Analyzing recommender systems for health promotion using a multidisciplinary taxonomy: A scoping review

Background: Recommender systems are information retrieval systems that provide users with relevant items (e.g., through messages). Despite their extensive use in the e-commerce and leisure domains, their application in healthcare is still in its infancy. These systems may be used to create tailored health interventions, thus reducing the cost of healthcare and fostering a healthier lifestyle in the population. Objective: This paper identifies, categorizes, and analyzes the existing knowledge in terms of the literature published over the past 10 years on the use of health recommender systems for patient interventions. The aim of this study is to understand the scientific evidence generated about health recommender systems, to identify any gaps in this field to achieve the United Nations Sustainable Development Goal 3 (SDG3) (namely, “Ensure healthy lives and promote well-being for all at all ages”), and to suggest possible reasons for these gaps as well as to propose some solutions. Methods: We conducted a scoping review, which consisted of a keyword search of the literature related to health recommender systems for patients in the following databases: ScienceDirect, PsycInfo, Association for Computing Machinery, IEEExplore, and Pubmed. Further, we limited our search to consider only English-lan-guage journal articles published in the last 10 years. The reviewing process comprised three researchers who filtered the results simultaneously. The quantitative synthesis was conducted in parallel by two researchers, who classified each paper in terms of four aspects—the domain, the methodological and procedural aspects, the health promotion theoretical factors and behavior change theories, and the technical aspects—using a new multidisciplinary taxonomy. Results: Nineteen papers met the inclusion criteria and were included in the data analysis, for which thirty-three features were assessed. The nine features associated with the health promotion theoretical factors and behavior change theories were not observed in any of the selected studies, did not use principles of tailoring, and did not assess (cost)-effectiveness. Discussion: Health recommender systems may be further improved by using relevant behavior change strategies and by implementing essential characteristics of tailored interventions. In addition, many of the features required to assess each of the domain aspects, the methodological and procedural aspects, and technical aspects were not reported in the studies. Conclusions: The studies analyzed presented few evidence in support of the positive effects of using health recommender systems in terms of cost-effectiveness and patient health outcomes. This is why future studies should ensure that all the proposed features are covered in our multidisciplinary taxonomy, including integration with electronic health records and the incorporation of health promotion theoretical factors and behavior change theories. This will render those studies more useful for policymakers since they will cover all aspects needed to determine their impact toward meeting SDG3.European Union's Horizon 2020 No 68112

Barriers and enablers to walking in individuals with intermittent claudication: a systematic review to conceptualize a relevant and patient-centered program

Background: Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population. Aim: To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC. Methods: A systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework. Results: Eighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention. Conclusions: This review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418

Patient Education and Consumer Activation in Chronic Disease

Presents suggestions from experts on patient and provider education, health behavior change, and information technologies for strategies, tactics, and activities for helping the chronically ill become active participants in their health and health care

Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: An interview study

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis

"There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned

Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program

Background While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. Objectives We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. Design To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. Setting and participants Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. Methods The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. Results The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. Conclusions The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice