Implementation of a text-messaging intervention for adolescents who self-harm (TeenTEXT): A feasibility study using Normalisation Process Theory

Background There are few interventions that directly address self-harming behaviour among adolescents. At the request of clinicians in Child and Adolescent Mental Health Services (CAMHS) in England and working with them, we redeveloped an adult SMS text-messaging intervention to meet the needs of adolescents under the care of CAMHS who self-harm. Methods We used Normalisation Process Theory (NPT) to assess the feasibility of delivering it through CAMHS. We planned to recruit 27 young people who self-harm and their clinicians, working as dyads and using the intervention (TeenTEXT) for six months. Results Despite strong engagement in principle from CAMHS teams, in practice we were able to recruit only three clinician/client dyads. Of these, two dropped out because the clients were too unwell. We identified a number of barriers to implementation. These included: a context of CAMHS in crisis, with heavy workloads and high stress levels; organisational gatekeeping practices, which limited the extent to which clinicians could engage with the intervention; perceived burdensomeness and technophobia on the part of clinicians, and a belief by many clinicians that CAMHS may be the wrong delivery setting and that the intervention may have better fit with schools and universal youth services. Conclusions User-centred design principles and the use of participatory methods in intervention development are no guarantee of implementability. Barriers to implementation cannot always be foreseen, and early clinical champions may overestimate the readiness of colleagues to embrace new ideas and technologies. NPT studies have an important role to play in identifying whether or not interventions are likely to receive widespread clinical support. This study of a text-messaging intervention to support adolescents who self-harm (TeenTEXT) showed that further work is needed to identify the right delivery setting, before testing the efficacy of the intervention.This feasibility study was funded by The BUPA Foundation. Earlier developmental work was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula (PenCLAHRC). The authors would like to thank everyone who helped with the earlier intervention development work and NeonTribe, who built the TeenTEXT software. We are especially grateful to Professor Tamsin Ford for her helpful comments on earlier drafts of this paper

Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals

Design of Mobile Healthcare Reminder for Chronic Diabetes

Mobile technology has been increasingly used in healthcare services. However, little has been done in handling patients of chronic disease. Accordingly, this study aims to design a mobile reminder system that cares for patients’ selfmanagement of their chronic diabetes. To achieve the main aim, the following sub objectives have been formulated; (i) to identify the requirements for the mobile healthcare reminder suitable for chronic diabetes, (ii) to develop and construct the prototype of the system, (iii) to evaluate the prototype in terms of perceived usefulness, perceived ease of use, and satisfaction. The prototype has been evaluated using an adapted questionnaire, involving 30 patients in Baghdad Hospital. The results reveal that the prototype is perceived useful and easy to use by the participants. Also, they are highly satisfied with the prototype. The outcome of this study would help mobile healthcare applications developers to design future mobile reminder system particularly for patients who are suffering from chronic diseas

Women's and midwives' perspectives on the design of a text messaging support for maternal obesity services.

This study was aimed to explore women’s and midwives’ views on the use of mobile technology in supporting obese pregnant women with healthy lifestyle choices. A purposive sample of 14 women and midwives participated in four focus groups in Doncaster, UK. A content analysis of the transcripts from the first focus group led to the emergence of three main constructs with associated subcategories including Benefits (“modernising,” “motivating,” “reminding,” and “reducing” the sense of isolation), Risks and Limitations (possibility of “being offensive,” “creating pressure or guilt,” and “being influenced by mood”), and Service Delivery (making it “available to all pregnant women,” giving attention to the “message tone” and development of “message content”). They also suggested the use of other modalities such as web-based services for weight management during pregnancy. Based on the above results a text messaging service was developed and presented to the 2nd focus group participants who confirmed the positive views from the first focus group on the use of the text messaging as being supportive and informative. The participants also welcomed “women’s engagement and choice” in deciding the content, timing and frequency of messages. The results informed the development of a text messaging service to support maternal obesity management. The implementation and acceptability of this service requires further investigation

Evaluation of an Internet–Short Message Service–Based Intervention for Promoting Physical Activity in Hong Kong Chinese Adolescent School Children: A Pilot Study

Evaluation of acceptability and preliminary efficacy of an Internet and short message service (SMS) intervention for promoting physical activity (PA) in Hong Kong Chinese school children. An 8-week quasi-experimental study non-randomly assigned 78 school children (mean age=12.8 years) to (a) an intervention group that received a stage-matched, Internet PA program two times a week and tailored SMS messages daily; or (b) a no-treatment control. Data were collected from September 2008 until June 2009. Acceptability measures included exposure rate and participant\u27s satisfaction. Efficacy measures were changes in stage of motivational readiness (SMR) and self-reported PA level. Intervention participants demonstrated significant pre-post increments in SMR (Z=−2.558, p=0.011) and self-reported PA level [F(1, 76)=4.50, p=0.04]. There was a non-significant trend between groups in both SMR (p=0.24) and PA (p=0.13). Despite the similar ratings of satisfaction between Internet (M=3.12±0.74) and SMS (M=3.12±0.84), participants displayed distinct patterns of exposure with 66% exhibiting a weekly login rate of 0.5 times/person and an average of 3.75 minutes/visit/person. In contrast, 79% of participants read an average of 1.3 SMS/person/week and 47% voluntarily replied to 3.8 SMS/person. These findings demonstrate the acceptability and preliminary efficacy of an Internet-SMS-based intervention for promoting PA in Hong Kong school children. The divergent exposure rates between the Internet and SMS may be a unique pattern for adolescents in early SMR. Future research should be cognizant of the importance of SMR since it may influence utilization and/or adherence

Mobile health for cancer in low to middle income countries: priorities for research and development.

The is the accepted manuscript of an article published in the European Journal of Cancer Care (Holeman, I., Evans, J., Kane, D., Grant, L., Pagliari, C. and Weller, D. (2014), Mobile health for cancer in low to middle income countries: priorities for research and development. European Journal of Cancer Care, 23: 750–756. doi: 10.1111/ecc.12250)Many current global health opportunities have less to do with new biomedical knowledge than with the coordination and delivery of care. While basic research remains vital, the growing cancer epidemic in countries of low and middle income warrants urgent action - focusing on both research and service delivery innovation. Mobile technology can reduce costs, improve access to health services, and strengthen health systems to meet the interrelated challenges of cancer and other noncommunicable diseases. Experience has shown that even very poor and remote communities that only have basic primary health care can benefit from mobile health (or 'mHealth') interventions. We argue that cancer researchers and practitioners have an opportunity to leverage mHealth technologies that have successfully targeted other health conditions, rather than reinventing these tools. We call for particular attention to human centred design approaches for adapting existing technologies to suit distinctive aspects of cancer care and to align delivery with local context - and we make a number of recommendations for integrating mHealth delivery research with the work of designers, engineers and implementers in large-scale delivery programmes

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Adolescent Help-Seeking: The Promise of Text Counseling

This qualitative study addresses the need for additional approaches to reaching youth who are struggling with mental health issues. The paper describes common barriers to serving a youth population, especially in a time of crisis. It explores the use of text counseling as a therapeutic response to youth in crisis or distress. It discusses the use of empowerment theory when developing and implementing services for a youth population. The study concludes with a description and discussion of the common themes identified through an inductive secondary data analysis of 14 text counseling sessions. The findings from this study were consistent with previous research. First, adolescent girls between the ages of 14-17 years old were the most frequent texters in this study. Second, youth quickly and openly make intimate disclosures about their feelings and thoughts when using a text platform. Third, and perhaps most importantly, adolescents do reach out for help when they are feeling overwhelmed, distressed, self-destructive and suicidal. Ongoing research in this area has the potential to strengthen our understanding of how to best serve and respond to the mental health needs of adolescents. Ideas for future research in this area are suggested