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Gupta A, Hu J, Huang S, Diaz L, Gore R, Levy N, Bergman M, Tanner M, Sherman SE, Islam N, Schwartz MD. Implementation fidelity to a behavioral diabetes prevention intervention in two New York City safety net primary care practices. BMC Public Health 2023; 23:575. [PMID: 36978071 PMCID: PMC10045092 DOI: 10.1186/s12889-023-15477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND It is critical to assess implementation fidelity of evidence-based interventions and factors moderating fidelity, to understand the reasons for their success or failure. However, fidelity and fidelity moderators are seldom systematically reported. The study objective was to conduct a concurrent implementation fidelity evaluation and examine fidelity moderators of CHORD (Community Health Outreach to Reduce Diabetes), a pragmatic, cluster-randomized, controlled trial to test the impact of a Community Health Workers (CHW)-led health coaching intervention to prevent incident type 2 Diabetes Mellitus in New York (NY). METHODS We applied the Conceptual Framework for Implementation Fidelity to assess implementation fidelity and factors moderating it across the four core intervention components: patient goal setting, education topic coaching, primary care (PC) visits, and referrals to address social determinants of health (SDH), using descriptive statistics and regression models. PC patients with prediabetes receiving care from safety-net patient-centered medical homes (PCMHs) at either, VA NY Harbor or at Bellevue Hospital (BH) were eligible to be randomized into the CHW-led CHORD intervention or usual care. Among 559 patients randomized and enrolled in the intervention group, 79.4% completed the intake survey and were included in the analytic sample for fidelity assessment. Fidelity was measured as coverage, content adherence and frequency of each core component, and the moderators assessed were implementation site and patient activation measure. RESULTS Content adherence was high for three components with nearly 80.0% of patients setting ≥ 1 goal, having ≥ 1 PC visit and receiving ≥ 1 education session. Only 45.0% patients received ≥ 1 SDH referral. After adjusting for patient gender, language, race, ethnicity, and age, the implementation site moderated adherence to goal setting (77.4% BH vs. 87.7% VA), educational coaching (78.9% BH vs. 88.3% VA), number of successful CHW-patient encounters (6 BH vs 4 VA) and percent of patients receiving all four components (41.1% BH vs. 25.7% VA). CONCLUSIONS The fidelity to the four CHORD intervention components differed between the two implementation sites, demonstrating the challenges in implementing complex evidence-based interventions in different settings. Our findings underscore the importance of measuring implementation fidelity in contextualizing the outcomes of randomized trials of complex multi-site behavioral interventions. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov on 30/12/2016 and the registration number is NCT03006666 .
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Affiliation(s)
- Avni Gupta
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Jiyuan Hu
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave 2F Rm 222, New York, NY, 10016, USA
| | - Shengnan Huang
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 2Nd Floor, New York, NY, 10016, USA
| | - Laura Diaz
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 9-43A, New York, NY, 10016, USA
| | - Radhika Gore
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Natalie Levy
- Department of Medicine, NYU Grossman School of Medicine, 462 First Avenue, Area 2d, New York, NY, 10016, USA
| | - Michael Bergman
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 2Nd Floor, New York, NY, 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, 423 East 23Rd Street, Room 16049C, New York, NY, 10010, USA
- VA New York Harbor Healthcare System, 423 East 23Rd Street, Room 16049C, New York, NY, 10010, USA
| | - Michael Tanner
- Department of Medicine, NYU Grossman School of Medicine, 462 1St Ave, New York, NY, 10016, USA
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
- VA New York Harbor Healthcare System, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Mark D Schwartz
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, Suite 955, New York, NY, 10016, USA
- VA New York Harbor Healthcare System, 180 Madison Avenue, Suite 955, New York, NY, 10016, USA
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Begum S, Povey R, Ellis N, Gidlow C. A systematic review of recruitment strategies and behaviour change techniques in group-based diabetes prevention programmes focusing on uptake and retention. Diabetes Res Clin Pract 2020; 166:108273. [PMID: 32590009 DOI: 10.1016/j.diabres.2020.108273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many countries worldwide have developed diabetes prevention programmes (DPPs) that involve lifestyle modification. Research has shown that uptake and retention of DPPs are important and by exploring recruitment strategies and behaviour change techniques (BCTs) used, factors that are most effective in promoting uptake and retention can be identified. OBJECTIVES This review aims to identify recruitment strategies of group-based DPPs that are associated with high uptake and common BCTs associated with high retention. METHODS Papers were identified with a systematic literature search. Programmes that were predominantly group-based and involved lifestyle modification and in which uptake and/or retention could be determined, were included. Intervention details were extracted, recruitment strategies and BCTs identified, and response, uptake and retention rates were calculated. RESULTS A range of recruitment strategies were used making it difficult to discern associations with uptake rates. For BCTs, all programmes used a credible source, 81% used instruction on how to perform a behaviour and 71% used goal setting (behaviour). BCTs more commonly found in high retention programmes included problem-solving, demonstrating the behaviour, using behavioural practice and reducing negative emotions. CONCLUSIONS Recommendations include that DPPs incorporate BCTs like problem-solving and demonstrating the behaviour to maximise retention.
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Affiliation(s)
- Sonia Begum
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK.
| | - Rachel Povey
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Naomi Ellis
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Christopher Gidlow
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
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Wang SL, Chiang IE, Kuo A, Lin HI. Design and Usability Evaluation of Mobile Cloud Healthcare System for Diabetes Prevention. Stud Health Technol Inform 2019; 257:455-459. [PMID: 30741239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this study, a mobile cloud healthcare system was implemented to assist middle- and old-aged people with diabetes preventive healthcare. First of all, a prototype system was developed. It was a system relying on data mining computing technology and big data analytics. Besides, it was constructed under the environment architecture of VMware cloud computing. This mobile cloud healthcare system was developed via mobile devices. Its purpose was to set up a diabetes preventive healthcare service for users, and to further assess the usability of this mobile cloud care system.
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Affiliation(s)
- Shu-Lin Wang
- National Taichung University of Science and Technology, Taichung City, Taiwan
| | - I-En Chiang
- Health Studies, University of Toronto, Ontario, Canada
| | - Alex Kuo
- School of Health Information Science, University of Victoria, Victoria, BC, Canada
| | - Hsin-I Lin
- National Taichung University of Science and Technology, Taichung City, Taiwan
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Abstract
A substantial gap remains between what we know about type 2 diabetes prevention and our ability to apply that knowledge in socially disadvantaged populations at highest risk. This gap results, in part, from a lack of integration between epidemiologic science and social psychology theory, particularly regarding the intersections of stress, self-regulatory health behaviors, and the biological mechanisms underlying the development of diabetes. In this commentary, we describe the utility of a theoretical framework that focuses on the intersection of biological, psychosocial, and environmental contexts as they apply to diabetes disparities, and how such a framework could inform a translational research agenda to reorient prevention efforts to address these inequalities. Such reorientation is needed to ensure that the implementation of prevention efforts does not inadvertently widen diabetes disparities.
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Affiliation(s)
- Briana Mezuk
- Department of Family Medicine, Virginia Commonwealth University School of Medicine
| | - Jeannie B Concha
- Department of Public Health Sciences, University of Texas at El Paso (UTEP)
| | - Paul Perrin
- Department of Psychology, Virginia Commonwealth University
| | - Tiffany Green
- Department of Health Behavior & Policy, Virginia Commonwealth University
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Philpott D, Guergachi A, Keshavjee K. Design and Validation of a Platform to Evaluate mHealth Apps. Stud Health Technol Inform 2017; 235:3-7. [PMID: 28423744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Emerging technologies show great potential in the field of patient care. One such technology is mobile heath applications (mhealth apps), which have exploded in number and variety in recent years, and offer great promise in the ability to collect and monitor patient health data. Despite their apparent success in proliferation and user adoption, these applications struggle to integrate into the primary care system and there is scant information regarding their efficacy to effect patient behavior and consequently health outcomes. In this paper we investigate the potential of a promising clinical evaluation methodology, response adaptive randomized clinical trials, to rapidly and effectively evaluate the efficacy and effectiveness of mhealth apps and to personalize mhealth app selection to individualize patient benefit. Diabetes prevention provides the use case for evaluating the case for and against response-adaptive randomized trials.
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Page-Reeves J, Mishra SI, Niforatos J, Regino L, Bulten R. An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement. Qual Rep 2013; 18:1-22. [PMID: 24490179 PMCID: PMC3905317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Diabetes is an enormous public health problem with particular concern within Hispanic communities and among individuals with low wealth. However, attempts to expand the public health paradigm to include social determinants of health rarely include analysis of social and contextual factors considered outside the purview of health research. As a result, conceptualization of the dynamics of diabetes health disparities remains shallow. We argue that using a holistic anthropological lens has the potential to offer insights regarding the nature of the interface between broader social determinants, health outcomes and health disparity. In a primarily Hispanic, immigrant community in Albuquerque, New Mexico, we conducted a mixed methods study that integrates an anthropological lens with a community engaged research design. Our data from focus groups, interviews, a survey and blood sampling demonstrate the need to conceptualize social determinants more broadly, more affectively and more dynamically than often considered. These results highlight a need to include, in addition to individual-level factors that are traditionally the focus of public health and more innovative structural factors that are currently in vogue, an in-depth, qualitative exploration of local context, social environment, and culture, and their interactions and intersectionality, as key factors when considering how to achieve change. The discussion presented here offers a model for culturally situated and contextually relevant scientific research. This model achieves the objectives and goals of both public health and anthropology while providing valuable insights and mechanisms for addressing health disparity such as that which exists in relation to diabetes among Hispanic immigrants in New Mexico. Such an approach has implications for how research projects are designed and conceptualizing social determinants more broadly. The discussion presented provides insights with relevance for both disciplines.
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Affiliation(s)
| | | | | | - Lidia Regino
- East Central Ministries, Albuquerque, New Mexico, USA
| | - Robert Bulten
- East Central Ministries, Albuquerque, New Mexico, USA
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