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

Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes: A Narrative Review of the Literature

Diabetis; Gent gran; Tècniques psicològiquesDiabetes; Elderly; Psychological techniquesDiabetes; Ancianos; Técnicas psicológicaBackground: in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. Objective: this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. Methods: a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions’ effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. Results: this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. Conclusions: there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults’ sensory deficits is necessary.This research received no external funding

Analysis of Effectiveness and Psychological Techniques Implemented in mHealth Solutions for Middle-Aged and Elderly Adults with Type 2 Diabetes : A Narrative Review of the Literature

Background: in diabetes, multiple mHealth solutions were produced and implemented for self-management behaviors. However, little research on the effectiveness of psychological techniques implemented within these mHealth solutions was carried out, and even less with the elderly population where technological barriers might exist. Reliable evidence generated through a comprehensive evaluation of mHealth interventions may accelerate its growth for successful long-term implementation and to help to experience mHealth benefits in an enhanced way in all ages. Objective: this study aimed to review mHealth solutions for diabetes self-management in older adults (adherence to treatments and glycemic control) by analyzing the effectiveness of specific psychological techniques implemented. Methods: a narrative review was conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed (Medline) and American Psychological Association (APA) PsycInfo databases were searched for published papers that addressed eHealth solutions' effectiveness for diabetes self-management. Studies in English, Spanish, and/or German of any design were screened, with no time constraints regarding the year of publication. A qualitative analysis of the selected papers was conducted in several steps. Results: this review found 38 studies setting up and analyzing mHealth solutions for older adults. Most research showed improvements in HbA1c, self-management behaviors, and medication adherence in T2DM patients post intervention. However, different mid-to-long term effects were found across studies, specifically concerning the maintenance and adherence to healthy behaviors. The most employed psychological framework was CBT, including techniques such as self-monitoring of outcome behaviors (mostly targeting glycemia measurements and healthy habits as physical activity and/or diet), tailored motivational feedback from medical staff, and psychoeducation or health coaches. The most successful mHealth intervention combined the feature of tailored feedback messages, interactive communication with healthcare professionals, and multifaceted functions. Conclusions: there is a lack of elaborate and detailed information in the literature regarding the factors considered in the design and development of mHealth solutions used as interventions for T2DM self-management in the elderly. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of useful and user-friendly self-management apps that can enhance the quality of life for diabetes patients. Further research adapting mHealth solutions to older adults' sensory deficits is necessary

A Systematic Review of the Relationships Among Psychosocial Factors and Coping in Adults With Type 2 Diabetes Mellitus

Type 2 diabetes mellitus contributes to poor health outcomes including mortality, yet there is a gap in the literature when seeking to understand the influence of psychosocial factors on coping in this population. The paper presents a systematic review of quantitative studies that examined relationships among psychosocial determinants and coping in adults with type 2 diabetes. This review is the second layer of knowledge discovery for the concept, “Taking on a life-altering change is a rhythmical journey of experiencing ups and downs on the way to acceptance.” The life-altering change was determined to be a diagnosis of type 2 diabetes, the journey is the ups and downs of coping with the diagnosis as people work toward acceptance of type 2 diabetes. The review includes a synthesis of findings from 22 quantitative studies of psychosocial factors and coping in adults with type 2 diabetes. Anxiety, depression, stress, and diabetes distress were identified as key influential psychosocial factors. Increased social support was inversely related to emotional distress and coping styles were related to social well-being, psychological health, and physical health outcomes. The positive coping style of problem-focused coping was linked to improved psychological and physical health. Emotional responses to diagnosis were related to depression and anxiety. Negative coping styles of resignation, protest, or isolation were higher in women and linked to poorer quality of life, while avoidance was linked to increased diabetes-related distress and depressive symptoms

Videogame Intervention for Improved Control of Type 1 Diabetes in Adolescents

Type 1 diabetes is a metabolic disease characterized by an inability to produce insulin, leading to hyperglycemia and other serious complications. Type 1 diabetes can be managed with exogenous insulin and careful dietary monitoring. However, adolescents with type 1 diabetes often have difficulty adhering to optimal treatment regimens, resulting in poorer diabetic control than patients in any other age group. In this study, we will test the efficacy of a serious videogame for increasing adherence to effective treatment regimens. We hypothesize that this intervention will lead to a significant reduction in glycosylated hemoglobin A1c, the standard assessment of diabetic control. We will randomize patients to the videogame intervention or a control group and measure hemoglobin A1c levels before and after intervention. This study will evaluate an engaging, age-appropriate tool to allow clinicians to connect with adolescent patients with the goal of decreasing their incidence of future diabetes-related complications

Diabetic education in nursing: A Rodgers' evolutionary concept analysis

Aim: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing.Background: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging.Design: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing.Data Source: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL). MedLine, and Psyclnfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms.Results: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds. needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes

Influence of Smartphone Diabetic Messaging on HbA1c

Associated personal, financial, and societal costs of a diagnosis of Type 2 Diabetes Mellitus impacted over 22 million Americans at a cost of over $245 billion in 2012. The project provided evidence-based outcomes that demonstrated improved HbA1c levels in the intervention group and positive feedback on diabetes related text messages. Ongoing opportunities are available to expand text messaging within the physician network; the potential for replication studies; and the feasibility and effectiveness of text messaging for improving engagement in managing people with T2DM health are also findings within the study

Integrating Behavioral Trigger Messages into a mHealth System Design for Chronic Disease Management

Recent changes in health information technology have dramatically altered the face, delivery, and management of healthcare particularly as it relates to mHealth. With increases in smart phone ownership, mHealth potentially has the ability to provide far-reaching transformation of chronic disease management particularly when aligned with behavioral change theories and persuasive technology. MHealth applications have an advantage over computers and various print communications as the consumer can engage with the application at any time and at any location. The Interactive Health Communication Application (IHCA) states that by combining support mechanisms such as behavior change theories into electronic devices as a method to transmit or receive health information can potentially lead to changes in knowledge, motivation and self-efficacy. Adding constructs of the Fogg Behavior Model, Social Cognitive Theory and Persuasive Technology to the IHCA framework can create an engaged persuasive system leading to improvements in self-efficacy, self-management and knowledge. The hypotheses for our study are 1) participants will demonstrate improved scores on self-efficacy, knowledge and self-management following the intervention period, 2) participants will be more engaged in the usage of capABILITY following behavioral triggers, and 3) participants who receive spark triggers involving motivation will engage in the utilization of capABILITY faster than those who receive facilitator triggers. The results of this study provide important findings for 1) mHealth system design utilizing IHCA with new constructs for chronic disease management, 2) design and develop of persuasive spark and facilitator trigger messages, and 3) understanding of user engagement when behavioral (spark and facilitator) trigger messages are utilized. The findings of the study revealed that self-efficacy, self-management, and knowledge did improve post intervention. In addition, the study showed that spark triggers continually cued participants to engage with capABILITY quicker than facilitator triggers

Design perspectives on diabetes management games

For decades, there has been scholarly interest in the use of serious digital games to assist individuals suffering from diabetes with the self-management of that disease. However, previous research in this area has not effectively integrated the knowledge of the expert game designer. This dissertation aims to further understandings of design approaches to serious games for diabetics by confronting both the arguments of the diabetes games literature and the diabetes games themselves with the experiences and opinions of expert game designers. The arguments of the diabetes games literature were synthesized into a design template composed of twenty-four interrelated desirable elements. This template was then used by three focus groups consisting of a total of twelve expert game designers to both evaluate six diabetes self-management games and respond to the assertions of the diabetes games literature. The findings from these three empirical studies indicate both that the diabetes games themselves are of uniformly unsuitable quality and that the diabetes games literature is rife with what the expert game designers consider to be problematic assumptions. The problems identified by the focus groups include those that fundamentally cripple the functionality of the game artifact, those that are embedded in a game’s rules and themes, and those to those that exist at superficial levels. Furthermore, the focus groups had an overall negative reaction to the arguments about games that they found to be deeply embedded in the design template’s elements. Tensions exist, however, between the reasons for the diabetes games literature’s demand for certain game features and the beliefs of the expert game designers. The findings strongly suggest that additional research is necessary and that an interdisciplinary effort, including both health care professionals and expert game designers, is necessary for the development of new, superior design scenarios for diabetes self-management games.Informatio

mHealth: A Utilization Review by Feature Classification for Sustained Use

mHealth is a fast growing segment for healthcare. However, there has been little research into the specific elements of mHealth that can drive continued use for optimization of the potential benefits. The purpose of this case study was to use the Delone and McLean Information System Model as a framework for classification of mHealth functionality and then to review the utilization of those categories over a six month period of time. A sample of 137 pediatric diabetics was reviewed. The activation rate was high at 94.9% indicating an interest in using mHealth. There was higher utilization of system features in the group of users with 60.3% of total uses being related to a system feature. There also were specific use patterns between gender with male patients consisting of 66.2% of the overall uses. Future applications should focus on system features and customization by gender to support sustained use