Coproduction of a theory-based digital resource for unpaid carers (the care companion) : mixed-methods study

Background: Family and other unpaid carers are crucial to supporting the growing population of older people that are living outside residential care with frailty and comorbidities. The burden associated with caring affects carers’ well-being, thus limiting the sustainability of such care. There is a need for accessible, flexible, and responsive interventions that promote carers’ coping and resilience, and hence support maintenance of the health, well-being, and independence of the cared-for person. Objective: This study aimed to coproduce a digital program for carers to promote resilience and coping through supporting effective use of information and other Web-based resources. Its overlapping stages comprised the following: understanding the ways in which Web-based interventions may address challenges faced by carers, identifying target behaviors for the intervention, identifying intervention components, and developing the intervention prototype. Methods: The study was informed by person-based theories of coproduction and involved substantial patient and public involvement. It drew on the Behavior Change Wheel framework to support a systematic focus on behavioral issues relevant to caring. It comprised scoping literature reviews, interviews, and focus groups with carers and organizational stakeholders, and an agile, lean approach to information technology development. Qualitative data were analyzed using a thematic approach. Results: Four behavioral challenges were identified: burden of care, lack of knowledge, self-efficacy, and lack of time. Local health and social care services for carers were only being accessed by a minority of carers. Carers appreciated the potential value of Web-based resources but described difficulty identifying reliable information at times of need. Key aspects of behavior change relevant to addressing these challenges were education (increasing knowledge and understanding), enablement (increasing means and reducing barriers for undertaking caring roles), and persuasion (changing beliefs and encouraging action toward active use of the intervention). In collaboration with carers, this was used to define requirements for the program. A resources library was created to link to websites, Web-based guidance, videos, and other material that addressed condition-specific and generic information. Each resource was classified according to a taxonomy itemizing over 30 different subcategories of need under the headings Care Needs (of the cared-for person), General Information and Advice, and Sustaining the Carer. In addition, features such as a journal and mood monitor were incorporated to address other enablement challenges. The need for proactive, personalized prompts emerged; the program regularly prompts the carer to revisit and update their profile, which, together with their previous use of the intervention, drives notifications about resources and actions that may be of value. Conclusions: The person-based approach allowed an in-depth understanding of the biopsychosocial context of caring to inform the production of an engaging, relevant, applicable, and feasible Web-based intervention. User acceptance and feasibility testing is currently underway

Determinants of Mobile Health Adoption in Burundi

Mobile health (or mHealth) can be broadly defined as the use of mobile devices and technologies to provide healthcare services. The potential of mHealth interventions to address healthcare issues, particularly in developing countries, is widely recognised. Although mHealth has yielded positive outcomes in various contexts, there is a need for designing mHealth interventions that are specifically tailored to the context of individual countries in order to increase the prospects of adoption. It is in this context that, using the Diffusion of Innovation (DOI) theory, this paper investigates the determinants for the adoption of mobile health by healthcare professionals in Burundi. From a sample of 212 primary healthcare professionals, this paper analyses what can influence Burundi’s primary healthcare workers to adopt mobile health. The results indicate that the relative advantages associated with mHealth interventions are perceived as predictors of mHealth adoption in Burundi. Moreover, work-related factors coupled with one’s experience with mobile devices are the DOI compatibility factors that influence the adoption of mHealth by Burundi’s healthcare professionals. mHealth being a new concept with the Burundi’s healthcare system, trialability and observability were found to have a significant influence on its adoption. However, mHealth complexity was found to have no influence on mHealth adoption. This paper advocates for education and awareness programs tailored specifically towards mHealth adoption by primary healthcare workers. It further recommends that the country leverage its East African Community (EAC) membership by forging partnerships with other EAC members in order to be acquainted with and learn from evidence-based outcomes of successful mHealth interventions within the region

Mobile device acceptance in nursing education

Mobile devices such as smartphones and tablets are being used in healthcare settings for better patient outcomes. By laying the foundation for mobile device use in the educational setting, students can be better prepared for nursing practice in this technology-rich environment (National League for Nursing [NLN], 2008). The purpose of this cross-sectional study was to investigate the mobile device acceptance (MDA) model that guides nursing students’ decision to use mobile devices as educational tools. The MDA model also guides the measurement development and psychometrics testing for the MDA constructs in order to understand mobile device use and to examine correlates in the nursing student population. The study included variables that measure diversity including students who are first generation college students (FGCS), English as a second language (ESL), Pell grant eligible, recipient of welfare/public housing, and ethnic minority. The study also tested moderating effects between demographic variables and MDA constructs. The study sample included 327 nursing students from two BSN programs who completed the study instrument. The results showed that the MDA instrument had strong reliability and promising construct validity. Diverse students (i.e., FGCS, ESL, Pell grant eligible, recipient of welfare, ethnic minority) had significantly higher MDA scores than non-diverse students. Age was considered a main variable in the MDA model. The preferred size and function of device had significant MDA results. Based on the regression analysis, three predictor variables (i.e., diversity, social persuasion, and affective state) explained a small percentage of variance in the standardized test scores (i.e., ATI). Nursing educators can support diverse nursing students through the continued use of mobile devices in the nursing curriculum. Further examination is needed to see if diverse students are affected more than non-diverse students by not gaining admission into nursing programs. As mobile devices continue to be embedded into health care, nurse educators and students can use them in educational settings

The “Lazio advice” telemedicine platform. First results of general practitioners’ usage, facilitators and barriers in the local health authority Roma 1

Background: Telemedical approaches represent a valuable tool for the management of coronavirus disease 2019 patients, allowing daily clinical assessment, monitoring of vital parameters, remote visits, and prescription of treatment or hospital ization in case of clinical worsening. This cross-sectional study aims to evaluate the use, barriers and facilitators of the “Lazio ADVICE” telemedical platform, a regional system for remote assistance for coronavirus disease 2019 patients at home, according to General Practitioners and Family Pediatricians of the Local Health Authority Roma 1, during the coronavirus disease 2019 pandemic. Methods: An interview-based survey was performed between December 2020 and January 2021. The survey investigated the demographic information of General Practitioner and Family Pediatricians, the knowledge of the platform, frequency of util ization, usefulness, strengths and weaknesses, and hypothesis of future implementation proposed. Results: We interviewed 214 physicians and 89 (41.6%) were classified as users and 125 (58.4%) as non-users. Older age and working in District 1, 14 and 15 (vs. District 13) significantly reduced the probability of using the platform physician. Among the 89 users, 19 (21.3%) used the platform every day or even several times a day, 40 (44.9%) several times a week but less than one access per day, 30 (33.7%) used the platform several times a month up to one entry per week. Most of them (92.3%) consider the platform useful. Barriers were poor integration with software and work routine (76.4%), and usability issues (53.9%). Among the 125 non-users, 14 (11.2%) didn’t know the existence of the platform, 60 (48.0%) never tried it and 51 (40.8%) tried to use it. Reported reasons for the interruption of use were not very user friendly (45.1%), perceived useless (37.3%), non-optimal functioning (23.5%), and lack of time (19.6%). Conclusion: The pandemic accelerated the implementation of telemedicine services around Lazio Region, starting a positive and continuous exchange of experiences, activities and best practices among physicians

Social Cognitive Theories and Electronic Health Design: Scoping Review

Background: There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective: This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods: The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results: Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions: This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution

MountainRise, Volume 2, Number 2

Volume 2, Number 2 (2005). MountainRise, an open, peer-reviewed, international electronic journal, was published by the Coulter Faculty Commons for Excellence in Teaching & Learning at Western Carolina University. Originating in the ancient mountains of western North Carolina, MountainRise served as an international vehicle for the Scholarship of Teaching & Learning (SoTL). MountainRise applied insightful scholarly methodologies to the processes of teaching and learning. The aim of the journal was to foster a higher education culture that embraced innovation in teaching and learning

Implementing a Self-measured Blood Pressure Monitoring Process

Practice Problem: Because of the prevalence of hypertension worldwide, it is prudent for all patients to have the knowledge and ability to self-monitor their blood pressure. Patients monitoring their own blood pressure and communicating the readings with healthcare providers facilitates a more comprehensive plan of care. PICOT: The PICOT question that guided this project was: In adults 18-90 years old with primary hypertension (P), will a self-measured blood pressure monitoring that includes a monthly telehealth visit with a provider (I), compared to blood pressure monitoring at routine office visits (C), decrease patients\u27 systolic blood pressure readings by five mmHg (O) within 8 weeks (T)? Evidence: Research shows that self-measured blood pressure monitoring reduces blood pressure, possibly because treatment adherence is improved due to daily monitoring and reporting the reading to a provider. Intervention: Twenty participants took their blood pressure at home with a verified monitor and entered the readings into the patient portal for the provider to review for 8 weeks. Pre and post-project blood pressure readings were analyzed for home monitoring effectiveness. Outcome: A two-tailed paired samples t-test was used to show that the mean of the pre-project systolic blood pressure was significantly higher (143.60 mmHg) than the mean of the post-project systolic blood pressure (130.50 mmHg). Clinical significance was observed by lower systolic blood pressure readings of the hypertensive participants by the end of the project. Conclusion: By monitoring at home daily, the patient is aware of their blood pressure readings and understands when treatment changes are necessary. This increases patient engagement in the self-care of hypertension while reducing their blood pressure