Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Doctor of Philosophy

dissertationDiabetes is a complex condition that can significantly affect quality of life and economic burden. New approaches to promoting diabetes knowledge and support to enhance diabetes management are necessary. Peer health is occurring within the diabetes online community (DOC), although very little is known about how it is being used to help manage diabetes. The purpose of this research was to better understand peer health within the nonmoderated, nontrained peer context of the DOC. In this multiple method approach, a cross-sectional survey was posted to DOC social media sites to describe adult DOC users, indicators of their health status, and perceived credibility of DOC information. A baby boomer subset of participants were interviewed to understand why they participated in the DOC, how they anticipated continued DOC use as they aged, and how they determined credibility of DOC information. Transcripts were analyzed using content analysis. Apomediation Theory guided this research. There were several significant findings. Individuals highly engaged with the DOC had better glycemic control. DOC users had high levels of diabetes self-care, health-related quality of life, and social capital. Baby boomers were using the DOC to increase their knowledge to improve self-care and for emotional support. The DOC was used in adjunct to, not in place of, regular healthcare visits to fill gaps in tacit knowledge and support. Baby boomer participants valued the wisdom of experienced individuals, "diabetes elders." Participants employed a process to find credible health information through the guidance of peers. Overall, DOC users found the DOC to be helpful with very little harm reported, suggesting DOC use is beneficial with low risk. Finally, DOC users found information from their healthcare providers to be more competent and trustworthy than information from the DOC, indicating DOC users still find their healthcare providers valuable. The findings from this research are promising. DOC users engage in a reciprocal process of sharing diabetes related experiences, encouraging knowledge attainment and support. Peer health in a naturally occurring online environment has the capacity to augment the traditional healthcare model by providing health information and peer support conveniently and at a low cost

What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.

People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards

Using System Level Quality Measures to Improve Home and Community-based Services in Maine

The purpose of this project was to identify a set of quality measures that could be used to profile the performance of Maine’s home and community based care (HCBS) system. The long term care system in Maine has been significantly restructured in the last five years. Funding for home care services has more than doubled and now represents approximately 20% of Medicaid and State funding for LTC. This has led to increased interest in assuring the quality of services that are being provided and developing ways to improve the delivery of services and outcomes for consumers. Using assessment data from the Maine MECARE system, residential care facilities and nursing facilities, an initial set of potential indicators was examined. Key stakeholders identified priority areas for quality improvement. The Bureau of Elder and Adult Services identified, prevalence of falls, as the first area to initiate a quality improvement activity. The Bureau of Elder and Adult Services convened a multi-disciplinary group of professionals in Maine to learn more about existing fall evaluation and prevention programs. Using practice guidelines published in the Annals of Internal Medicine, the Bureau is currently examining a number of fall intervention and prevention strategies. This project represented a first step in using long term care assessment data to improve the quality of home and community based services in Maine. Recommendations for future work include: Continue to build support for quality measures through the involvement of key opinion leaders and stakeholder groups. Identify a short list of quality indicators that represent multiple dimensions of quality. Identify at least one chronic condition for a quality improvement activity. Develop, pilot and make available consumer friendly reports to the public on Maine’s home and community based care system Develop a plan to maintain a sustainable and qualified workforce of people who provide home and community based services

Participant Experience of an Electronic Health Coaching Trial: A Qualitative Inquiry

Introduction: The study objective was to investigate the experience of individuals living with Type 2 diabetes (T2DM), some of who participated in a smartphone-based health coaching intervention, and, particularly, their motivations for health behaviour change. Methods: A qualitative investigation was undertaken with subjects from a larger T2DM self-management RCT (2011-2014) at the Black Creek Community Health Centre in Toronto, Ontario. Twenty semi- structured interviews were conducted and analyzed with a thematic analytic approach to explore relevant themes. The focus was to investigate the effectiveness of 6 months of smartphone-based health coaching versus a control group who also received health coaching but without smartphone assistance. Results: Data analysis resulted in four major themes (1) Smartphone and Software described how participants used the device in relation to health behaviour change; (2) Health Coach described the relationship between clients and health coaches; (3) Overall Experience described individuals perception and experience of the intervention; and (4) Frustrations in Managing Chronic Conditions, described the challenges of T2DM management. Discussion: Findings suggest that interventions with T2DM assisted by smartphone software and health coaches actively engage individuals in improved hemoglobin A1c (HbA1c) control

F as in Fat: How Obesity Policies Are Failing in America, 2006

Examines national and state obesity rates and government policies. Offers recommendations to check the obesity crisis, including a twenty-step action plan for addressing the healthcare burdens and financial costs associated with the epidemic