Leveraging mHealth to Mitigate the Impact of COVID-19 in Black American Communities: Qualitative Analysis

BACKGROUND

COVID-19 remains an ongoing public health crisis. Black Americans remain underrepresented among those vaccinated and overrepresented in both COVID-19 morbidity and mortality. Medical misinformation, specifically related to COVID-19, has exacerbated the impact of the disease in Black American communities. Communication tools and strategies to build relationships and disseminate credible and trustworthy diagnostic and preventative health information are necessary to improve outcomes and equity for historically oppressed populations.

OBJECTIVE

As the initial phase of a larger mixed methods project to develop, pilot, and evaluate a mobile health (mHealth) intervention among a population at high risk for COVID-19 and cardiovascular comorbidities, this study sought to explore COVID-19 information behavior among Black Americans. Specifically, this study examined (1) preferences for COVID-19 education via mHealth, (2) barriers and facilitators to COVID-19 education and diagnostic testing and routine care for associated cardiovascular and respiratory comorbidities in the local community, and (3) key content for inclusion in a COVID-19 mHealth app.

METHODS

This qualitative study used principles of community-based participatory research and information systems research to conduct 7 focus groups across 3 sites. Focus groups were audio recorded and transcribed for thematic analysis using an abductive approach.

RESULTS

The study sample included 54 individuals across sites with a mean age of 50.24 (SD 11.76; range 20-71) years. Participants were primarily female (n=42, 78%) and Black (n=54, 100%) with varied education levels. Over half (n=29, 54%) of the participants were employed full-time, and nearly three-fourths (n=40, 74%) had household incomes

CONCLUSIONS

Increasing transparency and building trust are 2 key strategies that may improve the impact of health information messaging in Black communities. Focusing on content over context fails in the provision of critical health information and perpetuates health inequities by reinforcing systemic and structural racism. COVID-19 messaging must consider contextual information, patient needs and preferences, and patient information-seeking and information-search behaviors to establish trust and credibility, positively impact patient health outcomes, and improve health equity.

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Key Words

• Black communities
• COVID-19
• cardiovascular
• cardiovascular health
• community
• develop
• evaluate
• health equity
• information-seeking behavior
• mHealth
• mHealth intervention
• mobile health
• morbidity
• mortality
• pilot
• qualitative analysis
• racism

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MESH Headings

• Female
• Humans
• Middle Aged
• Black or African American
• COVID-19/epidemiology
• Educational Status
• Post-Acute COVID-19 Syndrome
• Telemedicine
• Male
• Young Adult
• Adult
• Aged

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Grants

• K01 HL141676 NHLBI NIH HHS
• UL1 TR001425 NCATS NIH HHS

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Affiliation(s)

Kelly M Harris School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
Tilicia Mayo Gamble Department of Health Policy and Community Health, Georgia Southern University, Statesboro, GA, United States
Madelyn G Yoo School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
Lindsay A Spell School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
Timira N Minor School of Medicine, Washington University in St. Louis, Saint Louis, MO, United States
Holly Jones Martha S Pitzer Center for Women, Children, and Youth, College of Nursing, Ohio State University, Columbus, OH, United States
Donald Lynch Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati, Cincinnati, OH, United States

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A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders

BACKGROUND

eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of €100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health.

OBJECTIVE

The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews.

METHODS

This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of €100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method.

RESULTS

A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications.

CONCLUSIONS

This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health.

Study about evaluation of efficacy of methotrexate in localized scleroderma using ultrasonography

BACKGROUND

The treatment and curative effect evaluation of localized scleroderma (LS) still perplexes many clinical workers.

PURPOSE

To investigate the efficiacy of methotrexate in the treatment of LS by the evaluation of ultrasonography.

METHODS

A prospective study enrolled 10 patients treated with MTX for at least 6 months was conducted. Treatment outcome was evaluated by a clinical score and 15-MHz ultrasonography. Safety assessment included the monitoring of adverse drug reactions and clinical laboratory examinations.

RESULTS

Eight of the 10 patients achieved clinical remission only with MTX. One patient was relieved after MTX combined with corticosteroids, while another one does not improve after the treatment of mycophenolate mofetil and corticosteroids. The effective rate of MTX is 80%. Nine patients were significantly improved with a decrease of the Localized Scleroderma Cutaneous Assessment Tool (the mean score of the LoSCAT cutaneous activity dropped from 5.2 to 1.0, p < 0.001, the mean score of the LS cutaneous damage dropped from 4.3 to 2.3, p = 0.002). The average difference of thickness between skin lesions and normal skin evaluated by ultrasonography decreased from 0.13 cm to 0.04 cm (p = 0.009) in eight patients. No serious adverse reactions occurred.

CONCLUSION

Methotrexate is a safe and effective treatment for patients with LS. Ultrasonography can be considered as an efficient assessment tool for evaluation LS.

Application Values of Six Scoring Systems in the Prognosis of Stroke Patients

Objective: The present study aimed to evaluate the prognostic value of Acute Physiology and Chronic Health Evaluation (APACHE; II and III), Chinese Stroke Scale (CSS), National Institutes of Health Stroke Score (NIHSS), activities of daily living (ADL) (Barthel index, BI), and Glasgow Coma Scale (GCS) scores for stroke patients. Methods: A total of 352 stroke patients were evaluated using APACHE II, APACHE III, CSS, NIHSS, ADL, and GCS scores within 24 h after admission. And these patients were consecutive admissions to the hospital. The endpoint was in-hospital death. The scores of these scales were compared between the survival group and death group, and the receiver operating characteristic (ROC) curves were drawn. The ability of each scoring system to predict the prognosis of patients was evaluated using the area under the ROC curve, and the areas under the curves (AUCs) of these six scales were compared. Results: The AUCs of the APACHE II, APACHE III, CSS, NIHSS, ADL, and GCS scores were 0.882, 0.867, 0.832, 0.859, 0.838, and 0.819, respectively. Conclusion: APACHE II, APACHE III, CSS, NIHSS, ADL, and GCS scores have good predictive values in the prognosis of stroke patients. APACHE II is superior among the other five scales.

Will registries slow down or accelerate innovation?

The increasing use of regional and national registries of surgical implants has raised concerns that the cost and consequences of these initiatives will adversely influence innovation. The opposite appears to be true, with no evidence of a reduction in overall innovation and an association of increased innovation in countries with more evaluation using registries.

Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180065

Measurement of the nerve root of the lower lumbar region using digital images

The purpose of this study was to evaluate the relationship between the nerve root of lower lumbar and the surrounding structures using three-dimensional computed tomography (3D CT).Twenty-three consecutive patients with thoracolumbar fractures without obvious radiological degeneration were retrospectively studied at the spinal surgery department of the hospital. The parameters of the relationship between the nerve root of the lower lumbar and the surrounding structures were measured using 3D CT in the work station of the picture archiving and communication system.The size of the dorsal root ganglion (DRG) of the L4 was 5.5 ± 0.4 mm on the right side and 5.8 ± 0.3 mm on the left side. The size of the DRG of the L5 was 6.1 ± 0.5 mm on the right side and 5.7 ± 0.4 mm on the left side. The value of the preganglionic nerve root of the L4 was 11.2 ± 0.6 mm on the right side and 12.3 ± 0.8 mm on the left side, and the value of the preganglionic nerve root of the L5 was 15.1 ± 1.1 mm on the right side and 14.9 ± 0.9 mm on the left side.Using 3D CT imaging constructed in the picture archiving and communication system is a practical and convenient method for evaluating the relationship between the nerve root and the surrounding structures in the routine clinical work of a spinal surgeon. The data obtained through 3D CT imaging will be helpful for surgeons, allowing them to become more familiar with correlating anatomical knowledge of individual patient.