO International Clinical Trial Registry and the Cochrane Library. METHODS Two reviewers screened studies against the eligibility criteria. Implementation science taxonomies and methods, including Powell et al.'s compilation of implementation strategies, were used to guide analysis and synthesis of findings. RESULTS The search retrieved 13,833 papers and 23 studies were included. Only 4 studies were randomised controlled trials and 9 studies (39%) were feasibility studies. Thirty-seven discrete implementation strategies were reported across studies. Strategies related to training and educating clinicians (91%), providing interactive assistance (61%), and developing stakeholder interrelationships (43%) were most frequently reported. Few studies adequately described implementation strategies and methods for selecting strategies. Almost all studies measured implementation outcomes and determinants; most commonly, acceptability, compatibility and dose delivered of digital interventions. CONCLUSION The rigour of implementation methods in the field is currently poor. Digital interventions require carefully planned and tailored implementation to facilitate successful adoption into rehabilitation practice. To keep pace with rapidly advancing technology, future rehabilitation research should prioritise using implementation science methods to explore and evaluate implementation while testing effectiveness of digital interventions.
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Affiliation(s)
- Louise Pearce
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Royal Rehab LifeWorks Ryde, Royal Rehab Rehabilitation Centre, Sydney, Australia
| | - Nathalia Costa
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney/Sydney Local Health District, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Lovero KL, Kemp CG, Wagenaar BH, Giusto A, Greene MC, Powell BJ, Proctor EK. Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review. Implement Sci 2023; 18:56. [PMID: 37904218 PMCID: PMC10617067 DOI: 10.1186/s13012-023-01310-2] [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: 03/14/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The Expert Recommendations for Implementing Change (ERIC) project developed a compilation of implementation strategies that are intended to standardize reporting and evaluation. Little is known about the application of ERIC in low- and middle-income countries (LMICs). We systematically reviewed the literature on the use and specification of ERIC strategies for health intervention implementation in LMICs to identify gaps and inform future research. METHODS We searched peer-reviewed articles published through March 2023 in any language that (1) were conducted in an LMIC and (2) cited seminal ERIC articles or (3) mentioned ERIC in the title or abstract. Two co-authors independently screened all titles, abstracts, and full-text articles, then abstracted study, intervention, and implementation strategy characteristics of included studies. RESULTS The final sample included 60 studies describing research from all world regions, with over 30% published in the final year of our review period. Most studies took place in healthcare settings (n = 52, 86.7%), while 11 (18.2%) took place in community settings and four (6.7%) at the policy level. Across studies, 548 distinct implementation strategies were identified with a median of six strategies (range 1-46 strategies) included in each study. Most studies (n = 32, 53.3%) explicitly matched implementation strategies used for the ERIC compilation. Among those that did, 64 (87.3%) of the 73 ERIC strategies were represented. Many of the strategies not cited included those that target systems- or policy-level barriers. Nearly 85% of strategies included some component of strategy specification, though most only included specification of their action (75.2%), actor (57.3%), and action target (60.8%). A minority of studies employed randomized trials or high-quality quasi-experimental designs; only one study evaluated implementation strategy effectiveness. CONCLUSIONS While ERIC use in LMICs is rapidly growing, its application has not been consistent nor commonly used to test strategy effectiveness. Research in LMICs must better specify strategies and evaluate their impact on outcomes. Moreover, strategies that are tested need to be better specified, so they may be compared across contexts. Finally, strategies targeting policy-, systems-, and community-level determinants should be further explored. TRIAL REGISTRATION PROSPERO, CRD42021268374.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - M Claire Greene
- Program On Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Enola K Proctor
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
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Miao M, Morrow R, Salomon A, Mcculloch B, Evain JC, Wright MR, Murphy MT, Welsh M, Williams L, Power E, Rietdijk R, Debono D, Brunner M, Togher L. Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis. J Med Internet Res 2023; 25:e46396. [PMID: 37725413 PMCID: PMC10548320 DOI: 10.2196/46396] [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: 02/10/2023] [Revised: 05/10/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Acquired brain injuries (ABIs), such as stroke and traumatic brain injury, commonly cause cognitive-communication disorders, in which underlying cognitive difficulties also impair communication. As communication is an exchange with others, close others such as family and friends also experience the impact of cognitive-communication impairment. It is therefore an internationally recommended best practice for speech-language pathologists to provide communication support to both people with ABI and the people who communicate with them. Current research also identifies a need for neurorehabilitation professionals to support digital communication, such as social media use, after ABI. However, with >135 million people worldwide affected by ABI, alternate and supplementary service delivery models are needed to meet these communication needs. The "Social Brain Toolkit" is a novel suite of 3 interventions to deliver communication rehabilitation via the internet. However, digital health implementation is complex, and minimal guidance exists for ABI. OBJECTIVE This study aimed to support the implementation of the Social Brain Toolkit by coproducing implementation knowledge with people with ABI, people who communicate with people with ABI, clinicians, and leaders in digital health implementation. METHODS A maximum variation sample (N=35) of individuals with living experience of ABI, close others, clinicians, and digital health implementation leaders participated in an explanatory sequential mixed methods design. Stakeholders quantitatively prioritized 4 of the 7 theoretical domains of the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as being the most important for Social Brain Toolkit implementation. Qualitative interview and focus group data collection focused on these 4 domains. Data were deductively analyzed against the NASSS framework with stakeholder coauthors to determine implementation considerations and strategies. A collaborative autoethnography of the research was conducted. Interrelationships between considerations and strategies were identified through a post hoc network analysis. RESULTS Across the 4 prioritized domains of "condition," "technology," "value proposition," and "adopters," 48 digital health implementation considerations and 52 tailored developer and clinician implementation strategies were generated. Benefits and challenges of coproduction were identified. The post hoc network analysis revealed 172 unique relationships between the identified implementation considerations and strategies, with user and persona testing and responsive design identified as the potentially most impactful strategies. CONCLUSIONS People with ABI, close others, clinicians, and digital health leaders coproduced new knowledge of digital health implementation considerations for adults with ABI and the people who communicate with them, as well as tailored implementation strategies. Complexity-informed network analyses offered a data-driven method to identify the 2 most potentially impactful strategies. Although the study was limited by a focus on 4 NASSS domains and the underrepresentation of certain demographics, the wealth of actionable implementation knowledge produced supports future coproduction of implementation research with mutually beneficial outcomes for stakeholders and researchers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/35080.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosemary Morrow
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Alexander Salomon
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Ben Mcculloch
- Stakeholder with living experience of acquired brain injury, Sydney, Australia
| | - Jean-Christophe Evain
- Acquired Brain Injury Rehabilitation Ward, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
- Stakeholder with living experience of acquired brain injury, Melbourne, Australia
| | - Meg Rebecca Wright
- Stakeholder with living experience of acquired brain injury, Blenheim, Australia
| | - Marie Therese Murphy
- Stakeholder with living experience as a communication partner of a person with acquired brain injury, Sydney, Australia
- Faculty of Education, Western Sydney University, Sydney, Australia
- Faculty of Education and Social Work, The University of Sydney, Sydney, Australia
| | - Monica Welsh
- Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Liz Williams
- Brain Injury Rehabilitation Community and Home (BIRCH), South Australian Brain Injury Rehabilitation Service, Adelaide, Australia
| | - Emma Power
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Deborah Debono
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Bostrøm K, Børøsund E, Eide H, Varsi C, Kristjansdottir ÓB, Schreurs KMG, Waxenberg LB, Weiss KE, Morrison EJ, Stavenes Støle H, Cvancarova Småstuen M, Stubhaug A, Solberg Nes L. Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial. J Med Internet Res 2023; 25:e47284. [PMID: 37624622 PMCID: PMC10492177 DOI: 10.2196/47284] [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: 03/14/2023] [Revised: 04/23/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Chronic pain conditions involve numerous physical and psychological challenges, and while psychosocial self-management interventions can be of benefit for people living with chronic pain, such in-person treatment is not always accessible. Digital self-management approaches could improve this disparity, potentially bolstering outreach and providing easy, relatively low-cost access to pain self-management interventions. OBJECTIVE This randomized controlled trial aimed to evaluate the short-term efficacy of EPIO (ie, inspired by the Greek goddess for the soothing of pain, Epione), a digital self-management intervention, for people living with chronic pain. METHODS Patients (N=266) were randomly assigned to either the EPIO intervention (n=132) or a care-as-usual control group (n=134). Outcome measures included pain interference (Brief Pain Inventory; primary outcome measure), anxiety and depression (Hospital Anxiety and Depression Scale), self-regulatory fatigue (Self-Regulatory Fatigue 18 scale), health-related quality of life (SF-36 Short Form Health Survey), pain catastrophizing (Pain Catastrophizing Scale), and pain acceptance (Chronic Pain Acceptance Questionnaire). Linear regression models used change scores as the dependent variables. RESULTS The participants were primarily female (210/259, 81.1%), with a median age of 49 (range 22-78) years and a variety of pain conditions. Analyses (n=229) after 3 months revealed no statistically significant changes for the primary outcome of pain interference (P=.84), but significant reductions in the secondary outcomes of depression (mean difference -0.90; P=.03) and self-regulatory fatigue (mean difference -2.76; P=.008) in favor of the intervention group. No other statistically significant changes were observed at 3 months (all P>.05). Participants described EPIO as useful (ie, totally agree or agree; 95/109, 87.2%) and easy to use (101/109, 92.7%), with easily understandable exercises (106/109, 97.2%). CONCLUSIONS Evidence-informed, user-centered digital pain self-management interventions such as EPIO may have the potential to effectively support self-management and improve psychological functioning in the form of reduced symptoms of depression and improved capacity to regulate thoughts, feelings, and behavior for people living with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104.
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Affiliation(s)
- Katrine Bostrøm
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ólöf Birna Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Mental Health Team West, Primary Care of the Capital area, Reykjavik, Iceland
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Karen E Weiss
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Hanne Stavenes Støle
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
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Sui M, Cheng M, Zhang S, Wang Y, Yan Q, Yang Q, Wu F, Xue L, Shi Y, Fu C. The digitized chronic disease management model: scalable strategies for implementing standardized healthcare and big data analytics in Shanghai. Front Big Data 2023; 6:1241296. [PMID: 37693846 PMCID: PMC10483282 DOI: 10.3389/fdata.2023.1241296] [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: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Background Chronic disease management (CDM) falls under production relations, and digital technology belongs to the realm of productivity. Production relations must adapt to the development of productivity. Simultaneously, the prevalence and burden of chronic diseases are becoming increasingly severe, leveraging digital technology to innovate chronic disease management model is essential. Methods The model was built to cover experts in a number of fields, including administrative officials, public health experts, information technology staff, clinical experts, general practitioners, nurses, metrologists. Integration of multiple big data platforms such as General Practitioner Contract Platform, Integrated Community Multimorbidity Management System and Municipal and District-Level Health Information Comprehensive Platform. This study fully analyzes the organizational structure, participants, service objects, facilities and equipment, digital technology, operation process, etc., required for new model in the era of big data. Results Based on information technology, we build Integrated Community Multimorbidity Care Model (ICMCM). This model is based on big data, is driven by "technology + mechanism," and uses digital technology as a tool to achieve the integration of services, technology integration, and data integration, thereby providing patients with comprehensive people-centered services. In order to promote the implementation of the ICMCM, Shanghai has established an integrated chronic disease management information system, clarified the role of each module and institution, and achieved horizontal and vertical integration of data and services. Moreover, we adopt standardized service processes and accurate blood pressure and blood glucose measurement equipment to provide services for patients and upload data in real time. On the basis of Integrated Community Multimorbidity Care Model, a platform and index system have been established, and the platform's multidimensional cross-evaluation and indicators are used for management and visual display. Conclusions The Integrated Community Multimorbidity Care Model guides chronic disease management in other countries and regions. We have utilized models to achieve a combination of services and management that provide a grip on chronic disease management.
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Affiliation(s)
- Mengyun Sui
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- School of Public Health, Fudan University, Shanghai, China
| | - Minna Cheng
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Sheng Zhang
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yuheng Wang
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qinghua Yan
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qinping Yang
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Fei Wu
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Long Xue
- Medical Department, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Shi
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chen Fu
- Division of Chronic Non-communicable Diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
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12
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Kelly M, Fullen B, Martin D, Bradley C, O'Mahony B, McVeigh JG. Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - 'eHealth: It's TIME': a study protocol. HRB Open Res 2023; 5:73. [PMID: 37675192 PMCID: PMC10477747 DOI: 10.12688/hrbopenres.13611.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/08/2023] Open
Abstract
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the "eHealth: It's TIME prototype". The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 - 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 - 5) and musculoskeletal physiotherapists (n = 3 - 5). Conclusion: The eHealth: It's TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Department of Physiotherapy, Mercy University Hospital, Cork, Ireland
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Billy O'Mahony
- School of Computer Science and Information Technology, University College Cork, Cork, Ireland
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13
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van Dulmen S, Eide H, Finset A. Implementing lifestyle interventions in clinical practice: The importance of adherence. PATIENT EDUCATION AND COUNSELING 2023; 109:107651. [PMID: 36753828 DOI: 10.1016/j.pec.2023.107651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Hilde Eide
- Centre for Health and Technology Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Arnstein Finset
- Patient Education and Counseling and Department of Behavioural Medicine University of Oslo, Norway
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14
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Albers B, Auer R, Caci L, Nyantakyi E, Plys E, Podmore C, Riegel F, Selby K, Walder J, Clack L. Implementing organized colorectal cancer screening programs in Europe-protocol for a systematic review of determinants and strategies. Syst Rev 2023; 12:26. [PMID: 36849979 PMCID: PMC9969690 DOI: 10.1186/s13643-023-02193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND With a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants. METHODS A systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis. DISCUSSION With its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022306580).
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Affiliation(s)
- Bianca Albers
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Laura Caci
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Emanuela Nyantakyi
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Ekaterina Plys
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Clara Podmore
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Franziska Riegel
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Joel Walder
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care (IfIS), Medical Faculty, University of Zurich, Universitätstrasse 84, 8006, Zurich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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15
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Boonstra A, Reezigt C. A Complexity Framework for Project Management Strategies. PROJECT MANAGEMENT JOURNAL 2023. [DOI: 10.1177/87569728221142229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We examine how project complexity influences the choice of a project management strategy and present a framework that facilitates managers in selecting a suitable project management strategy. We distinguish the complexity of project domains from two dimensions, the degree of structural complexity and the degree of dynamic complexity, resulting in four generic project types. Four generic project management strategies are identified that match these project types. This complexity framework for project management allows key players to determine a better project management strategy and related practices given its content, the internal context, and the external environment.
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16
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Chen W, O’Bryan CM, Gorham G, Howard K, Balasubramanya B, Coffey P, Abeyaratne A, Cass A. Barriers and enablers to implementing and using clinical decision support systems for chronic diseases: a qualitative systematic review and meta-aggregation. Implement Sci Commun 2022; 3:81. [PMID: 35902894 PMCID: PMC9330991 DOI: 10.1186/s43058-022-00326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Clinical decision support (CDS) is increasingly used to facilitate chronic disease care. Despite increased availability of electronic health records and the ongoing development of new CDS technologies, uptake of CDS into routine clinical settings is inconsistent. This qualitative systematic review seeks to synthesise healthcare provider experiences of CDS—exploring the barriers and enablers to implementing, using, evaluating, and sustaining chronic disease CDS systems. Methods A search was conducted in Medline, CINAHL, APA PsychInfo, EconLit, and Web of Science from 2011 to 2021. Primary research studies incorporating qualitative findings were included if they targeted healthcare providers and studied a relevant chronic disease CDS intervention. Relevant CDS interventions were electronic health record-based and addressed one or more of the following chronic diseases: cardiovascular disease, diabetes, chronic kidney disease, hypertension, and hypercholesterolaemia. Qualitative findings were synthesised using a meta-aggregative approach. Results Thirty-three primary research articles were included in this qualitative systematic review. Meta-aggregation of qualitative data revealed 177 findings and 29 categories, which were aggregated into 8 synthesised findings. The synthesised findings related to clinical context, user, external context, and technical factors affecting CDS uptake. Key barriers to uptake included CDS systems that were simplistic, had limited clinical applicability in multimorbidity, and integrated poorly into existing workflows. Enablers to successful CDS interventions included perceived usefulness in providing relevant clinical knowledge and structured chronic disease care; user confidence gained through training and post training follow-up; external contexts comprised of strong clinical champions, allocated personnel, and technical support; and CDS technical features that are both highly functional, and attractive. Conclusion This systematic review explored healthcare provider experiences, focussing on barriers and enablers to CDS use for chronic diseases. The results provide an evidence-base for designing, implementing, and sustaining future CDS systems. Based on the findings from this review, we highlight actionable steps for practice and future research. Trial registration PROSPERO CRD42020203716 Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00326-x.
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17
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Saunders RP, Wilcox S, Hutto B. Influence of implementation strategies on implementation outcomes in a statewide dissemination of Faith, Activity, and Nutrition (FAN). HEALTH EDUCATION RESEARCH 2022; 37:420-433. [PMID: 36149635 DOI: 10.1093/her/cyac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools.
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Affiliation(s)
- Ruth P Saunders
- Prevention Research Center and Department of Health Promotion, Education, and Behavior, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Sara Wilcox
- Prevention Research Center and Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Brent Hutto
- Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
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18
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Kelly M, Fullen B, Martin D, Bradley C, O'Mahony B, McVeigh JG. Design and development of an eHealth intervention to support self-Management in people with musculoskeletal Disorders - ‘eHealth: It’s TIME’: a study protocol. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13611.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5). Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
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He J, Yang T. In the era of long COVID, can we seek new techniques for better rehabilitation? Chronic Dis Transl Med 2022; 8:149-153. [PMID: 36161203 PMCID: PMC9481878 DOI: 10.1002/cdt3.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/24/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jiaze He
- Graduate School of Capital Medical University Beijing China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention Beijing China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China‐Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention Beijing China
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Burrell A, Zrubka Z, Champion A, Zah V, Vinuesa L, Holtorf AP, Di Bidino R, Earla JR, Entwistle J, Boltyenkov AT, Braileanu G, Kolasa K, Roydhouse J, Asche C. How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1469-1479. [PMID: 36049797 DOI: 10.1016/j.jval.2022.04.1730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article. METHODS PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores. RESULTS The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms. CONCLUSIONS To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.
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Affiliation(s)
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | | | - Vladimir Zah
- HEOR, Z Rx Outcomes Research Inc, Mississauga, ON, Canada
| | | | | | - Rosella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | | | - George Braileanu
- National Institute for Health and Care Excellence, Manchester, England, UK
| | - Katarzyna Kolasa
- Health Economics and Healthcare Management, Kozminski University, Warszawa, Poland
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Carl Asche
- University of Illinois College of Medicine, Chicago, IL, USA
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21
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Grinspun D, Wallace K, Li SA, McNeill S, Squires JE, Bujalance J, D’Arpino M, De Souza G, Farshait N, Gabbay J, Graham ID, Hutchinson A, Kinder K, Laur C, Mah T, Moore JE, Plant J, Ploquin J, Ruiter PJA, St-Germain D, Sills-Maerov M, Tao M, Titler M, Zhao J. Exploring social movement concepts and actions in a knowledge uptake and sustainability context: A concept analysis. Int J Nurs Sci 2022; 9:411-421. [PMID: 36285080 PMCID: PMC9587399 DOI: 10.1016/j.ijnss.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To share a concept analysis of social movement aimed at advancing its application to evidence uptake and sustainability in health-care. Methods We applied Walker and Avant method to clarify the concept of social movement in the context of knowledge uptake and sustainability. Peer-reviewed and grey literature databases were systematically searched for relevant reports that described how social movement action led to evidence-based practice changes in health and community settings. Titles, abstracts and full texts were reviewed independently and in duplicate, resulting in 38 included articles. Results Social movement action for knowledge uptake and sustainability can be defined as individuals, groups, or organizations that, as voluntary and intrinsically motivated change agents, mobilize around a common cause to improve outcomes through knowledge uptake and sustainability. The 10 defining attributes, three antecedents and three consequences that we identified are dynamic and interrelated, often mutually reinforcing each other to fortify various aspects of the social movement. Examples of defining attributes include an urgent need for action, collective action and collective identity. The concept analysis resulted in the development of the Social Movement Action Framework. Conclusions Social movement action can provide a lens through which we view implementation science. Collective action and collective identity – concepts less frequently canvassed in implementation science literature – can lend insight into grassroots approaches to uptake and sustainability. Findings can also inform providers and change leaders on the practicalities of harnessing social movement action for real-world change initiatives. By mobilizing individuals, groups, or organizations through social movement approaches, they can engage as powered change agents and teams that impact the individual, organizational and health systems levels to facilitate knowledge uptake and sustainability.
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Affiliation(s)
- Doris Grinspun
- Registered Nurses’ Association of Ontario, Toronto, Canada
| | - Katherine Wallace
- Registered Nurses’ Association of Ontario, Toronto, Canada
- Corresponding author.
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Susan McNeill
- Registered Nurses’ Association of Ontario, Toronto, Canada
| | - Janet Elaine Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | | | | | - John Gabbay
- University of Southampton, Southampton, England, UK
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Alison Hutchinson
- School of Nursing and Midwifery, Deakin University Australia, Victoria, Australia
| | - Kim Kinder
- Healthcare Excellence Canada, Ottawa, Canada
| | - Celia Laur
- Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Toronto, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Tina Mah
- Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | | | | | | | | | | | | | - May Tao
- Toronto Public Health, Toronto, Canada
| | - Marita Titler
- School of Nursing, University of Michigan, Ann Arbor, United States
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
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22
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Wei X, Guo K, Shang X, Wang S, Yang C, Li J, Li Y, Yang K, Zhang X, Li X. Effects of different interventions on smoking cessation in chronic obstructive pulmonary disease patients: A systematic review and network meta-analysis. Int J Nurs Stud 2022; 136:104362. [DOI: 10.1016/j.ijnurstu.2022.104362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 07/21/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
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Lin JL, Huber B, Amir O, Gehrmann S, Ramirez KS, Ochoa KM, Asch SM, Gajos KZ, Grosz BJ, Sanders LM. Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study. J Med Internet Res 2022; 24:e30902. [PMID: 35998021 PMCID: PMC9449827 DOI: 10.2196/30902] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/03/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC. Objective The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation. Methods We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children’s hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (–2 strong barrier to +2 strong facilitator). Results Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo; providers: 30-minute tutorial and 5-minute video on use in a clinic visit; both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years; n=28, 80% female; n=17, 49% Caucasian; n=16, 46% Hispanic; and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK’s internet accessibility and email reminders (parents), and GK’s ability to set long-term goals and use at the end of visits (providers). A key barrier was GK’s lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers. Conclusions Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records. Trial Registration ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071
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Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Bernd Huber
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA, United States
| | - Ofra Amir
- Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sebastian Gehrmann
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA, United States
| | - Kimberly S Ramirez
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kimberly M Ochoa
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Steven M Asch
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.,Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Krzysztof Z Gajos
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA, United States
| | - Barbara J Grosz
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA, United States
| | - Lee M Sanders
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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24
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Miao M, Rietdijk R, Brunner M, Debono D, Togher L, Power E. Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review. J Med Internet Res 2022; 24:e38100. [PMID: 35881432 PMCID: PMC9328122 DOI: 10.2196/38100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1177/20552076211035988.
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | - Emma Power
- University of Technology Sydney, Sydney, Australia
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25
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Barriers and Supports in eHealth Implementation among People with Chronic Cardiovascular Ailments: Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148296. [PMID: 35886149 PMCID: PMC9318125 DOI: 10.3390/ijerph19148296] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023]
Abstract
eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities. OBJECTIVE Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions. METHOD An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified. RESULTS Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users' age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others. CONCLUSIONS eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed.
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26
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Bernard RM, Toppo C, Raggi A, de Mul M, de Miquel C, Pugliese MT, van der Feltz-Cornelis CM, Ortiz-Tallo A, Salvador-Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Staszewska K, Sabariego C. Strategies for Implementing Occupational eMental Health Interventions: Scoping Review. J Med Internet Res 2022; 24:e34479. [PMID: 35648457 PMCID: PMC9201704 DOI: 10.2196/34479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. OBJECTIVE The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. METHODS A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. RESULTS A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. CONCLUSIONS This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions.
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Affiliation(s)
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marleen de Mul
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Maria Teresa Pugliese
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Ana Ortiz-Tallo
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | - Sue Lukersmith
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - Kaja Staszewska
- Department of Health and Work Psychology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Center for Rehabilitation in Global Health Systems, World Health Organization Collaborating Center, University of Lucerne, Lucerne, Switzerland
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27
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Bostrøm K, Varsi C, Eide H, Børøsund E, Kristjansdottir ÓB, Schreurs KMG, Waxenberg LB, Weiss KE, Morrison EJ, Nordang EF, Stubhaug A, Nes LS. Engaging with EPIO, a digital pain self-management program: a qualitative study. BMC Health Serv Res 2022; 22:577. [PMID: 35488295 PMCID: PMC9052507 DOI: 10.1186/s12913-022-07963-x] [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] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background Chronic pain conditions entail significant personal and societal burdens and improved outreach of evidence-based pain self-management programs are needed. Digital cognitive-behavioral self-management interventions have shown promise. However, evidence is still scarce and several challenges with such interventions for chronic pain exist. Exploring patients' experiences and engagement with digital interventions may be an essential step towards developing meaningful digital self-management interventions for those living with chronic pain. Objectives This study aimed to gain insight into the experiences of people with chronic pain when engaging with EPIO, an application (app)-based cognitive-behavioral pain self-management intervention program. Methods Participants (N = 50) living with chronic pain received access to the EPIO intervention in a feasibility pilot-study for 3 months. During this time, all participants received a follow-up phone call at 2–3 weeks, and a subsample (n = 15) also participated in individual semi-structured interviews after 3 months. A qualitative design was used and thematic analysis was employed aiming to capture participants’ experiences when engaging with the EPIO intervention program. Results Findings identifying program-related experiences and engagement were organized into three main topics, each with three sub-themes: (1) Engaging with EPIO; motivation to learn, fostering joy and enthusiasm, and helpful reminders and personalization, (2) Coping with pain in everyday life; awareness, practice and using EPIO in everyday life, and (3) The value of engaging with the EPIO program; EPIO – a friend, making peace with the presence of pain, and fostering communication and social support. Conclusions This qualitative study explored participants’ experiences and engagement with EPIO, a digital self-management intervention program for people living with chronic pain. Findings identified valued aspects related to motivation for engagement, and showed how such a program may be incorporated into daily life, and encourage a sense of acceptance, social support and relatedness. The findings highlight vital components for facilitating digital program engagement and use in support of self-management for people living with chronic pain. Trial registration ClinicalTrials.gov NCT03705104. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07963-x.
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Affiliation(s)
- Katrine Bostrøm
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, Centre for Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Ólöf B Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit On Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Elise Flakk Nordang
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Regional Advisory Unit On Pain, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
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28
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Gijsbers H, Feenstra TM, Eminovic N, van Dam D, Nurmohamed SA, van de Belt T, Schijven MP. Enablers and barriers in upscaling telemonitoring across geographic boundaries: a scoping review. BMJ Open 2022; 12:e057494. [PMID: 35443957 PMCID: PMC9021767 DOI: 10.1136/bmjopen-2021-057494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Telemonitoring is a method to monitor a person's vital functions via their physiological data at distance, using technology. While pilot studies on the proposed benefits of telemonitoring show promising results, it appears challenging to implement telemonitoring on a larger scale. The aim of this scoping review is to identify the enablers and barriers for upscaling of telemonitoring across different settings and geographical boundaries in healthcare. METHODS PubMed, Embase, Cinahl, Web of Science, ProQuest and IEEE databases were searched. Resulting outcomes were assessed by two independent reviewers. Studies were considered eligible if they focused on remote monitoring of patients' vital functions and data was transmitted digitally. Using scoping review methodology, selected studies were systematically assessed on their factors of influence on upscaling of telemonitoring. RESULTS A total of 2298 titles and abstracts were screened, and 19 articles were included for final analysis. This analysis revealed 89 relevant factors of influence: 26 were reported as enabler, 18 were reported as barrier and 45 factors were reported being both. The actual utilisation of telemonitoring varied widely across studies. The most frequently mentioned factors of influence are: resources such as costs or reimbursement, access or interface with electronic medical record and knowledge of frontline staff. CONCLUSION Successful upscaling of telemonitoring requires insight into its critical success factors, especially at an overarching national level. To future-proof and facilitate upscaling of telemonitoring, it is recommended to use this type of technology in usual care and to find means for reimbursement early on. A wide programme on change management, nationally or regionally coordinated, is key. Clear regulatory conditions and professional guidelines may further facilitate widespread adoption and use of telemonitoring. Future research should focus on converting the 'enablers and barriers' as identified by this review into a guideline supporting further nationwide upscaling of telemonitoring.
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Affiliation(s)
- Harm Gijsbers
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Rehabilitation, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands, Amsterdam, The Netherlands
| | - Tim M Feenstra
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands, Amsterdam, The Netherlands
| | - Nina Eminovic
- Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Hospital Association, Utrecht, The Netherlands
| | - Debora van Dam
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Shaikh Azam Nurmohamed
- Internal Medicine (Nephrology), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van de Belt
- Health Innovations Lab, Radboudumc, Nijmegen, The Netherlands
| | - Marlies P Schijven
- Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, the Netherlands, Amsterdam, The Netherlands
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Hall R, Harvey MR, Patel V. Diabetes care in the time of
COVID
‐19: video consultation as a means of diabetes management. PRACTICAL DIABETES 2022. [PMCID: PMC9088658 DOI: 10.1002/pdi.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: This review specifically focuses on the use of video consultation in diabetes management, in comparison to standard care. The population of chronic condition sufferers in the UK is considerable and teleconsultation use has, in recent years, been explored. COVID‐19 has created an additional pressure on health services to use teleconsultation. Diabetes mellitus affects approximately four million people in the UK. If clinical outcomes are uncompromised, the benefits of using a remote service could encourage the use of video consultation for diabetes management in normal practice. Aims: A systematic review of the use of video consultation in place of standard consultation in the management of diabetes mellitus. Both clinical and non‐clinical outcomes are reviewed, in addition to patient satisfaction levels after using video consultation. Methods: A systematic literature search was conducted to select published articles from web‐based health databases. Data extraction and analysis of results followed. Results: Twelve studies were selected. Overall, the clinical outcomes (HbA1c, low‐density lipoprotein levels and blood pressure) appeared to be uncompromised with the use of video consultation. Patient satisfaction was high, with few limitations found. The economic and time saving benefits of this approach proved to be additional advantages. Conclusions: Despite there being a lack of literature identified in this field, the results support the use of video consultation in diabetes management. The evidence suggests that this approach should be utilised in the time of COVID‐19 and beyond. Future research should assess the use of video consultation over a reasonable duration through randomised controlled trials. Copyright © 2022 John Wiley & Sons.
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Hamid M, Rogers E, Chawla G, Gill J, Macanovic S, Mucsi I. Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review. Transplantation 2022; 106:722-733. [PMID: 34260472 DOI: 10.1097/tp.0000000000003893] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.
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Affiliation(s)
- Marzan Hamid
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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Neher M, Nygårdh A, Broström A, Lundgren J, Johansson P. Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study. J Med Internet Res 2022; 24:e28870. [PMID: 35089139 PMCID: PMC8838545 DOI: 10.2196/28870] [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: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.
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Affiliation(s)
- Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annette Nygårdh
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Miao M, Power E, Rietdijk R, Debono D, Brunner M, Salomon A, Mcculloch B, Wright MR, Welsh M, Tremblay B, Rixon C, Williams L, Morrow R, Evain JC, Togher L. Coproducing Knowledge of the Implementation of Complex Digital Health Interventions for Adults with Acquired Brain Injury and their Communication Partners: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e35080. [PMID: 35006082 PMCID: PMC8787662 DOI: 10.2196/35080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background The Social Brain Toolkit, conceived and developed in partnership with stakeholders, is a novel suite of web-based communication interventions for people with brain injury and their communication partners. To support effective implementation, the developers of the Social Brain Toolkit have collaborated with people with brain injury, communication partners, clinicians, and individuals with digital health implementation experience to coproduce new implementation knowledge. In recognition of the equal value of experiential and academic knowledge, both types of knowledge are included in this study protocol, with input from stakeholder coauthors. Objective This study aims to collaborate with stakeholders to prioritize theoretically based implementation targets for the Social Brain Toolkit, understand the nature of these priorities, and develop targeted implementation strategies to address these priorities, in order to support the Social Brain Toolkit’s implementation. Methods Theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation, a maximum variation sample (N=35) of stakeholders coproduced knowledge of the implementation of the Social Brain Toolkit. People with brain injury (n=10), communication partners (n=11), and clinicians (n=5) participated in an initial web-based prioritization survey based on the NASSS framework. Survey completion was facilitated by plain English explanations and accessible captioned videos developed through 3 rounds of piloting. A speech-language pathologist also assisted stakeholders with brain injury to participate in the survey via video teleconference. Participants subsequently elaborated on their identified priorities via 7 web-based focus groups, in which researchers and stakeholders exchanged stakeholder perspectives and research evidence from a concurrent systematic review. Stakeholders were supported to engage in focus groups through the use of visual supports and plain English explanations. Additionally, individuals with experience in digital health implementation (n=9) responded to the prioritization survey questions via individual interview. The results will be deductively analyzed in relation to the NASSS framework in a coauthorship process with people with brain injury, communication partners, and clinicians. Results Ethical approval was received from the University of Technology Sydney Health and Medical Research Ethics Committee (ETH20-5466) on December 15, 2020. Data were collected from April 13 to November 18, 2021. Data analysis is currently underway, with results expected for publication in mid-2022. Conclusions In this study, researchers supported individuals with living experience of acquired brain injury, of communicating with or clinically supporting someone post injury, and of digital health implementation, to directly access and leverage the latest implementation research evidence and theory. With this support, stakeholders were able to prioritize implementation research targets, develop targeted implementation solutions, and coauthor and publish new implementation findings. The results will be used to optimize the implementation of 3 real-world, evidence-based interventions and thus improve the outcomes of people with brain injury and their communication partners. International Registered Report Identifier (IRRID) DERR1-10.2196/35080
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Affiliation(s)
- Melissa Miao
- University of Technology Sydney, Sydney, Australia
| | - Emma Power
- University of Technology Sydney, Sydney, Australia
| | | | | | | | | | | | | | - Monica Welsh
- See Authors' Contributions, Australia.,Brain Injury Rehabilitation Unit, South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia
| | | | - Caleb Rixon
- See Authors' Contributions, Australia.,Genyus Network, Melbourne, Australia
| | - Liz Williams
- See Authors' Contributions, Australia.,Brain Injury Rehabilitation Community and Home, South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia
| | | | - Jean-Christophe Evain
- See Authors' Contributions, Australia.,Acquired Brain Injury Rehabilitation Centre, Caulfield Hospital, Alfred Health Network, Melbourne, Australia
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Barnett A, Kelly JT, Wright C, Campbell KL. Technology-supported models of nutrition care: Perspectives of health service providers. Digit Health 2022; 8:20552076221104670. [PMID: 35677784 PMCID: PMC9168874 DOI: 10.1177/20552076221104670] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/14/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To determine the perspectives to the adoption, scale-up, sustainability, and
spread of technology-supported models of nutrition care, in hospital and
ambulatory care settings. Methods Thirty-one health service providers participated in individual
semi-structured interviews from a tertiary health service in Queensland,
Australia. The Non-adoption, Abandonment, and challenges to the Scale up,
Spread and Sustainability (NASSS) framework, designed to evaluate
technology-supported models’ success, informed the qualitative design. Results Key findings were that technology-supported models of care could benefit many
chronic condition patient groups; dietitians are well suited to adopting
this technology: and the value proposition in creating efficiency gains in
the health service. However, challenges of transitioning and sustainability
were identified. Perceived enablers for technology supported models of care
included: previous intentions for technology supported models of care prior
to the 2019 novel coronavirus pandemic; opportunity for clinicians to
complete higher valued tasks; and integration of technology systems and
assisted staff roles. Perceived barriers included: suitability for patients
is dependent on experience and ability to use technology, varied confidence
by clinicians when conducting clinical assessments; high investment required
for set up and ongoing maintenance; and patients desire for adopting
face-to-face care over technology. Health service providers perceived that
embedding and adapting such models requires maintenance of high-quality
service and continued research. Conclusions Health service providers recognize adopting, scaling, and sustaining
technology-supported models of nutrition care benefits patients, clinicians,
and health services in general. Robust clinical trials and health service
evaluations of technology-supported models of care, across practice settings
are now needed.
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Affiliation(s)
- Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Charlene Wright
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Katrina L Campbell
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Ekstedt M, Kirsebom M, Lindqvist G, Kneck Å, Frykholm O, Flink M, Wannheden C. Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010391. [PMID: 35010652 PMCID: PMC8744716 DOI: 10.3390/ijerph19010391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 05/07/2023]
Abstract
The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.
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Affiliation(s)
- Mirjam Ekstedt
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| | - Marie Kirsebom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Gunilla Lindqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, Box 111 89, 100 61 Stockholm, Sweden;
| | - Oscar Frykholm
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Stockholm, Sweden;
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Carolina Wannheden
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
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Engelen M, van Gaal B, Vermeulen H, Zuidema R, Bredie S, van Dulmen S. The influencing contexts and potential mechanisms behind the use of online self-management support interventions: a realist evaluation (Preprint). JMIR Hum Factors 2021; 9:e34925. [PMID: 35776437 PMCID: PMC9288100 DOI: 10.2196/34925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/27/2022] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low. Objective This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not. Methods A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study. Results This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). Patients with CVD with higher self-management and quality of life scores were less likely to use the program, whereas patients with RA with higher self-management and quality of life scores were more likely to use the program. Interviews with 10 nonusers, 10 low users, and 18 high users were analyzed to provide insight into the relationship between mechanisms and outcome. Program use was encouraged by an easy-to-use, clear, and transparent design and by recommendations from professionals and email reminders. A total of 5 BCTs were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior, delayed feedback, providing information on peer behavior, and modeling. Conclusions This realistic evaluation showed that certain patient, disease, and program characteristics (age, education, diagnosis, program design, type of reminder, and BCTs) are associated with the use of web-based self-management support programs. These results represent the first step in improving the tailoring of web-based self-management support programs. Future research on the interaction between patient and program characteristics should be conducted to improve the tailoring of participants to program components.
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Affiliation(s)
- Marscha Engelen
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Betsie van Gaal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Hester Vermeulen
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Rixt Zuidema
- Research Group Proactive Care for Older People, Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Sebastian Bredie
- Division of Vascular Medicine, Department of Internal Medicine, Radboud university medical center, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
- Nivel - Netherlands institute for health services research, Department of Communication in healthcare, Utrecht, Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Louissaint J, Gibbs JT, Lok AS, Tapper EB. Strategies to Improve Video Visit Use in Persons With Liver Disease. Gastroenterology 2021; 161:1080-1084.e2. [PMID: 34197830 PMCID: PMC8973455 DOI: 10.1053/j.gastro.2021.06.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/02/2021] [Accepted: 06/01/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Jeremy Louissaint
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey T. Gibbs
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan,Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Johnsen TL, Johansen T, Momsen AMH, Tveito TH, Nielsen CV, Varsi C, Øyeflaten I. eHealth interventions to facilitate work participation: a scoping review. JBI Evid Synth 2021; 19:2739-2759. [PMID: 34224522 PMCID: PMC8528131 DOI: 10.11124/jbisrir-d-19-00433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review was to identify studies combining the concepts of eHealth and work participation for sick-listed employees across diagnostic groups in health care and workplace contexts. INTRODUCTION There is an increased demand for better health care services and technologies, and eHealth is proposed as a useful tool to improve efficiency and reduce costs. eHealth functions at the intersection of medical informatics, public health, and business, and may be a promising solution for managing the process of return to work among employees on sick leave. Assessment of work outcomes is essential in evaluating the effectiveness of health services, and there is a need to map the research literature on existing eHealth interventions to facilitate work participation. INCLUSION CRITERIA This scoping review considered studies combining two core concepts: eHealth and work participation. It considered studies on eHealth interventions for employees (18 to 65 years of age) on sick leave due to any type of diagnosis or disability, conducted by any stakeholder in workplace or health care contexts and in any country. Empirical data from both quantitative and qualitative studies were included. METHODS Published and unpublished studies from January 1, 2008, to August 21, 2020, written in English were included in this review. The search was conducted in MEDLINE, Scopus, Embase, PsycINFO, WHO clinical registry, and ClinicalTrials.gov. A three-step search strategy was followed. Data extraction was performed by two independent reviewers and undertaken using an extraction tool developed specifically for the scoping review objectives. RESULTS This review identified 15 studies eligible for inclusion. Four studies delivered the eHealth intervention by telephone, while 10 interventions were web-based. Of the web-based interventions, five had a blended approach, such as website and email support, or website and social media platforms. One study used an app-based intervention. Only eight studies targeted employees sick-listed due to common sick leave diagnoses, such as common mental disorders and musculoskeletal disorders. The workplace context was the target of the eHealth intervention in seven studies, although the intervention was still delivered by health personnel such as therapists or occupational physicians. Collaboration on individual cases between the health professional, employer, and employee to facilitate work participation seemed to be rare. Four studies reported both a theoretical and an empirical base for the intervention used. CONCLUSIONS This review demonstrated that the use of eHealth interventions to facilitate work participation is limited, and there is a need for future studies on the use of eHealth technology for this purpose. Developing eHealth interventions specifically for populations at risk of long-term sick leave, and encouraging collaboration between all relevant stakeholders, may help improve work participation.
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Affiliation(s)
- Tone Langjordet Johnsen
- NORCE, Norwegian Research Centre, Bergen, Norway
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Thomas Johansen
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Anne-Mette Hedeager Momsen
- Department of Public Health, Aarhus University, Denmark
- DEFACTUM - Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark
| | - Torill Helene Tveito
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Horten, Norway
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Denmark
- DEFACTUM - Social and Health Services and Labour Market, Corporate Quality, Central Denmark Region, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Region Hospital West Jutland, Denmark
| | - Cecilie Varsi
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Irene Øyeflaten
- NORCE, Norwegian Research Centre, Bergen, Norway
- National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
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Miao M, Power E, Rietdijk R, Brunner M, Togher L. Implementation of online psychosocial interventions for people with neurological conditions and their caregivers: A systematic review protocol. Digit Health 2021; 7:20552076211035988. [PMID: 34567610 PMCID: PMC8456620 DOI: 10.1177/20552076211035988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background As the burden of neurological conditions increases globally, online psychosocial interventions offer a potentially scalable solution to enabling healthcare access. However, their successful development and implementation require research into electronic healthcare implementation specifically. Methods Using a search strategy combining the concepts of implementation, electronic healthcare, psychosocial interventions and neurological conditions, we will conduct comprehensive electronic searches for primary implementation evidence in MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, SpeechBITE and NeuroBITE databases. Included studies will be analysed according to the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework, appraised using the Mixed-Methods Appraisal Tool and evaluated for theoretical underpinning in implementation science, with hybrid studies of effectiveness-implementation research classified according to the type of hybrid design. Discussion This review will be the first to use a theoretical underpinning in the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability framework to evaluate strengths and gaps in existing implementation research into online psychosocial interventions for people with neurological conditions and/or their caregivers. The results may be useful to provide direction and recommendations for future clinical implementation and research into online psychosocial interventions for people with neurological conditions and/or their caregivers. Systematic review registration PROSPERO 2020: CRD42020186387.
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Affiliation(s)
- Melissa Miao
- Graduate School of Health, University of Technology Sydney, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Australia
| | - Rachael Rietdijk
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Melissa Brunner
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Leanne Togher
- Faculty of Medicine and Health, The University of Sydney, Australia
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Blasi PR, Mettert KD, Coleman K, Lewis C, Wagner E, Coghill MN, Dang T, Richards JE. Transitioning patients from outpatient mental health services to primary care: A rapid literature review. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211041294. [PMID: 37089993 PMCID: PMC9981893 DOI: 10.1177/26334895211041294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background A lack of access to mental health services is a critical barrier to obtaining evidence-based care. One strategy to improve access is to transition stable patients out of mental health specialty services and into primary care, thus opening availability for new patients and those with acute mental health needs. To support these transitions, organizations might explore a range of new practices and implementation strategies. Methods We conducted a rapid literature review to summarize descriptions from the research literature about practices for transitioning stable patients from outpatient mental health services to primary care, as well as implementation strategies to enhance the adoption and sustainment of these practices. We searched PsycINFO and Cumulated Index to Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and August 2019. For articles meeting inclusion criteria, we abstracted data on study characteristics, transition practices, and implementation strategies. Results We included 11 articles representing diverse study designs, settings, and health care organizations. Across these articles, we identified six categories of commonly described transition practices, with patient engagement appearing the most frequently (10 articles), followed by shared treatment planning (eight articles), assessment of recovery and stability, care coordination, follow up and support, and medication management (seven articles each). Less frequently, articles included descriptions of implementation strategies, with five articles describing efforts to train and educate stakeholders and four articles describing the use of evaluative and iterative strategies. Conclusions We identified descriptions of several common practices to help patients transition from mental health specialty services to primary care, but there are opportunities for an increased focus on implementation strategies to enhance the adoption and sustainment of these transition practices. More research is needed to better understand the effectiveness of specific transition interventions and the feasibility of deploying these interventions in heterogeneous health care settings.
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Affiliation(s)
- Paula R. Blasi
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kayne D. Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katie Coleman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Edward Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Tobias Dang
- Kaiser Permanente Washington, Renton, WA, USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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40
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Skovlund SE, Nicolucci A, Balk-Møller N, Berthelsen DB, Glümer C, Perrild H, Kjær P, Nørgaard LM, Troelsen LH, Pietraszek A, Hessler D, Kaplan S, Ejskjær N. Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study. JMIR Res Protoc 2021; 10:e28391. [PMID: 34477563 PMCID: PMC8449301 DOI: 10.2196/28391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is growing evidence that digital patient-reported outcome (PRO) questionnaires and PRO-based decision support tools may help improve the active engagement of people with diabetes in self-care, thereby improving the quality of care. However, many barriers still exist for the real-world effectiveness and implementation of such PRO tools in routine care. Furthermore, limited research has evaluated the acceptability, feasibility, and benefits of such tools across different health care settings. OBJECTIVE This study aims to evaluate the acceptability, feasibility, and perceived benefits of the Danish digital PRO diabetes tool in different health care settings in Denmark and to determine the factors affecting its implementation. Furthermore, the study evaluates the psychometric characteristics of the Danish PRO Diabetes Questionnaire and the validity of the scoring algorithms for dialogue support. The objective of this study is to guide the ongoing optimization of the PRO diabetes tool, its implementation, and the design of future randomized controlled effectiveness studies. METHODS We designed a multicenter, mixed methods, single-arm acceptability-feasibility implementation study protocol to contribute to the real-world pilot test of a new digital PRO diabetes tool in routine diabetes care. The use of the tool involves two main steps. First, the people with diabetes will complete a digital PRO Diabetes Questionnaire in the days before a routine diabetes visit. Second, the health care professional (HCP) will use a digital PRO tool to review the PRO results together with the people with diabetes during the visit. The PRO diabetes tool is designed to encourage and support people to take an active role for the people with diabetes in their own care and to expedite the delivery of person-centered, collaborative, and coordinated care. RESULTS A multicenter pilot study protocol and psychometrically designed digital data collection tools for evaluation were developed and deployed as part of a national evaluation of a new digital PRO diabetes intervention. A total of 598 people with diabetes and 34 HCPs completed the study protocol by April 1, 2021. CONCLUSIONS A large-scale, mixed methods, multicenter study for evaluating the use of the nationally developed PRO Diabetes Questionnaire in routine care across all health care sectors in Denmark by using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model as a framework has been designed and is ongoing. This study is expected to provide new important and detailed information about the real-world acceptability, perceived relevance, and benefits of the PRO diabetes tool among a large heterogeneous population of people with diabetes in Denmark and HCPs in different care settings. The results will be used to further improve the PRO tool, design implementation facilitation support strategies, and design future controlled effectiveness studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28391.
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Affiliation(s)
- Søren Eik Skovlund
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Nina Balk-Møller
- PRO Secretariat, National Health Data Authority, Copenhagen, Denmark
| | - Dorthe B Berthelsen
- Department of Rehabilitation, Municipality of Guldborgsund, Nykoebing F, Denmark
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Charlotte Glümer
- Center for Diabetes, Copenhagen Municipality, Copenhagen, Denmark
| | - Hans Perrild
- Department of Endocrinology, Frederiksberg-Bisbebjerg Hospital, Copenhagen, Denmark
| | - Pernille Kjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lise Havbæk Troelsen
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Anna Pietraszek
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Danielle Hessler
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sherrie Kaplan
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Niels Ejskjær
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Obiezu-Umeh C, Nwaozuru U, Mason S, Gbaja-Biamila T, Oladele D, Ezechi O, Iwelunmor J. Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive Health Services in Sub-Saharan Africa: A Systematic Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684081. [PMID: 36304027 PMCID: PMC9580831 DOI: 10.3389/frph.2021.684081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes. Methods: A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues' 8 taxonomy of implementation outcomes. Results: We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0). Conclusion: Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.
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Affiliation(s)
- Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Stacey Mason
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbaja-Biamila
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - David Oladele
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States
- *Correspondence: Juliet Iwelunmor
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Shahid N, Rac VE, Bielecki J, Berta W. Understanding factors critical to the implementation of ehealth in chronic disease management: a realist review protocol. BMJ Open 2021; 11:e048250. [PMID: 34253670 PMCID: PMC8276298 DOI: 10.1136/bmjopen-2020-048250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Canadians are living longer, many with multiple chronic conditions. This population of older, frail Canadians continues to grow in size as do concurrent demands for community-based, outpatient and ambulatory models of care. Ideally, a multifaceted, proactive, planned and integrated care model includes ehealth. Although several factors are known to facilitate the implementation of ehealth in chronic disease management (CDM), for example, adequate support, usability, alignment of programme objectives, there is a growing body of inconclusive evidence on what is critical for implementation. We aim to achieve a fulsome understanding of factors critical to implementation by conducting a realist review-an approach suitable for understanding complex interventions. Our proposed review will identify factors critical to the implementation of ehealth in CDM (heart failure, chronic obstructive pulmonary disease, chronic kidney disease and/or diabetes (type 1 or 2)) without limitations to care setting, language, publication year or geography. Findings will be presented in configurations of contexts, mechanisms and outcomes (CMOs). METHODS AND ANALYSIS A search strategy will be iteratively developed based on the concepts of 'implementation' and 'adoption' of 'ehealth' interventions used within 'CDM' to identify the peer-reviewed and grey literature published before 31 March 2021 from five databases (Medline, Embase, Cochrane, CINAHL and PsychInfo) on ehealth interventions actively involving a healthcare provider for CDM among adults. Data extraction and synthesis will be guided by Realist and Meta-review Evidence Synthesis: Evolving Standards (RAMESES) guidelines informing core concepts of CMOs, and a study output will include a middle-range-theory describing the implementation of ehealth in CDM. ETHICS AND DISSEMINATION Findings will be published in an open-access peer-reviewed journal and presented at relevant conferences. A multistakeholder (patients, caregivers, healthcare providers and practitioners, decision-makers and policy-makers) perspective will be used in our dissemination approach. No formal ethics approval is required for this review. PROSPERO REGISTRATION NUMBER CRD42020208275.
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Affiliation(s)
- Nida Shahid
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Joanna Bielecki
- Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Broekhuis M, Weering MDV, Schuit C, Schürz S, van Velsen L. Designing a stakeholder-inclusive service model for an eHealth service to support older adults in an active and social life. BMC Health Serv Res 2021; 21:654. [PMID: 34225745 PMCID: PMC8256482 DOI: 10.1186/s12913-021-06597-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Service model design is slowly being recognized among eHealth developers as a valuable method for creating durable implementation strategies. Nonetheless, practical guidelines and case-studies that inform the community on how to design a service model for an eHealth innovation are lacking. This study describes the development of a service model for an eHealth service, titled 'SALSA', which intends to support older adults with a physically active and socially inclusive lifestyle. METHODS The service model for the SALSA service was developed in eight consecutive rounds, using a mixed-methods approach. First, a stakeholder salience analysis was conducted to identify the most relevant stakeholders. In rounds 2-4, in-depth insights about implementation barriers, facilitators and workflow processes of these stakeholders were gathered. Rounds 5 and 6 were set up to optimize the service model and receive feedback from stakeholders. In rounds 7 and 8, we focused on future implementation and integrating the service model with the technical components of the eHealth service. RESULTS While the initial goal was to create one digital platform for the eHealth service, the results of the service modelling showed how the needs of two important stakeholders, physiotherapists and sports trainers, were too different for integrating them in one platform. Therefore, the decision was made to create two platforms, one for preventive (senior sports activities) and one for curative (physical rehabilitation) purposes. CONCLUSIONS A service model shows the interplay between service model design, technical development and business modelling. The process of service modelling helps to align the interests of the different stakeholders to create support for future implementation of an eHealth service. This study provides clear documentation on how to conduct service model design processes which can enable future learning and kickstart new research. Our results show the potential that service model design has for service development and innovation in health care.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, eHealth group, Roessinghsbleekweg 33b, 7522AH, Enschede, The Netherlands. .,Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands.
| | | | - Cheyenne Schuit
- National Foundation for the Elderly, Smallepad 30e, 3811 MG, Amersfoort, The Netherlands
| | | | - Lex van Velsen
- Roessingh Research and Development, eHealth group, Roessinghsbleekweg 33b, 7522AH, Enschede, The Netherlands.,Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, Enschede, The Netherlands
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Betmouni S. Diagnostic digital pathology implementation: Learning from the digital health experience. Digit Health 2021; 7:20552076211020240. [PMID: 34211723 PMCID: PMC8216403 DOI: 10.1177/20552076211020240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/04/2021] [Indexed: 01/18/2023] Open
Abstract
Digital Pathology (also referred to as Telepathology and Whole Slide Imaging) is the process of producing high resolution digital images from tissue sections on glass slides. These glass slides are normally examined under a microscope by a pathologist as part of the diagnostic process. The emergence of digital pathology now means that digital images are stored on secure servers and can be viewed on computer monitors; enabling pathologists to work remotely and to collaborate with other colleagues when second opinions are needed. The implementation of digital pathology into clinical practice has many potential benefits. Although this has been long recognised, its adoption as a diagnostic tool remains low and pathologists’ projections about its future deployment are cautious. Notable early digital pathology adopters have led the way. The challenge now is to scale-up digital pathology beyond the relatively few large networks and centres of excellence. Many other areas of healthcare have accumulated experience about optimising approaches to digital health/healthcare technology deployment and sustainability. This has been done in a multi-disciplinary context and has applied theoretical/conceptual frameworks. Thus far there has been little use of similar frameworks in the planning of digital pathology deployment in clinical practice. In this essay, I will explore the scope of digital pathology implementation approaches that have been deployed in clinical practice and examine what can be learned from the wider healthcare experience of adopting, scaling-up and sustaining innovative healthcare solutions.
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Affiliation(s)
- Samar Betmouni
- Digital Health Enterprise Zone, University of Bradford, Bradford, UK.,Digital Health Enterprise Zone, University of Bradford, Bradford, UK
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Støme LN, Wilhelmsen CR, Kværner KJ. Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review. JMIR Form Res 2021; 5:e21357. [PMID: 33929330 PMCID: PMC8122291 DOI: 10.2196/21357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/15/2020] [Accepted: 04/13/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. OBJECTIVE This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. METHODS A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. RESULTS In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. CONCLUSIONS eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods.
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Bulaj G, Clark J, Ebrahimi M, Bald E. From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies. Front Pharmacol 2021; 12:612602. [PMID: 33972825 PMCID: PMC8105510 DOI: 10.3389/fphar.2021.612602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
| | - Jacqueline Clark
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Maryam Ebrahimi
- College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Elizabeth Bald
- Department of Pharmacotherapy, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States
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Seljelid B, Varsi C, Solberg Nes L, Øystese KA, Børøsund E. A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers. J Med Internet Res 2021; 23:e22399. [PMID: 33830063 PMCID: PMC8294341 DOI: 10.2196/22399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 03/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning.
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Affiliation(s)
- Berit Seljelid
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cooperation, Patient Education and Equivalent Health Services, CEO's Staff, Oslo University Hospital, Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - Kristin Astrid Øystese
- Section of Specialized Endocrinology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
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Paulsen MM, Varsi C, Andersen LF. Process evaluation of the implementation of a decision support system to prevent and treat disease-related malnutrition in a hospital setting. BMC Health Serv Res 2021; 21:281. [PMID: 33766017 PMCID: PMC7995565 DOI: 10.1186/s12913-021-06236-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Malnutrition is present in 30% of hospitalized patients and has adverse outcomes for the patient and the healthcare system. The current practice for nutritional care is associated with many barriers. The MyFood decision support system was developed to prevent and treat malnutrition. Methods This paper reports on a process evaluation that was completed within an effectiveness trial. MyFood is a digital tool with an interface consisting of an app and a website. MyFood includes functions to record and evaluate dietary intake. It also provides reports to nurses, including tailored recommendations for nutritional treatment. We used an effectiveness-implementation hybrid design in a randomized controlled trial. The RE-AIM (Reach, Efficiency, Adoption, Implementation, Maintenance) framework was used to perform a process evaluation alongside the randomized controlled trial, using a combination of quantitative and qualitative methods. An implementation plan, including implementation strategies, was developed to plan and guide the study. Results Reach: In total, 88% of eligible patients consented to participate (n = 100). Adoption: Approximately 75% of the nurses signed up to use MyFood and 50% used the reports. Implementation: MyFood empowered the patients in their nutritional situation and acted as a motivation to eat to reach their nutritional target. The compliance of using MyFood was higher among the patients than the nurses. A barrier for use of MyFood among the nurses was different digital systems which were not integrated and the log-in procedure to the MyFood website. Despite limited use by some nurses, the majority of the nurses claimed that MyFood was useful, better than the current practice, and should be implemented in the healthcare system. Conclusions This study used a process evaluation to interpret the results of a randomized controlled trial more in-depth. The patients were highly compliant, however, the compliance was lower among the nurses. MyFood empowered the patients in their nutritional situation, the usability was considered as high, and the experiences and attitudes towards MyFood were primarily positive. Focus on strategies to improve the nurses’ compliance may in the future improve the MyFood system’s potential. Trial registration The trial was registered in ClinicalTrials.gov 26/01/2018 (NCT03412695). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06236-3.
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Affiliation(s)
- Mari Mohn Paulsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110 Blindern, 0317, Oslo, Norway. .,National Advisory Unit on Disease-related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Cecilie Varsi
- Center for Digital Health Research, Oslo University Hospital, Division of Medicine, Aker hospital, box 4959 Nydalen, 0424, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, box 1110 Blindern, 0317, Oslo, Norway
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Varsi C, Ledel Solem IK, Eide H, Børøsund E, Kristjansdottir OB, Heldal K, Waxenberg LB, Weiss KE, Schreurs KMG, Morrison EJ, Stubhaug A, Solberg Nes L. Health care providers' experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study. BMC Health Serv Res 2021; 21:275. [PMID: 33766028 PMCID: PMC7992849 DOI: 10.1186/s12913-021-06278-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic pain constitutes a significant burden for the individuals affected, and is a frequent reason why patients seek health care services. While in-person psychosocial interventions can be of support to people living with chronic pain, such interventions are not always accessible. eHealth interventions may provide greater accessibility, but the evidence and use of digital self-management solutions for chronic pain are still limited and the lack of health care provider input in the development process of such solutions a concern. Therefore, the aim of the current study was to investigate health care providers' experiences of treating patients with chronic pain, their attitudes towards, and use of, digital solutions in pain management, and their suggestions for content and design elements for a potential digital pain self-management intervention. METHODS Twelve health care providers representing a variety of health care disciplines participated in semi-structured interviews. The interviews were analyzed using thematic analysis. RESULTS The material was analyzed into three main themes: [1] Patients with chronic pain and their current use of the health care services, [2] Health care providers' own motivation and impression of patient prerequisites for use of digital self-management interventions, and [3] Suggestions for content and design elements in a digital self-management intervention for people living with chronic pain. The challenges faced by patients living with chronic pain were described as numerous. Despite interest and positive attitudes, few of the health care providers had used or recommended eHealth solutions to their patients. A range of potential content and functionality elements were identified, including aspects of motivation and engagement and providers also emphasized the importance of easy access and positive, personal content to support existing treatment. CONCLUSIONS This study offers insights into health care providers' considerations for the potential of digital self-management interventions supporting patients living with chronic pain. Findings indicate the need for change and a more comprehensive treatment approach to pain management. eHealth solutions may contribute to such change, and providers pointed to a need for health care provider involvement, timely support and follow-up as important factors for integrating digital pain self-management interventions into clinical care. TRIAL REGISTRATION ClinicalTrials.gov : NCT03705104.
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Affiliation(s)
- Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Ingrid Konstanse Ledel Solem
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hilde Eide
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway
| | - Olöf B Kristjansdottir
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | | | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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Cardol CK, Tommel J, van Middendorp H, Ciere Y, Sont JK, Evers AWM, van Dijk S. Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3292. [PMID: 33806724 PMCID: PMC8005221 DOI: 10.3390/ijerph18063292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 01/19/2023]
Abstract
Many patients with lifestyle-related chronic diseases find it difficult to adhere to a healthy and active lifestyle, often due to psychosocial difficulties. The aim of the current study was to develop an eHealth care pathway aimed at detecting and treating psychosocial and lifestyle-related difficulties that fits the needs and preferences of individual patients across various lifestyle-related chronic diseases. Each intervention component was developed by (1) developing initial versions based on scientific evidence and/or the Behavior Change Wheel; (2) co-creation: acquiring feedback from patients and health professionals; and (3) refining to address users' needs. In the final eHealth care pathway, patients complete brief online screening questionnaires to detect psychosocial and lifestyle-related difficulties, i.e., increased-risk profiles. Scores are visualized in personal profile charts. Patients with increased-risk profiles receive complementary questionnaires to tailor a 3-month guided web-based cognitive behavioral therapy intervention to their priorities and goals. Progress is assessed with the screening tool. This systematic development process with a theory-based framework and co-creation methods resulted in a personalized eHealth care pathway that aids patients to overcome psychosocial barriers and adopt a healthy lifestyle. Prior to implementation in healthcare, randomized controlled trials will be conducted to evaluate its cost-effectiveness and effectiveness on psychosocial, lifestyle, and health-related outcomes.
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Affiliation(s)
- Cinderella K. Cardol
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
| | - Judith Tommel
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
| | - Yvette Ciere
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Jacob K. Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Andrea W. M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
- Healthy Society, Medical Delta, 2629 JH Delft, The Netherlands
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
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