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

Text Message Intervention for Latino Adults To Improve Diabetes Outcomes in an Urban Free Clinic Setting

Introduction: This text message intervention sought to help patients at a free clinic in the Southeastern U.S. that have uncontrolled diabetes (DM) (A1C \u3e or = 7) improve their DM clinical and behavioral outcomes, and thereby help them to live healthier, more hopeful and productive lives as they deal daily with this chronic illness. Eight weeks of educational text messages were sent to help improve DM care and outcomes. Method: Free clinic patient Latino adults with DM (n=25) pre-post one group design. Results: Statistically significant results (p \u3c .05) were seen in three (SKILLD, p=.001, DSES, p = .000, and SDSCA, p = .042) of the four tools/surveys administered. A1C improvements were significant from the pre-intervention (M = 9.10, SD = 1.51) and the trended post-intervention values/results (M=8.26, SD = 1.29, t [21] = 2.79, p = .0110). Discussion: Does personalized communication, education and follow up for patients at the free clinic improve diabetes knowledge, self-efficacy and self-care? This text message intervention shows great promise to improve outcomes for diabetes self-management

HealtheLife: Using a Patient Portal App to Reduce Type 2 Diabetes in East Los Angeles

The following proposal explores a potentially cost effective and cost efficient solution to alleviate the burden of type 2 diabetes among White Memorial Medical Center (WMMC) patients and their primary service area within Los Angeles County Service Planning Area 4 (SPA-4). SPA-4 is a medically underserved area with numerous key health indicators that indicate the need for increased self-management efforts among its Hispanic population. In response, WMMC has made a commitment to the SPA-4 community and made diabetes atop its community priority. An organization-wide Glycemic Control Project was created by WMMC administrators to provide more effective services by using Health Information Technology (HIT) within its operations. In support of this project, the WMMC Clinical Informatics Systems (CIS) department has proposed the use of Healthelife mobile application to improve diabetes self-management in WMMC transitional care. A literature review was conducted but, found very limited efficacy studies on mobile patient portal apps and patient portals mhealth interventions among Hispanic diabetics. However, several studies have implied that there are great research opportunities in tailoring the use of a patient portal mobile application for Hispanics, expanding its use within DMSE sessions through Community Health Workers, utilizing the trending mhealth functionality of patient portals, as well as proposing eHealth interventions that reduce health disparities. As a newly available resource to WMMC, the Healthelife mobile application is Cerner’s multilingual patient portal mobile application that is already live and fully integrated with WMMC’s “My Adventist Health” patient portal”. Accordingly, WMMC CIS has proposed a HealtheLife pilot program among its Hispanic patients to determine if its use will improve self-management efficacy and glycemic control among WMMC Type 2 diabetics (18+ years old). Technological Acceptance Model (TAM), Social Support, and Social Cognitive Theory will be applied throughout the pilot to gradually condition Healthelife usage among WMMC patients/caregivers for tailored educational experiences that strengthen WMMC Diabetes Self-Management (DSME) sessions. Essentially, diabetes educators will conduct the pilot program on adult Hispanics (18+) who are inpatient diabetics transitioning to Adventist Health Physician Network (AHPN) Physicians and DSME outpatient services. Primarily, the pilot will aim to improve A1Cs, Self-efficacy, and DSME attendance. Secondary outcomes of the intervention will be asses by qualitative assessment of Healthelife functionality, observed ED use, and ED readmission. All outcomes will be assessed through an internal quasi-experimental study examining an intervention group using Healthelife against a retrospective control groups from 2016. In sum, goal of the pilot program will set forth a care path that improve patients’ continuity of care and diabetes prevention beyond the walls of WMMC operations. By adopting the use of Healthelife as a population health tool, WMMC has the potential to intensify current DSME curriculum, to preventative unnecessary ED use, and to improve type 2 diabetes prevention efforts within SPA-4. More importantly, the suggestion to pilot Healthelife progressively introduces the benefits of HIT to Hispanic populations who are underserved and with limited resources

Reducing the Digital Divide: Why Culturally Relevant eHealth Interventions Can Reduce Latino Health Disparities

Objectives: This paper systematically reviews the recent literature on incorporating culturally relevant material in electronic health (eHealth) tools for Latinos. Latinos are a fast-growing ethnic population set to reach 119 million individuals by 2060 (Velasco-Mondragon et al., 2016). Latinos are also disproportionately affected by comorbidities and other poor health outcomes. Developing a culturally sensitive eHealth tool can lead to positive health outcomes among Latinos. Methods: Peer-reviewed articles and analyses were extracted to identify whether eHealth was associated with positive health outcomes among Latino adults. Four literature databases were used to extract English-language articles published from 2001 to 2022. Furthermore, data from the CDC and WHO were extracted for statistical data regarding Latinos in the US. Recommendations: Improvements in eHealth are needed to increase Latino engagement. Possible factors to consider when developing a culturally relevant eHealth intervention are peer support, technical training, and language done by community messengers like CHWs and trusted members of the community. Conclusion: eHealth use is increasing throughout the country, but the service is not tailored to Latino communities. With necessary improvements, eHealth can increase engagement in healthcare services and improve health outcomes among the target population

Adoption of mHealth among Latinos with Cardiometabolic Risk Factors

Purpose of the Study: The aim of this explanatory mixed methods study was to understand what factors motivate Latinos with cardiometabolic risk factors (CMRF) to use mHealth. Design and Methods: Data from N=101 participants (63=Female, 38=Male) in the cross-sectional survey and N=17 respondents in the semi-structured interviews were used to be analyzed and evaluated in the mixed methods phase. Survey items consisted of demographic information, clinical history, smoking and alcohol use, and predictors of mHealth use (Perceived health risks, Health Consciousness, Perceived usefulness, and mHealth literacy). In-depth interviews were conducted with Latinos with CMRF and transcripts of the interviews were analyzed for thematic content. Relationship between predictors of mHealth use was tested using regression and chi-squared analysis. Transcripts were analyzed using qualitative content analysis. Results: Health consciousness was found to be a statistically significant predictor of Perceived usefulness (β=0.24, P=0.050). Both Health consciousness and Perceived Usefulness were positively associated with mHealth use (β=0.15, P=0.151), (β=0.90, P=0.000) respectively. mHealth literacy moderated the relationship between Perceived usefulness and mHealth use (β=-2.05, P=0.046), and was related to both barriers and facilitators to mHealth use even though the interaction effect was negative. Seven major themes emerged with three facilitators of mHealth use: (1) Intrinsic motivation to learn how to improve health, (2) Availability of social resources, (3) Personalized features to meet their needs; and four barriers: (4) Lack of self-efficacy to operate devices, (5) Concern over affordability and financing mHealth, (6) Competing priorities lead to sedentary behaviors, and (7) Navigating a new country. Conclusion: In Latinos with CMRF, there is a strong awareness of perceived disease risk and the need to take care of oneself. mHealth was qualitatively reported as an important tool that can help with disease self-management. Yet, mHealth literacy was needed to moderate the relationship between how participants appreciate its utility and their actual uptake. Given that such barriers are unique to the Latino community, researchers should create mHealth interventions that are literacy focused, culturally tailored, and affordable since they all influence mHealth use and CMRF self-management

Designing Personalised mHealth solutions: An overview

Introduction Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. Materials and Methods We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. Results Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self-management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. Discussion Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. Conclusions Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques

Designing personalised mHealth solutions: An overview

Introduction: Mobile health, or mHealth, is based on mobile information and communication technologies and provides solutions for empowering individuals to participate in healthcare. Personalisation techniques have been used to increase user engagement and adherence to interventions delivered as mHealth solutions. This study aims to explore the current state of personalisation in mHealth, including its current trends and implementation. Materials and Methods: We conducted a review following PRISMA guidelines. Four databases (PubMed, ACM Digital Library, IEEE Xplore, and APA PsycInfo) were searched for studies on mHealth solutions that integrate personalisation. The retrieved papers were assessed for eligibility and useful information regarding integrated personalisation techniques. Results: Out of the 1,139 retrieved studies, 62 were included in the narrative synthesis. Research interest in the personalisation of mHealth solutions has increased since 2020. mHealth solutions were mainly applied to endocrine, nutritional, and metabolic diseases; mental, behavioural, or neurodevelopmental diseases; or the promotion of healthy lifestyle behaviours. Its main purposes are to support disease self- management and promote healthy lifestyle behaviours. Mobile applications are the most prevalent technological solution. Although several design models, such as user-centred and patient-centred designs, were used, no specific frameworks or models for personalisation were followed. These solutions rely on behaviour change theories, use gamification or motivational messages, and personalise the content rather than functionality. A broad range of data is used for personalisation purposes. There is a lack of studies assessing the efficacy of these solutions; therefore, further evidence is needed. Discussion: Personalisation in mHealth has not been well researched. Although several techniques have been integrated, the effects of using a combination of personalisation techniques remain unclear. Although personalisation is considered a persuasive strategy, many mHealth solutions do not employ it. Conclusions: Open research questions concern guidelines for successful personalisation techniques in mHealth, design frameworks, and comprehensive studies on the effects and interactions among multiple personalisation techniques

Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study

BACKGROUND: Approximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension. METHODS: In this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data. RESULTS: Black and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure. CONCLUSION: This study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources

Development of a diabetes self-management + mHealth program: Tailoring the intervention for a pilot study in a low-income setting in Mexico

Background: Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. Method: Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. Results: The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20-30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. Discussion: We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program

Utilizing mHealth to increase follow-up in Latinx adults with hyperlipidemia.

Background: Management of hyperlipidemia (HLD) is crucial to the prevention and management of cardiovascular disease cardiovascular disease (CVD), a leading cause of death in the United States (US) and Latinx adults (Centers for Disease Control and Prevention (CDC), 2019). The main difficulty affecting monitoring of lipid levels in patients diagnosed with HLD is lack of adherence to follow-up appointments. Purpose: The purpose of this Quality Improvement (QI) project is to evaluate the impact of culturally competent translated short message service (SMS) texts to increase adherence follow-up on a Latinx population served at the Kentucky Racing Services Health Center (KRSHC). Intervention: This project utilized the rapid plan, do, study, act (PDSA) cycle for quality improvement to evaluate the impact of culturally competent SMS texts appointment reminders. A retrospective review identified patients requiring intervention. Rate of change and two proportion z test was used to calculate follow-up rates and statistical significance between pre- and post-intervention groups. Results: Although not statistically significant, the rate of change was 2.7%. More than 50% of patients in both groups were male. Gender assigned at birth and age distribution were similar between both groups. Discussion: SMS text reminders are a quick and cost-effective method to communicate with Latinx patients. mHealth as a form of communication may prove to be a more effective means of communication as the population becomes more familiar with it