eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review.

The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States.We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics.We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use.Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed.Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use

Experiences and opinions of adults with type 2 diabetes regarding a self-regulation-based eHealth intervention targeting physical activity and sedentary behaviour

Background: Online interventions targeting a healthy lifestyle in adults with type 2 diabetes are more effective when informed by behaviour change theories. Although these theories provide guidance in developing the content of an intervention, information regarding how to present this content in an engaging way is often lacking. Consequently, incorporating users’ views in the creation of eHealth interventions has become an important target. Methods: Via a qualitative interview study with 21 adults with type 2 diabetes who had completed an online self-regulation-based intervention (‘MyPlan 2.0’), we assessed participants’ opinions regarding the usefulness of the implemented self-regulation techniques, the design of the programme as well as their knowledge regarding physical activity and sedentary behaviour. A directed content analysis was performed to synthesize the interview data. Results: Participants experienced difficulties completing the coping planning component. The simple design of the website was considered helpful, and most participants were aware of the beneficial effects of an active lifestyle. Conclusions: ‘MyPlan 2.0’ was well-accepted by the majority of participants. However, the coping planning component will need to be adapted. Based on these findings, recommendations on how to tailor eHealth interventions to the population of adults with type 2 diabetes have been formulated

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Internet skills performance tests: are people ready for eHealth?

Background:\ud Despite the amount of online health information, there are several barriers that limit the Internet’s adoption as a source of health information. One of these barriers is highlighted in conceptualizations of the digital divide which include the differential possession of Internet skills, or “eHealth literacy”. Most measures of Internet skills among populations at large use self-assessments. The research discussed here applies a multifaceted definition of Internet skills and uses actual performance tests.\ud \ud Objective:\ud The purpose of this study was to assess how ready a sample of the general population is for eHealth. More specifically, four types of Internet skills were measured in a performance test in which subjects had to complete health-related assignments on the Internet.\ud \ud Methods:\ud From November 1, 2009, through February 28, 2010, 88 subjects participated in the study. Subjects were randomly selected from a telephone directory. A selective quota sample was used divided over equal subsamples of gender, age, and education. Each subject had to accomplish assignments on the Internet. The Internet skills accounted for were categorized as operational (basic skills to use the Internet), formal (navigation and orientation), information (finding information), and strategic (using the information for personal benefits). The tests took approximately 1.5 hours and were conducted in a University office, making the setting equally new for all. Successful completion and time spent on the assignments—the two main outcomes—were directly measured by the test leader.\ud \ud Results:\ud The subjects successfully completed an average of 73% (5.8/8) of the operational Internet skill tasks and an average of 73% (2.9/4) of the formal Internet skill tasks. Of the information Internet skills tasks, an average of 50% (1.5/3) was completed successfully and, of the strategic Internet skills tasks, 35% (0.7/2). Only 28% (25/88) of the subjects were able to successfully complete all operational skills tasks, 39% (34/88) all formal skills tasks, 13% (11/88) all information skills tasks, and 20% (18/88) both the strategic skill tasks. The time spent on the assignments varied substantially. Age and education were the most important contributors to the operational and formal Internet skills. Regarding the formal Internet skills, years of Internet experience also had some influence. Educational level of attainment was the most important contributor to the information and strategic Internet skills.\ud \ud Conclusions:\ud Although the amount of online health-related information and services is consistently growing, it appears that the general population lacks the skills to keep up. Most problematic appear to be the lack of information and strategic Internet skills, which, in the context of health, are very important. The lack of these skills is also problematic for members of younger generations, who are often considered skilled Internet users. This primarily seems to account for the operational and formal Internet skills. The results of the study strongly call for policies to increase the level of Internet skills

Acceptability of artificial intelligence (AI)-enabled chatbots, video consultations and live webchats as online platforms for sexual health advice

Objectives Sexual and reproductive health (SRH) services are undergoing a digital transformation. This study explored the acceptability of three digital services, (i) video consultations via Skype, (ii) live webchats with a health advisor and (iii) artificial intelligence (AI)-enabled chatbots, as potential platforms for SRH advice. Methods A pencil-and-paper 33-item survey was distributed in three clinics in Hampshire, UK for patients attending SRH services. Logistic regressions were performed to identify the correlates of acceptability. Results In total, 257 patients (57% women, 50% aged <25 years) completed the survey. As the first point of contact, 70% preferred face-to-face consultations, 17% telephone consultation, 10% webchats and 3% video consultations. Most would be willing to use video consultations (58%) and webchat facilities (73%) for ongoing care, but only 40% found AI chatbots acceptable. Younger age (<25 years) (OR 2.43, 95% CI 1.35 to 4.38), White ethnicity (OR 2.87, 95% CI 1.30 to 6.34), past sexually transmitted infection (STI) diagnosis (OR 2.05, 95% CI 1.07 to 3.95), self-reported STI symptoms (OR 0.58, 95% CI 0.34 to 0.97), smartphone ownership (OR 16.0, 95% CI 3.64 to 70.5) and the preference for a SRH smartphone application (OR 1.95, 95% CI 1.13 to 3.35) were associated with video consultations, webchats or chatbots acceptability. Conclusions Although video consultations and webchat services appear acceptable, there is currently little support for SRH chatbots. The findings demonstrate a preference for human interaction in SRH services. Policymakers and intervention developers need to ensure that digital transformation is not only cost-effective but also acceptable to users, easily accessible and equitable to all populations using SRH services

A Scoping Review Exploration of the Intended and Unintended Consequences of eHealth on Older People:A Health Equity Impact Assessment

eHealth is one perceived mechanism to extend the range and reach of limited health-care resources for older adults. A decade-scoping review (2007–2017) was conducted to systematically search and synthesize evidence to understand the intended and unintended consequences of eHealth initiatives, informed by a health equity impact assessment framework. Scoping review sources included international academic and grey literature on eHealth initiatives (e.g., eHealth records, telemedicine/telecare, and mobile eHealth application) focused on the varying needs of older adults (aged 60+), particularly individuals experiencing sociocultural and economic difficulties. Findings suggest that eHealth has several potential benefits for older adults, but also the possibility of further excluding already marginalized groups, thereby exacerbating existing health disparities. Ongoing evaluation of eHealth initiatives for older adults is necessary and requires attention to unique individual-level, socioeconomic, and cultural characteristics to heighten benefits and better capture both the intended and unintended outcomes of advanced eHealth systems.peerReviewe

Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): Study protocol for a randomised controlled trial

Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. Methods and analysis Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. Ethics and dissemination The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. Trial registration number ACTRN12617001084370; Pre-results