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Salahshurian E, Pozehl BJ, Lundgren SW, Bills S, Pandey A, Carbone S, Alonso WW. 'Working me to life': longitudinal perceptions from adults with heart failure with preserved ejection fraction enrolled in an exercise training clinical trial. Eur J Cardiovasc Nurs 2024; 23:763-770. [PMID: 38597735 DOI: 10.1093/eurjcn/zvae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
AIMS Adults with heart failure with preserved ejection fraction (HFpEF) responded more favourably to an exercise intervention compared with those with reduced ejection fraction. This study explores factors that contributed to this response, focusing on the qualitative perceptions of adults with HFpEF enrolled in an exercise intervention. METHODS AND RESULTS This qualitative descriptive study is a secondary analysis of longitudinal interviews collected at 3, 6, 12, and 18 months from participants with HFpEF enrolled in a randomized controlled trial testing an intervention to promote adherence to exercise. We included participants with at least two interviews. Interviews were examined across and within participants and time points using thematic analysis. Analyses included 67 interviews from 21 adults with HFpEF enrolled in the intervention arm. The sample consisted of 52% (11/21) males and over 47% (10/21) non-White participants. Mean age at enrolment was 63.7 ± 9.9 years. We identified four major themes: (1) overcoming negative attitudes, barriers, and injury, (2) motivations to exercise, (3) exercise-the panacea for HFpEF symptoms and quality of life, and (4) advice for others with HFpEF. CONCLUSION Our findings suggest that for many adults with HFpEF, initial hesitancy, fear, and negative attitudes about exercise can be overcome. Exercise coaching using social cognitive constructs, medical fitness centre memberships, and heart rate self-monitoring are successful strategies of engaging adults with HFpEF in long-term unsupervised exercise training. REGISTRATION ClinicalTrials.gov, NCT01658670.
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Affiliation(s)
- Erin Salahshurian
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Scott W Lundgren
- Division of Cardiovascular Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Sara Bills
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Salvatore Carbone
- Department of Kinesiology and Health Sciences, College of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA
| | - Windy W Alonso
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
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Bashir AZ, Yetman A, Wehrmann M. Technological Interventions to Implement Prevention and Health Promotion in Cardiovascular Patients. Healthcare (Basel) 2024; 12:2055. [PMID: 39451470 PMCID: PMC11507996 DOI: 10.3390/healthcare12202055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 10/11/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
Background/Objectives: The aim of the narrative review is to identify information on the impact of technological interventions (such as telehealth and mobile health) on the health promotion of cardiac patients from diverse populations. Methods: The online databases of PubMed and the Cochrane Library were searched for articles in the English language regarding technological interventions for health promotion in cardiac patients. In addition, a methodological quality control process was conducted. Exclusion was based on first reading the abstract, and then the full manuscript was scanned to confirm that the content was not related to cardiac patients and technological interventions. Results: In all, 11 studies were included in this review after quality control analysis. The sample size reported in these studies ranged from 12 to 1424 subjects. In eight studies mobile phones, smartphones, and apps were used as mHealth interventions with tracking and texting components; two studies used videoconferencing as a digital intervention program, while three studies focused on using physical activity trackers. Conclusions: This review highlights the positive aspects of patient satisfaction with the technological interventions including, but not limited to, accessibility to health care providers, sense of security, and well-being. The digital divide becomes apparent in the articles reviewed, as individuals with limited eHealth literacy and lack of technological knowledge are not motivated or able participate in these interventions. Finding methods to overcome these barriers is important and can be solved to some extent by providing the technology and technical support.
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Affiliation(s)
- Ayisha Z. Bashir
- The Child Health Research Institute (CHRI), The University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA; (A.Y.); (M.W.)
- Department of Pediatrics, Division of Cardiology, The University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Anji Yetman
- The Child Health Research Institute (CHRI), The University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA; (A.Y.); (M.W.)
- Department of Pediatrics, Division of Cardiology, The University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Melissa Wehrmann
- The Child Health Research Institute (CHRI), The University of Nebraska Medical Center (UNMC), Omaha, NE 68198, USA; (A.Y.); (M.W.)
- Department of Pediatrics, Division of Cardiology, The University of Nebraska Medical Center, Omaha, NE 68198, USA
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Safaei M, Mahdavi A, Mehdipour-Rabori R. Designing and evaluating a mobile app to assist patients undergoing coronary angiography and assessing its impact on anxiety, stress levels, and self-care. BMC Med Inform Decis Mak 2024; 24:292. [PMID: 39379898 PMCID: PMC11460224 DOI: 10.1186/s12911-024-02703-z] [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: 09/24/2023] [Accepted: 09/30/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Coronary artery disease is one of the leading causes of death and disability worldwide. Coronary angiography is a diagnostic procedure used to detect atherosclerosis. Patients typically experience anxiety and stress before and during the angiography procedure. Furthermore, self-care ability is crucial following angiography. AIM This study aims to describe the design and evaluation of a mobile application focusing on stress, anxiety, and self-care abilities in patients undergoing coronary angiography. METHOD The researchers developed a mobile application for patients undergoing angiography. The application provides information about angiography and tips for enhancing self-care following the procedure. An interventional study was conducted on 70 patients admitted to the angiography ward in hospitals in Kerman, Iran, between 2022 and 2023. The participants were randomly divided into two groups: control and intervention. The interventional group received the intervention application the night before angiography. Two groups completed the Anxiety and Stress Questionnaire (DAS) and Kearney-Flescher Self-Care Survey before the intervention. The researchers used questionnaires that had been prepared and previously utilized in other studies. The two groups completed the anxiety and stress questionnaire within three to six hours and the self-care questionnaire one month after angiography. SPSS 15 software was used for data analysis, with a significance level set at 0.05. RESULTS The study found that the majority of participants were women. Before the study, there was no significant difference between the two groups in terms of anxiety, stress, and self-care scores. However, after the study, the intervention group showed a significant decrease in average anxiety and stress scores (p < 0.001). Additionally, compared to the control group, the intervention group demonstrated significant improvement in average self-care score (p < 0.001). CONCLUSION According to this study, AP can be effective in influencing the anxiety, stress levels, and self-care ability of patients who undergo coronary angiography. It can help to reduce stress and anxiety while increasing self-care. Instructive software is user-friendly, cost-effective, and can be recommended by nurses and doctors.
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Affiliation(s)
- Milad Safaei
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Amin Mahdavi
- Kerman Medical University, Kerman University of Medical Sciences, Cardiologist, Kerman, Iran
| | - Roghayeh Mehdipour-Rabori
- Department of medical- surgical nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
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Zhu Y, Zhao Y, Wu Y. Effectiveness of mobile health applications on clinical outcomes and health behaviors in patients with coronary heart disease: A systematic review and meta-analysis. Int J Nurs Sci 2024; 11:258-275. [PMID: 38707688 PMCID: PMC11064579 DOI: 10.1016/j.ijnss.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 05/07/2024] Open
Abstract
Objective Mobile health applications (apps) have gained significant popularity and widespread utilization among patients with coronary heart disease (CHD). The objective of this study is to evaluate the effects of mHealth apps on clinical outcomes and health behaviors in patients with CHD. Methods Databases were searched from inception until December 2023, including Cochrane Library, PubMed, EMBASE, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Service System (SinoMed), Wanfang Data, China Science and Technology Journal Database (VIP), for randomized controlled trials (RCTs) regarding the effectiveness of mHealth apps in patients with CHD. Two researchers conducted a comprehensive review of the literature, extracting relevant data and evaluating each study's methodological quality separately. The meta-analysis was performed utilizing Review Manager v5.4 software. Results A total of 34 RCTs were included, with 5,319 participants. The findings demonstrated that using mHealth apps could decrease the incidence of major adverse cardiac events (RR = 0.68, P = 0.03), readmission rate (RR = 0.56, P < 0.001), total cholesterol (WMD = -0.19, P = 0.03), total triglycerides (WMD = -0.24, P < 0.001), waist circumference (WMD = -1.92, P = 0.01), Self-Rating Anxiety Scale score (WMD = -6.70, P < 0.001), and Self-Rating Depression Scale score (WMD = -7.87, P < 0.001). They can also increase the LVEF (WMD = 6.50, P < 0.001), VO2 max (WMD = 1.89, P < 0.001), 6-min walk distance (6MWD) (WMD = 19.43, P = 0.004), Morisky Medication Adherence Scale-8 score (WMD = 0.96, P = 0.004), and medication adherence rate (RR = 1.24, P = 0.03). Nevertheless, there is no proof that mHealth apps can lower low-density lipoprote in cholesterol, blood pressure, BMI, or other indicator (P > 0.05). Conclusion Mobile health apps have the potential to lower the incidence of major adverse cardiac events (MACEs), readmission rates, and blood lipids in patients with CHD. They can also help enhance cardiac function, promote medication adherence, and alleviate symptoms of anxiety and depression. To further corroborate these results, larger-scale, multi-center RCTs with longer follow-up periods are needed.
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Affiliation(s)
- Yining Zhu
- School of Nursing, Capital Medical University, Beijing, China
| | - Yuhan Zhao
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Chong MS, Sit JWH, Choi KC, Suhaimi A, Chair SY. Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross-sectional study. J Clin Nurs 2024; 33:1084-1093. [PMID: 37909483 DOI: 10.1111/jocn.16919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/01/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
AIMS AND OBJECTIVES The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. BACKGROUND Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country. DESIGN A cross-sectional study design. METHODS A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). RESULTS Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach. CONCLUSION Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. RELEVANCE TO CLINICAL PRACTICE By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.
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Affiliation(s)
- Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Anwar Suhaimi
- Rehabilitation Medicine Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
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Chew HSJ, Achananuparp P, Dalakoti M, Chew NWS, Chin YH, Gao Y, So BYJ, Shabbir A, Peng LE, Ngiam KY. Public acceptance of using artificial intelligence-assisted weight management apps in high-income southeast Asian adults with overweight and obesity: a cross-sectional study. Front Nutr 2024; 11:1287156. [PMID: 38385011 PMCID: PMC10879329 DOI: 10.3389/fnut.2024.1287156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction With in increase in interest to incorporate artificial intelligence (AI) into weight management programs, we aimed to examine user perceptions of AI-based mobile apps for weight management in adults with overweight and obesity. Methods 280 participants were recruited between May and November 2022. Participants completed a questionnaire on sociodemographic profiles, Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), and Self-Regulation of Eating Behavior Questionnaire. Structural equation modeling was performed using R. Model fit was tested using maximum-likelihood generalized unweighted least squares. Associations between influencing factors were analyzed using correlation and linear regression. Results 271 participant responses were analyzed, representing participants with a mean age of 31.56 ± 10.75 years, median (interquartile range) BMI, and waist circumference of 27.2 kg/m2 (24.2-28.4 kg/m2) and 86.4 (80.0-94.0) cm, respectively. In total, 188 (69.4%) participants intended to use AI-assisted weight loss apps. UTAUT2 explained 63.3% of the variance in our intention of the sample to use AI-assisted weight management apps with satisfactory model fit: CMIN/df = 1.932, GFI = 0.966, AGFI = 0.954, NFI = 0.909, CFI = 0.954, RMSEA = 0.059, SRMR = 0.050. Only performance expectancy, hedonic motivation, and the habit of using AI-assisted apps were significant predictors of intention. Comparison with existing literature revealed vast variabilities in the determinants of AI- and non-AI weight loss app acceptability in adults with and without overweight and obesity. UTAUT2 produced a good fit in explaining the acceptability of AI-assisted apps among a multi-ethnic, developed, southeast Asian sample with overweight and obesity. Conclusion UTAUT2 model is recommended to guide the development of AI-assisted weight management apps among people with overweight and obesity.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Palakorn Achananuparp
- School of Computing and Information Systems, Singapore Management University, Singapore, Singapore
| | - Mayank Dalakoti
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Nicholas W. S. Chew
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yujia Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Bok Yan Jimmy So
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Lim Ee Peng
- School of Computing and Information Systems, Singapore Management University, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
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Atluri N, Mishra SR, Anderson T, Stevens R, Edwards A, Luff E, Nallamothu BK, Golbus JR. Acceptability of a Text Message-Based Mobile Health Intervention to Promote Physical Activity in Cardiac Rehabilitation Enrollees: A Qualitative Substudy of Participant Perspectives. J Am Heart Assoc 2024; 13:e030807. [PMID: 38226512 PMCID: PMC10926792 DOI: 10.1161/jaha.123.030807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Mobile health (mHealth) interventions have the potential to deliver longitudinal support to users outside of episodic clinical encounters. We performed a qualitative substudy to assess the acceptability of a text message-based mHealth intervention designed to increase and sustain physical activity in cardiac rehabilitation enrollees. METHODS AND RESULTS Semistructured interviews were conducted with intervention arm participants of a randomized controlled trial delivered to low- and moderate-risk cardiac rehabilitation enrollees. Interviews explored participants' interaction with the mobile application, reflections on tailored text messages, integration with cardiac rehabilitation, and opportunities for improvement. Transcripts were thematically analyzed using an iteratively developed codebook. Sample size consisted of 17 participants with mean age of 65.7 (SD 8.2) years; 29% were women, 29% had low functional capacity, and 12% were non-White. Four themes emerged from interviews: engagement, health impact, personalization, and future directions. Participants engaged meaningfully with the mHealth intervention, finding it beneficial in promoting increased physical activity. However, participants desired greater personalization to their individual health goals, fitness levels, and real-time environment. Generally, those with lower functional capacity and less experience with exercise were more likely to view the intervention positively. Finally, participants identified future directions for the intervention including better incorporation of exercise physiologists and social support systems. CONCLUSIONS Cardiac rehabilitation enrollees viewed a text message-based mHealth intervention favorably, suggesting the potentially high usefulness of mHealth technologies in this population. Addressing participant-identified needs on increased user customization and inclusion of clinical and social support is crucial to enhancing the effectiveness of future mHealth interventions. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04587882.
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Affiliation(s)
- Namratha Atluri
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Sonali R. Mishra
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Theresa Anderson
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Rachel Stevens
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Angel Edwards
- Department of PharmacyUniversity of MichiganAnn ArborMIUSA
| | - Evan Luff
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP)University of MichiganAnn ArborMIUSA
- The Center for Clinical Management and Research, Ann Arbor VA Medical CenterAnn ArborMIUSA
| | - Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- The Center for Clinical Management and Research, Ann Arbor VA Medical CenterAnn ArborMIUSA
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Patterson K, Keegan R, Davey R, Freene N. Implementing a Sedentary Behavior Change Smartphone App in Cardiac Rehabilitation: A Qualitative Analysis Guided by the Theoretical Domains Framework and Capability, Opportunity, and Motivation-Behavior Model. J Cardiovasc Nurs 2024; 39:E12-E20. [PMID: 36971651 PMCID: PMC11805482 DOI: 10.1097/jcn.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Smartphone apps used in research offer a variety of capabilities to track and influence behavior; however, they often do not translate well into real-world use. Implementation strategies for using apps to reduce sedentary behavior in cardiac rehabilitation are currently unknown. OBJECTIVE The aim of this study was to explore (1) barriers and enablers for use of a behavioral smartphone app (Vire and ToDo-CR program) for reducing sedentary behavior in cardiac rehabilitation participants and (2) implementation strategies for future smartphone apps aimed at reducing sedentary behavior in this population. METHODS In-depth semistructured interviews were conducted with cardiac rehabilitation participants in the ToDo-CR randomized controlled trial. Participants had used the Vire app and a wearable activity tracker for 6 months. Interviews were audio recorded and transcribed. The researchers used thematic analysis and deductive mapping of themes to the Theoretical Domains Framework and the Capability, Opportunity, and Motivation-Behavior model. Sociodemographic and clinical variables were recorded. RESULTS Fifteen participants aged 59 ± 14 years were interviewed. Most were male, tertiary educated, and employed, and had varying experiences with smartphone apps and wearable activity trackers. Five core themes explaining the user experiences of cardiac rehabilitation participants with the Vire app were identified: (1) being tech savvy can be both an enabler and a barrier, (2) app messaging needs to be clear-set expectations from the beginning, (3) get to know me-personalization is important, (4) curious to know more instant feedback, and (5) first impression is key. The themes and subthemes mapped to 12 of the 14 Theoretical Domains Framework domains. Improving engagement and implementation of future smartphone apps for sedentary behavior may be aided by building psychological capability, physical opportunity, and reflective motivation. CONCLUSIONS Shifting to in-the-moment behavioral nudges, setting clear expectations, assisting participants to monitor their sitting time, increasing the frequency of tailoring, and understanding more about the participant as well as their experiences and needs for reducing sedentary behavior in cardiac rehabilitation are important future directions.
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Oladele DA, Iwelunmor J, Gbajabiamila T, Obiezu-Umeh C, Okwuzu JO, Nwaozuru U, Musa AZ, Tahlil K, Idigbe I, Ong J, Tang W, Tucker J, Ezechi O. An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility. JMIR Form Res 2023; 7:e44402. [PMID: 37747780 PMCID: PMC10562967 DOI: 10.2196/44402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. OBJECTIVE The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. METHODS We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. RESULTS A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). CONCLUSIONS This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach.
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Affiliation(s)
- David Ayoola Oladele
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbajabiamila
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Jane Ogoamaka Okwuzu
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Adesola Zaidat Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Kadija Tahlil
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ifeoma Idigbe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Jason Ong
- Melbourne Sexual Health Centre (MSHC), University of Melbourne, Melbourne, Australia
| | - Weiming Tang
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph Tucker
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
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Kircher J, Swoboda W, Holl F. Examining standardized tools used for the evaluation of mobile health applications for cardiovascular disease. Front Public Health 2023; 11:1155433. [PMID: 37388154 PMCID: PMC10303135 DOI: 10.3389/fpubh.2023.1155433] [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: 01/31/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Cardiovascular disease is one of the leading causes of death worldwide. Scarce resources and rising costs are pushing healthcare systems to their limits. There is an urgency to develop, optimize and evaluate technologies that provide more effective care for patients. Modern technologies, such as mobile health (mHealth) applications, can provide relief as a key strategy. To integrate digital interventions into care structures, a detailed impact assessment of all professional mHealth applications is needed. The aim of this study is to analyze the standardized tools used in the field of cardiovascular disease. The results show that questionnaires, usage logs, and key indicators are predominantly used. Although the identified mHealth interventions are specific to cardiovascular disease and thus require particular questions to evaluate apps, the user readiness, usability, or quality of life criteria are non-specific. Therefore, the results contribute to understanding how different mHealth interventions can be assessed, categorized, evaluated, and accepted.
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Affiliation(s)
- Jennifer Kircher
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
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Idrees AR, Kraft R, Winter M, Küchler AM, Baumeister H, Reilly R, Reichert M, Pryss R. Exploring the usability of an internet-based intervention and its providing eHealth platform in an eye-tracking study. JOURNAL OF AMBIENT INTELLIGENCE AND HUMANIZED COMPUTING 2023; 14:9621-9636. [PMID: 37288130 PMCID: PMC10195654 DOI: 10.1007/s12652-023-04635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/02/2023] [Indexed: 06/09/2023]
Abstract
The proliferation of online eHealth has made it much easier for users to access healthcare services and interventions from the comfort of their own homes. This study looks at how well one such platform-eSano-performs in terms of user experience when delivering mindfulness interventions. In order to assess usability and user experience, several tools such as eye-tracking technology, think-aloud sessions, a system usability scale questionnaire, an application questionnaire, and post-experiment interviews were employed. Participants were evaluated while they accessed the first module of the mindfulness intervention provided by eSano to measure their interaction with the app, and their level of engagement, and to obtain feedback on both the intervention and its overall usability. The results revealed that although users generally rated their experience with the app positively in terms of overall satisfaction, according to data collected through the system usability scale questionnaire, participants rated the first module of the mindfulness intervention as below average. Additionally, eye-tracking data showed that some users skipped long text blocks in favor of answering questions quickly while others spent more than half their time reading them. Henceforth, recommendations were put forward to improve both the usability and persuasiveness of the app-such as incorporating shorter text blocks and more engaging interactive elements-in order to raise adherence rates. Overall findings from this study provide valuable insights into how users interact with the eSano's participant app which can be used as guidelines for the future development of more effective and user-friendly platforms. Moreover, considering these potential improvements will help foster more positive experiences that promote regular engagement with these types of apps; taking into account emotional states and needs that vary across different age groups and abilities. Supplementary Information The online version contains supplementary material available at 10.1007/s12652-023-04635-4.
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Affiliation(s)
- Abdul Rahman Idrees
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Robin Kraft
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Michael Winter
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Ronan Reilly
- Computer Science and Associate VP for International Affairs, Maynooth University, Maynooth, Ireland
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
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12
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Oclaman JM, Murray ML, Grandis DJ, Beatty AL. The Association Between Mobile App Use and Change in Functional Capacity Among Cardiac Rehabilitation Participants: Cohort Study. JMIR Cardio 2023; 7:e44433. [PMID: 37184917 PMCID: PMC10227697 DOI: 10.2196/44433] [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: 11/18/2022] [Revised: 03/09/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is underused in the United States and globally, with participation disparities across gender, socioeconomic status, race, and ethnicities. The pandemic led to greater adoption of telehealth CR and mobile app use. OBJECTIVE Our primary objective was to estimate the association between CR mobile app use and change in functional capacity from enrollment to completion in patients participating in a CR program that offered in-person, hybrid, and telehealth CR. Our secondary objectives were to study the association between mobile app use and changes in blood pressure (BP) or program completion. METHODS We conducted a retrospective cohort study of participants enrolled in CR at an urban CR program in the United States. Participants were English speaking, at least 18 years of age, participated in the program between May 22, 2020, and May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by number of exercise logs, vitals logs, and education material views. The primary outcome was change in functional capacity, measured by change in 6-minute walk distance (6MWD) from enrollment to completion. The secondary outcome was change in BP from enrollment to completion. We estimated associations using multivariable linear or logistic regression models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for CR referral. RESULTS A total of 107 participants (mean age 62.9, SD 13.02 years; 90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) meter increase in 6MWD between enrollment and completion (P<.001). From enrollment to completion, participants with an elevated BP at baseline (≥130/80 mmHg) experienced a significant decrease in BP (systolic BP -11.5 mmHg; P=.002 and diastolic BP -7.7 mmHg; P=.003). We found no significant association between total app interactions and change in 6MWD (coefficient -0.03, 95% CI -0.1 to 0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI -0.03 to 0.03; P=.87 and diastolic coefficient -0.005, 95% CI -0.03 to 0.02; P=.65). There was no significant association between total exercise logs and change in 6MWD (coefficient 0.1, 95% CI -0.3 to 0.4; P=.57) or total BP logs and change in BP (systolic coefficient -0.02, 95% CI -0.1 to 0.06; P=.63 and diastolic coefficient -0.02, 95% CI -0.09 to 0.04; P=.50). There was no significant association between total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 0.99-1.01; P=.44). CONCLUSIONS CR mobile app use as part of an in-person, hybrid, or telehealth CR program was not associated with greater improvement in functional capacity or BP or with program completion.
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Affiliation(s)
- Janah May Oclaman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Michelle L Murray
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Donald J Grandis
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Alexis L Beatty
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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13
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Naranjo-Rojas A, Perula-de Torres LÁ, Cruz-Mosquera FE, Molina-Recio G. Usability of a mobile application for the clinical follow-up of patients with chronic obstructive pulmonary disease and home oxygen therapy. Int J Med Inform 2023; 175:105089. [PMID: 37172506 DOI: 10.1016/j.ijmedinf.2023.105089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Technological health tools (e-Health) may potentially facilitate the treatment of patients with chronic diseases through development of self-management and -care skills in patients and caregivers. However, these tools are usually marketed without prior analysis and without providing any context to final users, which frequently results in low adherence to their use. PURPOSE To determine the usability of and satisfaction toward a mobile app for the clinical monitoring of patients with chronic obstructive pulmonary disease (COPD) receiving oxygen therapy at home. METHODS This was a participative-qualitative study focused on final users-with direct intervention by patients and professionals-consisting of three phases as follows: (i) medium-fidelity mockups design, (ii) development of a usability test for each user profile, and (iii) assessment of the satisfaction level regarding the usability of the mobile app. A sample was established and selected through non-probability convenience sampling and was divided into two groups as follows: healthcare professionals (n = 13) and patients (n = 7). Each participant received a smartphone with mockup designs. The "think-aloud" method was applied in the usability test. Participants were audio recorded and the anonymous transcriptions were analyzed, highlighting fragments about mockups characteristics and the usability test. The difficulty level of the tasks was assessed with a scale from 1 (very easy) to 5 (too difficult), and task non-completion was considered a critical mistake. The satisfaction level related to test usability was assessed with a 4-score Likert scale ranging from 4 (totally agree) to 1 (totally disagree). RESULTS Regarding the difficulty level, >60% of professionals described most tasks as "very easy" and 70% of patients as "easy." No participant made critical mistakes and both groups reported a high satisfaction level regarding the usability variables. The patient and professionals group required 18 and 11 min to complete all tasks, respectively. CONCLUSIONS Participants described the app as intuitive and easy to use. The usability satisfaction results show a high level of satisfaction for both groups. This positive assessment and performance in user tests showed that the mobile application was able to be apprehended and used by participants in the circumstances of use in the usability tests. Usability evaluation through satisfaction surveys and qualitative data analysis allows for greater insight into the use of mobile applications in healthcare.
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Affiliation(s)
- Anisbed Naranjo-Rojas
- Universidad Santiago de Cali. Cali, Colombia, Faculty of Health, Health and Education Research Group (GINEYSA). Biomedicine doctoral program, University of cordoba, Spain.
| | - Luis Ángel Perula-de Torres
- Multiprofessional Teaching Unit for Family and Community Healthcare in the Districts of Cordoba and Guadalquivir. Maimonides Biomedical Research Institute of Córdoba. (IMIBIC), Hospital Universitario Reina Sofía, University of Córdoba, Spain
| | | | - Guillermo Molina-Recio
- Nursing, Pharmacology and Physiotherapy Department. University of Cordoba. Lifestyles, Innovation and Health (GA-16). Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
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Tadas S, Dickson J, Coyle D. Using Patient-Generated Data to Support Cardiac Rehabilitation and the Transition to Self-Care. PROCEEDINGS OF THE 2023 CHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS 2023:1-16. [DOI: 10.1145/3544548.3580822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Shreya Tadas
- School of Computer Science, University College Dublin, Ireland
| | | | - David Coyle
- School of Computer Science, University College Dublin, Ireland
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15
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Wang LYT, Lua JYH, Chan CXC, Ong RLL, Wee CF, Woo BFY. Health information needs and dissemination methods for individuals living with ischemic heart disease: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 108:107594. [PMID: 36563574 DOI: 10.1016/j.pec.2022.107594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This review aimed to identify the health information needs and preferred approaches to receive health information of individuals with Ischaemic Heart Disease (IHD). METHODS A systematic review was conducted. Relevant literature, published in English (January 2011 to October 2021), was identified across six databases. Guided by Coulter et al.'s framework for developing patient information materials, thematic analysis was performed. The findings were presented in tables and prose. RESULTS Fifty-nine studies were included. Eleven themes summarised the information needs of individuals with IHD. Each theme was supported with subthemes. Forty-five studies included information on preferred methods of dissemination. CONCLUSIONS Our review has characterised the diverse information needs of individuals living with IHD and dissemination methods for outreach to this population. Such insights inform healthcare providers in formulating patient-centred educational interventions to empower patients to undertake successful behavioural modification. PRACTICE IMPLICATIONS Patient education should be personalised and delivered according to individuals' risks for IHD and modifiable risk factors. The use of web-based dissemination of patient education has gained popularity among healthcare providers but sub-optimal adherence to these web-based interventions limits behavioural modification. Adding elements of in-person patient education session to complement web-based interventions may be more propitious to effecting behavioural modification.
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Affiliation(s)
- Laureen Y T Wang
- Alexandra Hospital, National University Health System, Singapore; National University Heart Centre, Singapore, National University Health System, Singapore
| | | | - Cassandra X C Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Rachel L L Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caitlin F Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Brigitte F Y Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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16
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Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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17
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Stamm-Balderjahn S, Bernert S, Rossek S. Promoting patient self-management following cardiac rehabilitation using a web-based application: A pilot study. Digit Health 2023; 9:20552076231211546. [PMID: 37954686 PMCID: PMC10637162 DOI: 10.1177/20552076231211546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Background The use of health-related mobile apps has become an important component of healthcare. Patients can use a range of tools to strengthen their health literacy and promote disease management. The aim of the project was to develop a web-based application for use on smartphones, tablets and computers for patients with cardiovascular diseases (cardio-app). Methods A semi-standardized written survey was conducted among rehabilitation patients with cardiovascular diseases (n = 158). The usability of the cardio-app was assessed using the System Usability Scale (SUS). The usage behaviour was conducted with a self-developed questionnaire. Results The study enrolled 158 eligible rehabilitation patients. The SUS of the cardio-app determined was 74.4 (SD ± 17.4). For 86%, the menu navigation was self-explanatory and logical. The visual presentation appealed to 92% of respondents. The content of the texts used in the app was understandable for 95%, and 93% found the technical terms used in the glossary well explained. For 57%, the app was helpful in planning their physical activities. 83% of the rehabilitation patients would recommend the app to others. The main criticisms of the app were the lack of synchronization options with other apps. Of those who did not use the app, the following reasons for non-use were most frequently cited: too much effort (43%), lack of time (29%) and pandemic-related reasons (29%). Conclusions The cardio-app revealed high agreement values. Whether the use of the app is associated with improved clinical state and outcome would have to be verified in further studies.
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Affiliation(s)
- Sabine Stamm-Balderjahn
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Bernert
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Rossek
- Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
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18
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Stark AL, Krayter S, Dockweiler C. Competencies required by patients and health professionals regarding telerehabilitation: A scoping review. Digit Health 2023; 9:20552076231218841. [PMID: 38107985 PMCID: PMC10722929 DOI: 10.1177/20552076231218841] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care. Objective The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies. Methods We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home. Results One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear. Conclusions Telerehabilitation requires a variety of different competencies from patients and health professionals - going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.
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Affiliation(s)
- Anna Lea Stark
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Stephan Krayter
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Christoph Dockweiler
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
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Antonelli K, Steverson A, Cmar JL. Usability of 4to24: A Transition Application for Parents of Students With Visual Impairments. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2023. [DOI: 10.1177/0145482x221150239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Introduction: This article covers the technical development and usability testing of 4to24, a mobile application (app) for students with visual impairments and their parents. The app includes information and resources on numerous topics to support and encourage preparation for employment from an early age. Methods: We partnered with technical developers from the blindness field to design and develop the app using an iterative approach that included usability testing at two key points in the development process. Technical developers incorporated accessibility into the app's design as it was built. Researchers conducted two rounds of usability testing with a total of 9 parents and 10 students. Participants completed specific tasks in the app and completed the System Usability Scale (SUS) to assess the app's usability. Results: Mean SUS scores were 80.83 for Round 1 and 83.75 for Round 2, indicating above-average usability at both time points. In each round, participants provided feedback on the app interface and identified issues impacting the app's ease of use. Discussion: We devised a system that automatically sends relevant informational modules to users based on the student's age, grade level, experience, and progress. The iterative design process allowed us to seek user feedback through usability testing and correct identified issues as development progressed, resulting in an intuitive and easy-to-use app. We also assessed and corrected accessibility issues as they arose, ensuring that the app met users’ accessibility needs. Implications for Practitioners: 4to24 is a usable and accessible mobile app that provides parents and students with relevant, timely information and resources to help students prepare for employment as they grow.
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Affiliation(s)
- Karla Antonelli
- The National Research & Training Center on Blindness & Low Vision, Mississippi State University, Mississippi State, MS, USA
| | - Anne Steverson
- The National Research & Training Center on Blindness & Low Vision, Mississippi State University, Mississippi State, MS, USA
| | - Jennifer L. Cmar
- The National Research & Training Center on Blindness & Low Vision, Mississippi State University, Mississippi State, MS, USA
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20
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Steverson A, Cmar JL, Antonelli K. The Experiences of Parents of and Students With Visual Impairments With 4to24, a Transition Application. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2022. [DOI: 10.1177/0145482x221132849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: This article describes the field test of 4to24, a transition application (app) for parents of and students with visual impairments. In this stage of the development process, researchers evaluated the app's usability and gained feedback on app use and experience from end users. Methods: Participants, including 27 parents of and 19 students with visual impairments, used 4to24 for 6 months. They completed a baseline survey, a survey about the account setup process, and three additional surveys at 2-month intervals (i.e., 2, 4, and 6 months). Results: Participants found the app account setup process quick and easy to complete. Parents and students used the app more frequently during the first 2 months, and then app usage decreased over time. Participants’ average ratings for app enjoyability, ease of use, understandability of information, and relevance of information were generally high and consistent across time points. Participants found 4to24 useful to track activities to help students prepare for college and work, and most planned to continue using it after the study. Discussion: Findings indicate that the app was usable, enjoyable, easy to use, and helpful. The decline in app usage over the 6 months may signify that participants lost interest, were impacted by the COVID-19 pandemic, or spent more time working on activities within the modules. Students rated app enjoyability and relevance higher than parents, which may relate to the language and tone of the student-focused modules. Introductory topics may have been unnecessary for some parents, which could have contributed to their lower relevance ratings. Implications for Practitioners: Service providers can inform parents and students about 4to24 and its potential benefits. 4to24 can encourage conversations about college and work, provide resources and activity suggestions, and serve as a resource for parents who are not connected or knowledgeable about services.
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Affiliation(s)
- Anne Steverson
- The National Research and Training Center on Blindness and Low Vision, Mississippi State University, Mississippi, MS, USA
| | - Jennifer L. Cmar
- The National Research and Training Center on Blindness and Low Vision, Mississippi State University, Mississippi, MS, USA
| | - Karla Antonelli
- The National Research and Training Center on Blindness and Low Vision, Mississippi State University, Mississippi, MS, USA
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Clinical Outcomes and Qualitative Perceptions of In-person, Hybrid, and Virtual Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:338-346. [PMID: 35420563 DOI: 10.1097/hcr.0000000000000688] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) is evolving to include both in-person and virtual delivery. Our objective was to compare, in CR patients, the association of in-person, hybrid, and virtual CR with change in performance on the 6-min walk test (6MWT) between enrollment and completion. METHODS Patients enrolled in CR between October 22, 2019, and May 10, 2021, were categorized into in-person, hybrid, or virtual groups by number of in-person and virtual visits. All patients received individualized exercise training and health behavior counseling. Cardiac rehabilitation was delivered to patients in the hybrid and virtual cohorts using synchronous video exercise and/or asynchronous telephone visits. Measurements at CR enrollment and completion included the 6MWT, blood pressure (BP), depression, anxiety, waist-to-hip ratio, and cardiac self-efficacy. RESULTS Of 187 CR patients, 37/97 (38.1%) were in-person patients and 58/90 (64.4%) were hybrid/virtual patients ( P = .001). Compared to in-person (51.5 ± 59.4 m) improvement in the 6MWT was similar in hybrid (63.4 ± 55.6; P = .46) and virtual (63.2 ± 59.6; P = .55) compared with in-person (51.5 ± 59.4). Hybrid and virtual patients experienced similar improvements in BP control and anxiety. Virtual patients experienced less improvement in depression symptoms. There were no statistically significant changes in waist-to-hip ratio or cardiac self-efficacy. Qualitative themes included the adaptability of virtual CR, importance of relationships between patients and CR staff, and need for training and organizational adjustments to adopt virtual CR. CONCLUSIONS Hybrid and virtual CR were associated with similar improvements in functional capacity to in-person. Virtual and hybrid CR have the potential to expand availability without compromising outcomes.
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22
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Meddar JM, Ponnapalli A, Azhar R, Turchioe MR, Duran AT, Creber RM. A Structured Review of Commercially Available Cardiac Rehabilitation mHealth Applications Using the Mobile Application Rating Scale. J Cardiopulm Rehabil Prev 2022; 42:141-147. [PMID: 35135963 PMCID: PMC11086945 DOI: 10.1097/hcr.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study systematically evaluated the quality and functionalities of patient-facing, commercially available mobile health (mHealth) apps for cardiac rehabilitation (CR). METHODS We performed our search in two of the most widely used commercial mobile app stores: Apple iTunes Appstore and Google Play Store (Android apps). Six search terms were used to query relevant CR apps: "cardiac rehabilitation," "heart disease and remote therapy," "heart failure exercise," "heart therapy and cardiac recovery," "cardiac recovery," and "heart therapy." App quality was evaluated using the Mobile Application Rating Scale (MARS). App functionality was evaluated using the IQVIA functionality scale, and app content was evaluated against the American Heart Association guidelines for CR. Apps meeting our inclusion criteria were downloaded and evaluated by two to three reviewers, and interclass correlations between reviewers were calculated. RESULTS We reviewed 3121 apps and nine apps met our inclusion criteria. On average, the apps scored a 3.0 on the MARS (5-point Likert scale) for overall quality. The two top-ranking mHealth apps for CR for all three quality, functionality, and consistency with evidence-based guidelines were My Cardiac Coach and Love My Heart for Women, both of which scored ≥4.0 for behavior change. CONCLUSION Overall, the quality and functionality of free apps for mobile CR was high, with two apps performing the best across all three quality categories. High-quality CR apps are available that can expand access to CR for patients with cardiovascular disease.
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Affiliation(s)
- John M Meddar
- Department of Population Health Sciences, New York University Grossman School of Medicine, New York (Mr Meddar); Department of Population Health Sciences, Weill Cornell Medicine, New York, New York (Mr Ponnapalli, Ms Azhar, and Drs Turchioe and Creber); and Center for Behavioral Cardiovascular Health, Columbia Irving Medical Center, New York, New York (Dr Duran)
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Stambler DM, Feddema E, Riggins O, Campeau K, Breuch LAK, Kessler MM, Misono S. REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study. JMIR Hum Factors 2022; 9:e26461. [PMID: 35333191 PMCID: PMC8994149 DOI: 10.2196/26461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/10/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based health interventions are increasingly common and are promising for patients with voice disorders because web-based participation does not require voice use. To address needs such as Health Insurance Portability and Accountability Act compliance, unique user access, the ability to send automated reminders, and a limited development budget, we used the Research Electronic Data Capture (REDCap) data management platform to deliver a patient-facing psychological intervention designed for patients with voice disorders. This was a novel use of REDCap. OBJECTIVE We aimed to evaluate the usability of the intervention, with this intervention serving as a use case for REDCap-based patient-facing interventions. METHODS We used REDCap survey instruments to develop the web-based voice intervention modules, then conducted usability evaluations using (1) heuristic evaluations by 2 evaluators, and (2) formal usability testing with 7 participants, consisting of predetermined tasks, a think-aloud protocol, ease-of-use measurements, a product reaction card, and a debriefing interview. RESULTS Heuristic evaluations found strengths in visibility of system status and real-world match, and weaknesses in user control and help documentation. Based on this feedback, changes to the intervention were made before usability testing. Overall, usability testing participants found the intervention useful and easy to use, although testing revealed some concerns with design, content, and terminology. Some concerns were readily addressed, and others required adaptations within REDCap. CONCLUSIONS The REDCap version of a complex web-based patient-facing intervention performed well in heuristic evaluation and formal usability testing. REDCap can effectively be used for patient-facing intervention delivery, particularly if the limitations of the platform are anticipated and mitigated.
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Affiliation(s)
| | - Erin Feddema
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
| | - Olivia Riggins
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, United States
| | - Kari Campeau
- Department of English, University of Colorado-Denver, Denver, CO, United States
| | | | - Molly M Kessler
- Department of Writing Studies, University of Minnesota, Minneapolis, MN, United States
| | - Stephanie Misono
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
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24
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Hughes JW, Serber ER, Kuhn T. Psychosocial management in cardiac rehabilitation: Current practices, recommendations, and opportunities. Prog Cardiovasc Dis 2022; 73:76-83. [PMID: 35016916 DOI: 10.1016/j.pcad.2021.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
Psychosocial management is a core component of outpatient Phase-II cardiac rehabilitation (CR) and includes psychosocial assessment, providing interventions, measuring outcomes, and care coordination. Psychosocial management contributes to the effectiveness of comprehensive CR, but the implementation is not always consistent or clearly described in the literature, in part due to the availability of behavioral health specialists. Patients in CR have many psychosocial needs including anxiety, depression, substance use disorders, sleep problems, psychosocial stress, and cognitive impairment. Behavioral considerations are inherent in many other aspects of CR,such as participation in CR, health behaviors, adherence, and tobacco cessation. Evaluation, or psychosocial assessment, should identify significant issues, record related medications, and incorporate findings in the individual treatment plan. Some patients require further evaluation and treatment by a qualified behavioral health specialist. Psychosocial interventions provided to all patients include patient education, counseling, stress-management, a supportive environment, and exercise. Measuring outcomes entails repeating the psychosocial assessment when patients finish CR and documenting changes. Coordinating care requires understanding available local mental health infrastructure and procedures for making referrals, and may entail identifying additional resources. Interventions provided concurrently with CR to a subset of patients with more extensive needs are typically pharmacotherapy, psychotherapy, or addictions counseling, which are beyond the scope of practice for most CR professionals. The way psychosocial management is implemented suggests clinical and research opportunities. For example, the combined effects of antidepressants and CR on depression and anxiety are not known. A prominent clinical opportunity is to fully implement psychosocial assessment, as required by statute and the core components. This could involve referring patients for whom clinically significant psychosocial concerns are identified during the evaluation for a more thorough assessment by a behavioral health specialist using an appropriate billing model. A research priority is a contemporary description of behavioral health services available to CR programs, including how psychosocial management is implemented. As delivery of CR comes to include more alternative models (e.g., home-based), research is needed on how that affects the delivery of psychosocial management. Increased use of telehealth may broaden clinical opportunities for psychosocial management.
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Affiliation(s)
- Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH 44242, United States of America.
| | - Eva R Serber
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Bio-behavioral Medicine, Charleston, SC 29425, United States of America
| | - Tyler Kuhn
- Department of Psychological Sciences, Kent State University, Kent, OH 44242, United States of America
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25
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Holl F, Kircher J, Swoboda WJ, Schobel J. Methods Used to Evaluate mHealth Applications for Cardiovascular Disease: A Quasi-Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12315. [PMID: 34886039 PMCID: PMC8656469 DOI: 10.3390/ijerph182312315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
In the face of demographic change and constantly increasing health care costs, health care system decision-makers face ever greater challenges. Mobile health applications (mHealth apps) have the potential to combat this trend. However, in order to integrate mHealth apps into care structures, an evaluation of such apps is needed. In this paper, we focus on the criteria and methods of evaluating mHealth apps for cardiovascular disease and the implications for developing a widely applicable evaluation framework for mHealth interventions. Our aim is to derive substantiated patterns and starting points for future research by conducting a quasi-systematic scoping review of relevant peer-reviewed literature published in English or German between 2000 and 2021. We screened 4066 articles and identified n = 38 studies that met our inclusion criteria. The results of the data derived from these studies show that usability, motivation, and user experience were evaluated primarily using standardized questionnaires. Usage protocols and clinical outcomes were assessed primarily via laboratory diagnostics and quality-of-life questionnaires, and cost effectiveness was tested primarily based on economic measures. Based on these findings, we propose important considerations and elements for the development of a common evaluation framework for professional mHealth apps, including study designs, data collection tools, and perspectives.
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Affiliation(s)
- Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, 81377 Munich, Germany
| | - Jennifer Kircher
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
| | - Walter J. Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
| | - Johannes Schobel
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany; (J.K.); (W.J.S.); (J.S.)
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26
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Oladele D, Iwelunmor J, Gbajabiamila T, Obiezu-Umeh C, Okwuzu JO, Nwaozuru U, Musa AZ, Idigbe I, Tahlil K, Tang W, Conserve DF, Rosenberg NE, David AN, Tucker J, Ezechi O. The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences. JMIR Form Res 2021; 5:e25824. [PMID: 34787579 PMCID: PMC8663582 DOI: 10.2196/25824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/31/2021] [Accepted: 08/01/2021] [Indexed: 12/28/2022] Open
Abstract
Background Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results A total of 19 users—12 women and 7 men—with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app’s low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app’s self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user’s privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app’s linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people.
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Affiliation(s)
- David Oladele
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbajabiamila
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Jane Ogoamaka Okwuzu
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Adesola Zaidat Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ifeoma Idigbe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Kadija Tahlil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Nora E Rosenberg
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Agatha N David
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Joseph Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill,, NC, United States.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
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Nutrition Intervention in Cardiac Rehabilitation: A REVIEW OF THE LITERATURE AND STRATEGIES FOR THE FUTURE. J Cardiopulm Rehabil Prev 2021; 41:383-388. [PMID: 34727557 DOI: 10.1097/hcr.0000000000000660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Despite guideline consensus that quality of nutrition affects most modifiable cardiovascular disease risk factors, the implementation of dietary interventions varies considerably in cardiac rehabilitation (CR) programs. The purpose of this review is to highlight the current existing literature and provide recommendations on best practices for nutrition interventions and future research that support secondary prevention outcomes. REVIEW METHODS The review examines original investigations, systematic reviews, and guidelines regarding nutrition intervention in CR. SUMMARY Nutrition intervention in CR plays an integral role in the success of patients; however, the literature is limited and standardization of practice is in its infancy. The role of a qualified registered dietician nutritionist, standardization of dietary assessments, individualized and intensive nutrition interventions, and application of specific behavior change techniques are central components in improving diet in CR. This review provides an overview of the evidence-based cardioprotective diets, nutritional interventions and behavioral strategies in CR, and explores areas for best practices and opportunities for innovation in the delivery of nutrition intervention in CR.
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28
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Tadas S, Pretorius C, Foster EJ, Gorely T, Leslie SJ, Coyle D. Transitions in Technology-Mediated Cardiac Rehabilitation and Self-management: Qualitative Study Using the Theoretical Domains Framework. JMIR Cardio 2021; 5:e30428. [PMID: 34647892 PMCID: PMC8554673 DOI: 10.2196/30428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background An acute cardiac incident is a life-changing event that often necessitates surgery. Although surgery has high success rates, rehabilitation, behavioral changes, and self-care are critical to long-term health. Recent systematic reviews have highlighted the potential of technology in this area; however, significant shortcomings have also been identified, particularly with regard to patient experience. Objective This study aims to improve future systems and to explore the experiences of cardiac patients during key phases after hospitalization: recuperation, initial rehabilitation, and long-term self-management. The key objective is to provide a holistic understanding of behavioral factors that impact people across these phases, understand how experiences evolve over time, and provide user-centered recommendations to improve the design of cardiac rehabilitation and self-management technologies. Methods Semistructured interviews were conducted with people who attended rehabilitation programs following hospitalization for acute cardiac events. Interviews were developed and data were analyzed via the Theoretical Domains Framework, a pragmatic framework that synthesizes prior theories of behavioral change. Results Three phases that arise posthospitalization were examined, namely, recuperation, rehabilitation, and long-term self-management. Through these phases, we describe the impact of key factors and important changes that occur in patients’ experiences over time, including the desire for and redefinition of normal life, the need for different types of formal and informal knowledge, the benefits of safe zoning and connectedness, and the need to recognize capability. The use of the Theoretical Domains Framework allows us to show how factors that influence behavior evolve over time and to identify potential sources of tension. Conclusions This study provides empirically grounded recommendations for the design of technology-mediated cardiac rehabilitation and self-management systems. Key recommendations include the use of technology to support a normal life, leveraging social influences to extend participants’ sense of normality, the use of technology to provide a safe zone, the need to support both emotional and physical well-being, and a focus on recognizing capability and providing recommendations that are positive and reinforce this capability.
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Affiliation(s)
- Shreya Tadas
- School of Computer Science, University College Dublin, Dublin, Ireland
| | | | - Emma J Foster
- Cardiac Unit, NHS Highland, Inverness, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Stephen J Leslie
- School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, United Kingdom
| | - David Coyle
- School of Computer Science, University College Dublin, Dublin, Ireland
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Shieh MD, Hsieh HY. Study of Influence of Different Models of E-Learning Content Product Design on Students' Learning Motivation and Effectiveness. Front Psychol 2021; 12:753458. [PMID: 34616349 PMCID: PMC8488078 DOI: 10.3389/fpsyg.2021.753458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022] Open
Abstract
As teachers provide one-way teaching demonstration or reference materials in class, students lack of the opportunities for direct operation. The provision of interactive e-materials could reduce the need for instructors to prepare complicated teaching aids and could deal with issues of climate and location. Learners could learn any time, anywhere, and learning could be reinforced by repeating the instruction with no need to disrupt timetables. The participants in the experimental teaching study were 275 product design students who engaged in e-learning for 15 weeks (3 h per week for a total of 45 h). The research results are summarized as follows: (1) Interactive teaching materials can enhance students' active learning styles so that, in the product design area, this method could reduce learning differences in students. (2) E-materials deliver knowledge using simple and specific images, animation, audio, and video, making learning interesting and relaxed for the product design students. E-learning is easy and practical and reduces learners' cognitive load. (3) Students' cognitive development and prior knowledge should be considered in the development of e-materials. Simple images, animations, text, and language could improve the attention and learning motivation of product design students and allow students to learn based on prior knowledge. A suggestion, based on the findings, is the application of various communication teaching models using e-materials to course work for the product design students, enabling discussion, analysis, concept formation, and problem-solving.
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Affiliation(s)
- Meng-Dar Shieh
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yin Hsieh
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
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30
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Kessler MM, Breuch LAK, Stambler DM, Campeau KL, Riggins OJ, Feddema E, Doornink SI, Misono S. User Experience in Health & Medicine: Building Methods for Patient Experience Design in Multidisciplinary Collaborations. JOURNAL OF TECHNICAL WRITING AND COMMUNICATION 2021; 51:380-406. [PMID: 35873946 PMCID: PMC9307135 DOI: 10.1177/00472816211044498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Health and medical contexts have emerged as an important area of inquiry for researchers at the intersection of user experience and technical communication. In addressing this intersection, this article advocates and extends patient experience design or PXD (Melonçon, 2017) as an important framework for user experience research within health and medicine. Specifically, this article presents several PXD insights from a task-based usability study that examined an online intervention program for people with voice problems. We respond to Melonçon's call (2017) to build PXD as a framework for user experience and technical communication research by describing ways traditional usability methods can provide PXD insights and asking the following question: What insights can emerge from combining traditional usability methods and PXD research? In addressing this question, we outline two primary methodological and practical considerations we found central to conducting PXD research: 1) engaging patients as participants, and 2) leveraging multidisciplinary collaboration.
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Affiliation(s)
- Molly M Kessler
- Department of Writing Studies, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Lee-Ann K Breuch
- Department of Writing Studies, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Danielle M Stambler
- Department of Writing Studies, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Kari L Campeau
- Department of English, University of Colorado Denver, Denver, CO, USA
| | - Olivia J Riggins
- Department of Writing Studies, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Erin Feddema
- Department of Otolaryngology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Sarah I Doornink
- Department of Otolaryngology, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Stephanie Misono
- Department of Otolaryngology, University of Minnesota Twin Cities, Minneapolis, MN, USA
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31
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Elnaggar A, von Oppenfeld J, Whooley MA, Merek S, Park LG. Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study. JMIR Hum Factors 2021; 8:e25356. [PMID: 34473064 PMCID: PMC8446842 DOI: 10.2196/25356] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/24/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. OBJECTIVE This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. METHODS We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. RESULTS Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. CONCLUSIONS By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults.
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Affiliation(s)
- Abdelaziz Elnaggar
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | | | - Mary A Whooley
- Veterans Affairs Medical Center, San Francisco, CA, United States.,Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Stephanie Merek
- Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Linda G Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, San Francisco, CA, United States
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32
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Bruggmann C, Adjedj J, Sardy S, Muller O, Voirol P, Sadeghipour F. Effects of the Interactive Web-Based Video "Mon Coeur, Mon BASIC" on Drug Adherence of Patients With Myocardial Infarction: Randomized Controlled Trial. J Med Internet Res 2021; 23:e21938. [PMID: 34459744 PMCID: PMC8438608 DOI: 10.2196/21938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/11/2021] [Accepted: 04/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Secondary prevention strategies after acute coronary syndrome (ACS) presentation with the use of drug combinations are essential to reduce the recurrence of cardiovascular events. However, lack of drug adherence is known to be common in this population and to be related to treatment failure. To improve drug adherence, we developed the "Mon Coeur, Mon BASIC" video. This online video has been specifically designed to inform patients about their disease and their current medications. Interactivity has been used to increase patient attention, and the video can also be viewed on smartphones and tablets. OBJECTIVE The objective of this study was to assess the long-term impact of an informative web-based video on drug adherence in patients admitted for an ACS. METHODS This randomized study was conducted with consecutive patients admitted to University Hospital of Lausanne for ACS. We randomized patients to an intervention group, which had access to the web-based video and a short interview with the pharmacist, and a control group receiving usual care. The primary outcome was the difference in drug adherence, assessed with the Adherence to Refills and Medication Scale (ARMS; 9 multiple-choice questions, scores ranging from 12 for perfect adherence to 48 for lack of adherence), between groups at 1, 3, and 6 months. We assessed the difference in ARMS score between both groups with the Wilcoxon rank sum test. Secondary outcomes were differences in knowledge, readmissions, and emergency room visits between groups and patients' satisfaction with the video. RESULTS Sixty patients were included at baseline. The median age of the participants was 59 years (IQR 49-69), and 85% (51/60) were male. At 1 month, 51 patients participated in the follow-up, 50 patients participated at 3 months, and 47 patients participated at 6 months. The mean ARMS scores at 1 and 6 months did not differ between the intervention and control groups (13.24 vs 13.15, 13.52 vs 13.68, respectively). At 3 months, this score was significantly lower in the intervention group than in the control group (12.54 vs 13.75; P=.03). We observed significant increases in knowledge from baseline to 1 and 3 months, but not to 6 months, in the intervention group. Readmissions and emergency room visits have been very rare, and the proportion was not different among groups. Patients in the intervention group were highly satisfied with the video. CONCLUSIONS Despite a lower sample size than we expected to reach, we observed that the "Mon Coeur, Mon BASIC" web-based interactive video improved patients' knowledge and seemed to have an impact on drug adherence. These results are encouraging, and the video will be offered to all patients admitted to our hospital with ACS. TRIAL REGISTRATION ClinicalTrials.gov NCT03949608; https://clinicaltrials.gov/ct2/show/NCT03949608.
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Affiliation(s)
- Christel Bruggmann
- Department of Pharmacy, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Department of Pharmacy, University Hospital of Geneva, Geneva, Switzerland
| | - Julien Adjedj
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Sylvain Sardy
- Section of Mathematics, University of Geneva, Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Pierre Voirol
- Department of Pharmacy, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Farshid Sadeghipour
- Department of Pharmacy, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Ding EY, Erskine N, Stut W, McManus DD, Peterson A, Wang Z, Escobar Valle J, Albuquerque D, Alonso A, Botkin NF, Pack QR, McManus DD. MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study. JMIR Hum Factors 2021; 8:e18130. [PMID: 34255660 PMCID: PMC8299347 DOI: 10.2196/18130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/17/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. OBJECTIVE In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch-informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. METHODS We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. RESULTS Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). CONCLUSIONS This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.
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Affiliation(s)
- Eric Y Ding
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nathaniel Erskine
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Wim Stut
- Philips Research, Eindhoven, Netherlands
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Amy Peterson
- University of Massachusetts Memorial Marlborough Hospital, Marlborough, MA, United States
| | - Ziyue Wang
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Daniella Albuquerque
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Alvaro Alonso
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Naomi F Botkin
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Quinn R Pack
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Winnige P, Vysoky R, Dosbaba F, Batalik L. Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases. World J Clin Cases 2021; 9:1761-1784. [PMID: 33748226 PMCID: PMC7953385 DOI: 10.12998/wjcc.v9.i8.1761] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are the most common causes of mortality worldwide. They are frequently the reasons for patient hospitalization, their incapability for work, and disability. These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families. It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle, and so modification of the latter is an essential component of both primary and secondary prevention. Cardiac rehabilitation (CR) represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity. This review presents an overview of basic information on CR with a focus on current trends, such as the issue of the various training modalities, utilization, and barriers to it or the use of telemedicine technologies. Appropriate attention should be devoted to these domains, as CR continues evolving as an effective and readily available intervention in the future.
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Affiliation(s)
- Petr Winnige
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic, Brno 62500, Jihomoravsky, Czech Republic
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Robert Vysoky
- Department of Public Health, Faculty of Medicine, Masaryk University, Czech Republic, Brno 62500, Jihomoravsky, Czech Republic
- Department of Health Promotion, Faculty of Sports Studies, Masaryk University, Brno 62500, Jihomoravsky, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
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Bashi N, Varnfield M, Karunanithi M. A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach. JMIR Form Res 2020; 4:e17542. [PMID: 33337339 PMCID: PMC7775820 DOI: 10.2196/17542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/27/2020] [Accepted: 10/03/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. OBJECTIVE The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. METHODS The content of Mobile Technology-Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists' survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. RESULTS The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients' data and provide support. CONCLUSIONS The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS.
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Affiliation(s)
- Nazli Bashi
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Marlien Varnfield
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Mohanraj Karunanithi
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
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Tadas S, Coyle D. Barriers to and Facilitators of Technology in Cardiac Rehabilitation and Self-Management: Systematic Qualitative Grounded Theory Review. J Med Internet Res 2020; 22:e18025. [PMID: 33174847 PMCID: PMC7688378 DOI: 10.2196/18025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people’s experiences of technology in this space. Objective Through a qualitative approach, this review aims to engage more directly with people’s experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space.
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Strubbia C, Levack WMM, Grainger R, Takahashi K, Tomori K. Use of technology in supporting goal setting in rehabilitation for adults: a scoping review. BMJ Open 2020; 10:e041730. [PMID: 33172946 PMCID: PMC7656911 DOI: 10.1136/bmjopen-2020-041730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/25/2020] [Accepted: 09/23/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To map the extant literature evaluating the use of technology for goal setting in adult rehabilitation and the impact of technology for patient outcomes. DESIGN Scoping review. METHODS MEDLINE (via Ovid), CINAHL (via EBSCO), AMED and Scopus were searched for articles describing observational or interventional studies. ProQuest Dissertations and Theses database were searched for grey literature. Two review authors independently screened all titles and abstracts for potentially relevant articles. We included articles describing studies that had evaluated the development or application of technology to facilitate goal setting in rehabilitation for adults. Articles were excluded if the technology described did not include features to facilitate goal setting or were not in English. Narrative reviews, opinion pieces and editorials were also excluded. RESULTS After screening 1640 publications of potential interest, we identified 27 studies for inclusion. These 27 articles described studies involving a total of 16 different technologies including, seven mobile apps, three websites, two mobile apps/website hybrids, two apps and two websites connected to a pedometer. We found that most technologies described were designed to facilitate self-management with goal setting as a feature and that only five included a shared decision moment around goal setting. Only six of the 16 technologies had research providing evidence of effectiveness in terms of improved patient outcomes, with the best evidence of beneficial effects associated with technologies that linked goal setting to pedometer use. CONCLUSIONS The identified technologies for use in adult rehabilitation that included goal setting as a feature were largely accepted and valued by patients and health professionals. The limited data suggest that there is a need for further research; specific foci may include the impact of incorporation of a shared decision-making moment and evaluation of effectiveness on patient outcomes.
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Affiliation(s)
- Carla Strubbia
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | | | - Kayoko Takahashi
- Department of Occupational Therapy, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Kounosuke Tomori
- Department of Occupational Therapy, Tokyo University of Technology, Ohta-ku, Tokyo, Japan
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Freene N, van Berlo S, McManus M, Mair T, Davey R. A Behavioral Change Smartphone App and Program (ToDo-CR) to Decrease Sedentary Behavior in Cardiac Rehabilitation Participants: Prospective Feasibility Cohort Study. JMIR Form Res 2020; 4:e17359. [PMID: 33141091 PMCID: PMC7671837 DOI: 10.2196/17359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/12/2020] [Accepted: 10/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior. OBJECTIVE This study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants. METHODS Using a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do's). Do's were delivered via the app, with participants receiving 14 to 19 Do's during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure. RESULTS Between January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P<.001). Participants were, on average, aged 54 (SD 13) years, mostly male (17/20, 85%), and working (12/20, 67%). At 6 weeks, 95% (19/20) of participants were assessed, and 60% (12/20) of participants were assessed at 16 weeks. Participants were relatively satisfied with the usability of the app (UTAUT2 questionnaire). Overall, participants spent 11 to 12 hours per day sitting. There was a medium effect size (Cohen d=0.54) for the reduction in sedentary behavior (minutes per day) over 16 weeks. CONCLUSIONS The use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, University of Canberra, Bruce, Australia.,Health Research Institute, University of Canberra, Bruce, Australia
| | | | | | - Tarryn Mair
- Exercise Physiology, Canberra Health Services, Garran, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, Australia
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Kooman JP, Wieringa FP, Han M, Chaudhuri S, van der Sande FM, Usvyat LA, Kotanko P. Wearable health devices and personal area networks: can they improve outcomes in haemodialysis patients? Nephrol Dial Transplant 2020; 35:ii43-ii50. [PMID: 32162666 PMCID: PMC7066542 DOI: 10.1093/ndt/gfaa015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Digitization of healthcare will be a major innovation driver in the coming decade. Also, enabled by technological advancements and electronics miniaturization, wearable health device (WHD) applications are expected to grow exponentially. This, in turn, may make 4P medicine (predictive, precise, preventive and personalized) a more attainable goal within dialysis patient care. This article discusses different use cases where WHD could be of relevance for dialysis patient care, i.e. measurement of heart rate, arrhythmia detection, blood pressure, hyperkalaemia, fluid overload and physical activity. After adequate validation of the different WHD in this specific population, data obtained from WHD could form part of a body area network (BAN), which could serve different purposes such as feedback on actionable parameters like physical inactivity, fluid overload, danger signalling or event prediction. For a BAN to become clinical reality, not only must technical issues, cybersecurity and data privacy be addressed, but also adequate models based on artificial intelligence and mathematical analysis need to be developed for signal optimization, data representation, data reliability labelling and interpretation. Moreover, the potential of WHD and BAN can only be fulfilled if they are part of a transformative healthcare system with a shared responsibility between patients, healthcare providers and the payors, using a step-up approach that may include digital assistants and dedicated ‘digital clinics’. The coming decade will be critical in observing how these developments will impact and transform dialysis patient care and will undoubtedly ask for an increased ‘digital literacy’ for all those implicated in their care.
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Affiliation(s)
- Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Fokko Pieter Wieringa
- Connected Health Solutions, imec, Eindhoven, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Maggie Han
- Renal Research Institute, New York, NY, USA
| | - Sheetal Chaudhuri
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
| | - Len A Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
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Wegner S, Lohmeyer Q, Wahlen D, Neumann S, Groebli JC, Meboldt M. Value of Eye-Tracking Data for Classification of Information Processing-Intensive Handling Tasks: Quasi-Experimental Study on Cognition and User Interface Design. JMIR Hum Factors 2020; 7:e15581. [PMID: 32490840 PMCID: PMC7301256 DOI: 10.2196/15581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 02/12/2020] [Accepted: 03/28/2020] [Indexed: 01/16/2023] Open
Abstract
Background In order to give a wide range of people the opportunity to ensure and support home care, one approach is to develop medical devices that are as user-friendly as possible. This allows nonexperts to use medical devices that were originally too complicated to use. For a user-centric development of such medical devices, it is essential to understand which user interface design best supports patients, caregivers, and health care professionals. Objective Using the benefits of mobile eye tracking, this work aims to gain a deeper understanding of the challenges of user cognition. As a consequence, its goal is to identify the obstacles to the usability of the features of two different designs of a single medical device user interface. The medical device is a patient assistance device for home use in peritoneal dialysis therapy. Methods A total of 16 participants, with a subset of seniors (8/16, mean age 73.7 years) and young adults (8/16, mean age 25.0 years), were recruited and participated in this study. The handling cycle consisted of seven main tasks. Data analysis started with the analysis of task effectiveness for searching for error-related tasks. Subsequently, the in-depth gaze data analysis focused on these identified critical tasks. In order to understand the challenges of user cognition in critical tasks, gaze data were analyzed with respect to individual user interface features of the medical device system. Therefore, it focused on the two dimensions of dwell time and fixation duration of the gaze. Results In total, 97% of the handling steps for design 1 and 96% for design 2 were performed correctly, with the main challenges being task 1 insert, task 2 connect, and task 6 disconnect for both designs. In order to understand the two analyzed dimensions of the physiological measurements simultaneously, the authors propose a new graphical representation. It distinguishes four different patterns to compare the eye movements associated with the two designs. The patterns identified for the critical tasks are consistent with the results of the task performance. Conclusions This study showed that mobile eye tracking provides insights into information processing in intensive handling tasks related to individual user interface features. The evaluation of each feature of the user interface promises an optimal design by combining the best found features. In this way, manufacturers are able to develop products that can be used by untrained people without prior knowledge. This would allow home care to be provided not only by highly qualified nurses and caregivers, but also by patients themselves, partners, children, or neighbors.
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Affiliation(s)
- Stephan Wegner
- Product Development Group Zurich, Institute of Design, Materials and Fabrication, Department of Mechanical and Process Engineering, Swiss Federal Institute of Technology in Zurich, Zürich, Switzerland
| | - Quentin Lohmeyer
- Product Development Group Zurich, Institute of Design, Materials and Fabrication, Department of Mechanical and Process Engineering, Swiss Federal Institute of Technology in Zurich, Zürich, Switzerland
| | - Dimitri Wahlen
- Product Development Group Zurich, Institute of Design, Materials and Fabrication, Department of Mechanical and Process Engineering, Swiss Federal Institute of Technology in Zurich, Zürich, Switzerland
| | | | | | - Mirko Meboldt
- Product Development Group Zurich, Institute of Design, Materials and Fabrication, Department of Mechanical and Process Engineering, Swiss Federal Institute of Technology in Zurich, Zürich, Switzerland
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Chien SC, Islam MM, Yeh CA, Chien PH, Chen CY, Chin YP, Lin MC. Mutual-Aid Mobile App for Emergency Care: Feasibility Study. JMIR Form Res 2020; 4:e15494. [PMID: 32191212 PMCID: PMC7118550 DOI: 10.2196/15494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/28/2019] [Accepted: 12/16/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Improving the quality of patient care through the use of mobile devices is one of the hot topics in the health care field. In unwanted situations like an accident, ambulances and rescuers often require a certain amount of time to arrive at the scene. Providing immediate cardiopulmonary resuscitation (CPR) to patients might improve survival. OBJECTIVE The primary objective of this study was to evaluate the feasibility of an emergency and mutual-aid app model in Taiwan and to provide a reference for government policy. METHODS A structured questionnaire was developed as a research tool. All questionnaires were designed according to the technology acceptance model, and a Likert scale was used to measure the degree of agreement or disagreement. Moreover, in-depth interviews were conducted with six experts from medical, legal, and mobile app departments. Each expert was interviewed once to discuss feasible countermeasures and suggestions. Statistical Package for the Social Sciences (SPSS version 19; IBM Corp, Armonk, New York) was used to perform all statistical analyses, including descriptive statistics, independent sample t-tests, variance analysis, and Pearson correlation analysis. RESULTS We conducted this study between October 20, 2017, and November 10, 2017, at the Taipei Medical University Hospital. Questionnaires were distributed to medical personnel, visiting guests, family members, and volunteers. A total of 113 valid questionnaires were finally obtained after the exclusion of incomplete questionnaires. Cronbach α values for self-efficacy (perceived ease of use), use attitude (perceived usefulness), and use willingness and frequency were above .85, meeting the criterion of greater than .70. We observed that the reliability of each subquestion was acceptable and the values for use attitude (perceive usefulness) and use willingness and frequency were more than .90. CONCLUSIONS The findings suggest that perceived ease of use and perceived usefulness of the app model affect use willingness. However, perceived usefulness had an intermediary influence on use willingness. Experts in law, medical, and technology fields consider that an emergency and mutual-aid model can be implemented in Taiwan. Along with the development of an emergency and mutual-aid app model, we recommend an increase in the number of automated external defibrillators per region and promotion of correct knowledge about CPR in order to decrease morbidity and mortality.
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Affiliation(s)
- Shuo-Chen Chien
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chen-An Yeh
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Po-Han Chien
- Business Administration, National Taiwan University, Taipei, Taiwan
| | - Chun You Chen
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yen-Po Chin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chin Lin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Quantification of Avoidable Radiation Exposure in Interventional Fluoroscopy With Eye Tracking Technology. Invest Radiol 2020; 55:457-462. [PMID: 32149859 DOI: 10.1097/rli.0000000000000658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Reducing avoidable radiation exposure during medical procedures is a top priority. The purpose of this study was to quantify, for the first time, the percentage of avoidable radiation during fluoroscopically guided cardiovascular interventions using eye tracking technologies. MATERIALS AND METHODS Mobile eye tracking glasses were used to measure precisely when the operators looked at a fluoroscopy screen during the interventions. A novel machine learning algorithm and image processing techniques were used to automatically analyze the data and compute the percentage of avoidable radiation. Based on this percentage, the amount of potentially avoidable radiation dose was computed. RESULTS This study included 30 cardiovascular interventions performed by 5 different operators. A significant percentage of the administered radiation (mean [SD], 43.5% [12.6%]) was avoidable (t29 = 18.86, P < 0.00001); that is, the operators were not looking at the fluoroscopy screen while the x-ray was on. On average, this corresponded to avoidable amounts of air kerma (mean [SD], 229 [66] mGy) and dose area product (mean [SD], 32,781 [9420] mGycm), or more than 11 minutes of avoidable x-ray usage, per procedure. CONCLUSIONS A significant amount of the administered radiation during cardiovascular interventions is in fact avoidable.
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Huang CY, Yang MC. Empirical Investigation of Factors Influencing Consumer Intention to Use an Artificial Intelligence-Powered Mobile Application for Weight Loss and Health Management. Telemed J E Health 2020; 26:1240-1251. [PMID: 31971883 DOI: 10.1089/tmj.2019.0182] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Research into interventions based on mobile health (m-Health) applications (apps) has attracted considerable attention among researchers; however, most previous studies have focused on research-led apps and their effectiveness when applied to overweight/obese adults. There remains a paucity of research on the attitudes of typical consumers toward the adoption of m-Health apps for weight management. This study adopted the tenets of the extended unified theory of acceptance and use of technology 2 (UTAUT2) as the theoretical foundation in developing a model that integrates personal innovativeness (PI) and network externality (NE) in seeking to identify the factors with the most pronounced effect on one's intention to use an artificial intelligence-powered weight loss and health management app. Materials and Methods: An online survey was conducted for Taiwanese participants aged ≥21 years from May 23 to June 30, 2018. Hypotheses were tested using structural equation modeling. Results: In the analysis of 458 responses, the proposed research model explained 75.5% of variance in behavioral intention (BI). Habit was the independent variable with the strongest performance in predicting user intention, followed by PI, NE, and performance expectancy (PE). Social influence weakly affects user intention through PE. In multi-group analysis, education was shown to exert a moderating influence on some of the relationships hypothesized in the model. Conclusions: The empirically validated model in this study provides insights into the primary determinants of user intention toward the adoption of m-Health app for weight loss and health management. The theoretical and practical implications are relevant to researchers seeking to extend the applicability of the UTAUT2 model to health apps as well as practitioners seeking to promote the adoption of m-Health apps. In the future, researchers could extend the model to assess the effects of BI on actual use behavior.
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Affiliation(s)
- Chin-Yuan Huang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Ming-Chin Yang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
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Farias N, Rose-Davis B, Hong P, Wozney L. An Automated Text Messaging System (Tonsil-Text-To-Me) to Improve Tonsillectomy Perioperative Experience: Exploratory Qualitative Usability and Feasibility Study. JMIR Perioper Med 2020; 3:e14601. [PMID: 33393931 PMCID: PMC7709859 DOI: 10.2196/14601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/11/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background Inexperience and forgetting perioperative care instruction are significant drivers of parental stress during pediatric tonsillectomy care. With the widespread use of mobile technology, parents now desire a system that provides them with information that is timely, accessible, and comprehensive. Tonsil-Text-To-Me (TTTM) is a text messaging system that sends out automated and timed texts to parents of children who are undergoing tonsillectomy. Objective The objective of this study was to pilot-test TTTM to assess for feasibility and usability and collect suggestions for system improvements desired by parents from a pediatric otolaryngology text message service. Methods Parents of pediatric patients who were being scheduled for tonsillectomy with or without adenoidectomy were prospectively enrolled. An exploratory qualitative study using a semistructured interview guide was performed after parents received the automated texts 2 weeks before and 1 week after their child’s surgery. Results A total of 7 parents were interviewed (data saturation was reached). Participants were all of maternal relation to the patient. Overall, all parents felt that the TTTM service was an improvement to the current standard model of information delivery. Parents also reported that the text messages reduced their anxiety and improved their performance when caring for their children during the perioperative period. No parents expressed privacy concerns about receiving texts and regarding the information included in the messages. Service suggestions showed that parents were eager for more information and had a high threshold for message reception regarding their child’s surgical care. Conclusions All parents expressed enthusiasm for a text message service during their child’s tonsillectomy perioperative period. The care instructions and reminders provided to parents via automated and timed text messages may be a strategy to improve information delivery in a simple and accessible format that could empower families in their own health care.
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Affiliation(s)
- Nathan Farias
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Benjamin Rose-Davis
- Centre for Research in Family Health, Izaak Walton Killam Health Centre, Halifax, NS, Canada
| | - Paul Hong
- Division of Otolaryngology, Izaak Walton Killam Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Lori Wozney
- Nova Scotia Health Authority, Dartmouth, NS, Canada
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Development of an intervention tool for precision oral self-care: Personalized and evidence-based practice for patients with periodontal disease. PLoS One 2019; 14:e0225453. [PMID: 31751411 PMCID: PMC6874065 DOI: 10.1371/journal.pone.0225453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background Oral self-care plays an important role in maintaining oral health and preventing the occurrence of oral diseases. The association between good oral care and good oral hygiene is well known. However, the adherence to a proper daily oral hygiene regimen generally remains poor, so the prevalence of oral diseases remains high. Periodontal disease is the most common oral disease in the population. To enhance the adherence to good oral hygiene behaviors for patients with periodontal disease, we developed a personalized and evidence-based mobile application as an intervention tool for the purpose of initiating and improving good oral self-care. Objective The objective of this study was to demonstrate the systematic development process and content of the oral self-care mobile application, OSCA. Methods The systematic development process of OSCA consists of three phases: behavioral diagnosis, intervention design, and assessment of OSCA. Firstly, behavioral problem of oral self-care was identified by the experts in periodontics care. Secondly, the intervention functions and the mode of delivery were designed based on the capability-opportunity-motivation behavioral model, which is the underpinning model behind the behavior change wheel framework. Thirdly, the developed app was evaluated by the experts through a heuristics evaluation checklist by adopting Morville’s Honeycomb model, and the final version of OSCA was assessed by the patients with periodontal disease using the System Usability Scale (SUS). Results The problems of target behavior were identified and incorporated into the design of intervention functions. For the beta version of the OSCA, experts proposed four main suggestions to improve the usefulness. Experts evaluated the beta and final versions of the app using a heuristics evaluation checklist, providing mean scores of 4.38 and 4.62, respectively. For usability testing, 87 participants completed both the specified tasks and the SUS questionnaire, providing an SUS median score of 77.5 (IQR = 12.5) and an overall mean completion time of 12.22 minutes for the specified tasks. The mean scores of the intervention functions for capability establishment, motivation enhancement, and opportunity creation were 6.13, 5.88, and 6.06, respectively. Conclusions The study presents a rigorous design process of developing an evidence-based and personalized mobile application for oral self-care. The results of the expert evaluation confirmed the validated design and the participants were satisfied with the designed app.
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Stotts MJ, Grischkan JA, Khungar V. Improving cirrhosis care: The potential for telemedicine and mobile health technologies. World J Gastroenterol 2019; 25:3849-3856. [PMID: 31413523 PMCID: PMC6689809 DOI: 10.3748/wjg.v25.i29.3849] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.
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Affiliation(s)
- Matthew Jonathon Stotts
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Justin Alexander Grischkan
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Vandana Khungar
- Department of Medicine, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Huffman JC, Smith DM, Ibrahim NE, Duque L, Moskowitz JT, Celano CM. Using mHealth interventions to promote cardiovascular health. Acta Cardiol 2019; 74:283-285. [PMID: 30328777 DOI: 10.1080/00015385.2018.1501139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jeff C. Huffman
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Diana M. Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Nasrien E. Ibrahim
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Laura Duque
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Christopher M. Celano
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Hannan AL, Harders MP, Hing W, Climstein M, Coombes JS, Furness J. Impact of wearable physical activity monitoring devices with exercise prescription or advice in the maintenance phase of cardiac rehabilitation: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2019; 11:14. [PMID: 31384474 PMCID: PMC6668165 DOI: 10.1186/s13102-019-0126-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Physical activity (PA) is a component of cardiac rehabilitation (CR). However, life-long engagement in PA is required to maintain benefits gained. Wearable PA monitoring devices (WPAM) are thought to increase PA. There appear to be no reviews which investigate the effect of WPAM in cardiac populations. We firstly aimed to systematically review randomised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR. We specifically examined the effect on cardiorespiratory fitness (CRF), amount and intensity of daily PA, and sedentary time. Secondly, we aimed to collate outcome measures reported, reasons for drop out, adverse events, and psychological impact from utilising a WPAM. METHODS A systematic search (up to January 2019) of relevant databases was completed, followed by a narrative synthesis, meta-analysis and qualitative analysis. RESULTS Nine studies involving 1,352 participants were included. CRF was improved to a greater extent in participants using WPAM with exercise prescription or advice compared with controls (MD 1.65 mL/kg/min;95% confidence interval [CI; 0.64-2.66]; p = 0.001; I2 = 0%). There was no significant between group difference in six-minute walk test distance. In 70% of studies, step count was greater in participants using a WPAM with exercise prescription or advice, however the overall effect was not significant (SMD 0.45;95% [CI; - 0.17-1.07] p = 0.15; I2 = 81%). A sensitivity analysis resulted in significantly greater step counts in participants using a WPAM with exercise prescription or advice and reduced the heterogeneity from 81 to 0% (SMD 0.78;95% [CI;0.54-1.02]; p < 0.001; I2 = 0%). Three out of four studies reporting on intensity, found significantly increased time spent in moderate and moderate-vigorous intensity PA. No difference between groups was found for sedentary time. Three of six studies reported improved psychological benefits.No cardiac adverse events related to physical activity were reported and 62% of non-cardiac adverse events were primarily musculoskeletal injuries. Reasons for dropping out included medical conditions, lack of motivation, loss of interest, and technical difficulties. CONCLUSIONS Our meta-analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use. Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count. WPAM with exercise prescription or advice did not change sedentary time. Psychological health and exercise intensity may potentially be enhanced by WPAM with exercise prescription or advice, however further research would strengthen this conclusion. TRIAL REGISTRATION PROSPERO Registration Number: CRD42019106591.
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Affiliation(s)
- Amanda L. Hannan
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
| | - Michael P. Harders
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
| | - Mike Climstein
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group Faculty of Health Sciences, University of Sydney, Lidcombe, NSW Australia
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD Australia
| | - Jeff S. Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - James Furness
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
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Xu L, Li F, Zhou C, Li J, Hong C, Tong Q. The effect of mobile applications for improving adherence in cardiac rehabilitation: a systematic review and meta-analysis. BMC Cardiovasc Disord 2019; 19:166. [PMID: 31299903 PMCID: PMC6625064 DOI: 10.1186/s12872-019-1149-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/05/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite of the established effectiveness, the acceptance and adherence of cardiac rehabilitation (CR) remains sub-optimal. Mobile technologies are increasingly used in promoting CR without any firm evidence of their safety and efficacy. This systematic review and meta-analysis were aimed to assess the effect of mobile applications as an intervention for improving adherence to CR. METHODS Relevant studies were searched in PubMed, the Cochrane Library, Embase and Web of Science from inception to 29th December 2018. Eligible studies were the ones which used mobile applications as a stand-alone intervention or as the primary component for the intervention directed at improving CR adherence, without any limitations on outpatient or home-based CR. RESULTS Eight studies were eligible for the systematic review including four randomized controlled trials (RCTs) as well as four before-after studies of which only one had control group. Four RCTs and 185 patients in experimental group were included in meta-analysis, which had evaluated the effect of mobile health applications on CR completion and had reported that the adherence of patients using mobile applications was 1.4 times higher than the control group (RR = 1.38; CI 1.16 to 1.65; P = 0.0003). Moreover, we also found mixed results in exercise capacity, mental health and quality of life. CONCLUSION The use of mobile applications for improving the adherence of the CR might be effective. However, it appears to be in the initial stage of implementing mobile applications in CR and more research is essential to validate their effectiveness.
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Affiliation(s)
- Linqi Xu
- School of Nursing, Jilin University, Changchun, 130000 China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, 130000 China
| | - Changli Zhou
- School of Nursing, Jilin University, Changchun, 130000 China
| | - Jinwei Li
- School of Nursing, Jilin University, Changchun, 130000 China
| | - Chengcheng Hong
- School of Health Sciences University of Manchester, M13 9PL, Manchester, UK
| | - Qian Tong
- The First Hospital of Jilin University, No 71, Xin Min Avenue, Changchun, 130000 China
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Alwashmi MF, Hawboldt J, Davis E, Fetters MD. The Iterative Convergent Design for Mobile Health Usability Testing: Mixed Methods Approach. JMIR Mhealth Uhealth 2019; 7:e11656. [PMID: 31025951 PMCID: PMC6658163 DOI: 10.2196/11656] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/05/2018] [Accepted: 03/24/2019] [Indexed: 01/12/2023] Open
Abstract
Although patients express an interest in using mobile health (mHealth) interventions to manage their health and chronic conditions, many current mHealth interventions are difficult to use. Usability testing is critical for the success of novel mHealth interventions. Researchers recognize the utility of using qualitative and quantitative approaches for usability testing, but many mHealth researchers lack the awareness of integration approaches from advances in mixed methods research that can add value to mHealth technology. As efficient usability testing proceeds iteratively, we introduce a novel mixed methods design developed specifically for mHealth researchers. The iterative convergent mixed methods design involves simultaneous qualitative and quantitative data collection and analysis that continues cyclically through multiple rounds of mixed methods data collection and analysis until the mHealth technology under evaluation is found to work to the satisfaction of the researcher. In cyclical iterations, early development is more qualitatively driven but progressively becomes more quantitatively driven. Using this design, mHealth researchers can leverage mixed methods integration procedures in the research question, data collection, data analysis, interpretation, and dissemination dimensions. This study demonstrates how the iterative convergent mixed methods design provides a novel framework for generating unique insights into multifaceted phenomena impacting mHealth usability. Understanding these practices can help developers and researchers leverage the strengths of an integrated mixed methods design.
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Affiliation(s)
| | | | - Erin Davis
- Memorial University, St John's, NL, Canada
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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