1,435 research outputs found

    Strategies to prevent Type 2 Diabetes in the postnatal period, in women with history of Gestational Diabetes Exploring different research methodologies based on dietary and pharmacological interventions

    Get PDF
    Aim and objectives The aim of this thesis is to investigate methods to prevent the progression to type 2 diabetes in the immediate postnatal period, in women diagnosed with gestational diabetes mellitus (GDM). The objectives of this thesis are to explore the views of pregnant women diagnosed with gestational diabetes and healthcare professionals, with regards to the use of an app in the postnatal period which will provide information about diet for type 2 diabetes prevention. The development of a protocol for a single-arm feasibility study on a Mediterranean-style diet for the prevention of type 2 diabetes in the postnatal period. To pilot the trial design and study processes and assess the feasibility of a large-scale trial on the effectiveness of a Mediterranean-style diet in postnatal period for type 2 diabetes prevention. To examine the acceptability of a Mediterranean-style diet for type 2 diabetes prevention in women taking part in a feasibility study and explore the opinions of women and healthcare professionals on trial processes. To develop a protocol for a pilot trial on metformin for the prevention of type 2 diabetes in the postnatal period. Pilot the trial design and study processes and assess the feasibility of a large-scale trial on the effectiveness of metformin in postnatal period for type 2 diabetes prevention. Methods The methods employed in this thesis include a cross-sectional survey, a single arm mixed method feasibility study with qualitative evaluation (which included the use of an app) and a mixed method randomised controlled double blind feasibility study with the use of metformin or placebo. Results Survey The survey demonstrated that app usage is part of everyday life, with 84% (85/101) of pregnant GDM women and 82% (71/87) of healthcare professionals using apps daily. All pregnant women who participated in this survey had a device by which they could access apps (100%, 101/101) and 95% (179/188) of the participants had a smartphone. The participants agreed that an app which provides dietary information in the postnatal period for diabetes prevention would be welcomed by postnatal women with GDM history. Single arm feasibility study on a Mediterranean-style diet for the prevention of T2D in the postnatal period (MERIT) A total of 69% (83/121) of eligible multi-ethnic women agreed to participate and 67% (56/83) of those initially recruited commenced the intervention. The last visit (12 months postnatally) was completed by 73.2% (41/56) of participants. A higher number of participants completed visit 2 (which is at 6 months postnatally) 80.4% (45/56), but this visit was completed remotely due to COVID-19 pandemic lockdown restrictions, whereas visit 3 was completed face-to-face. Participants had high engagement with the coach, both face-to-face and via phone-calls or text messages. Adherence based on the ESTEEM diet questionnaire was high at the end of the study. There was a trend of reduction of total dysglycaemia, and the participants weight was also reduced by 1.3kg, from visit 1 (6 to 13 weeks) to visit 3 (12 months postnatally). Clinical effectiveness discussion is exploratory due to the small sample size. The intervention and trial processes were acceptable to women and healthcare professionals, adherence was high when women had a supportive environment, provided by their family and the health coach. The group chat function was not successful in this study. Randomised double-blind placebo-controlled pilot trial on metformin for the prevention of T2D in the postnatal period (OMAhA) A total of 57.9% (175/302) of eligible multi-ethnic women agreed to take part in the study, out of those 82.3% (144/175) were randomised to receive metformin or placebo. The attendance rates for visits 2 (6 months) and 3 (12 months) were similar, with 54.6% (71/130) and 55.7 (64/115) attending each visit respectively. Due to the COVID-19 pandemic visit 3 was completed over the phone for 21.7% (39/115) of the participants which led to limited blood samples collection. Total dysglycaemia reduction was evident in the metformin group (18.3%) compared to the placebo group (24.7%) but this discussion is exploratory, and the study is not powered to measure effectiveness. The metformin group maintained their weight throughout the study, whereas the placebo group gained 400g. Adherence was 54.1% (participants who took at least 75% of the recommended dosage). The study was acceptable to both women and healthcare professionals, but the element of peer-support should be included in future studies. Conclusion It is feasible and acceptable to recruit women in the postnatal period in studies that are focused on diabetes prevention and introduce dietary or pharmacological interventions. The MERIT protocol will have to be revised to address how follow-up rates can be improved. The OMAhA protocol will also be revised to target improvement in adherence and follow-up rates. The COVID-19 pandemic lockdown restrictions and staffing issues have impacted data collection of both studies. More research is needed in this population with larger sample sizes to be able to prove efficacy. The strongest motivator that affects adherence and retention is the woman’s perception of her own risk of developing diabetes. Future studies should include the element of peer support and an education session about the risk of Type 2 Diabetes in postnatal period

    Multidisciplinary perspectives on Artificial Intelligence and the law

    Get PDF
    This open access book presents an interdisciplinary, multi-authored, edited collection of chapters on Artificial Intelligence (‘AI’) and the Law. AI technology has come to play a central role in the modern data economy. Through a combination of increased computing power, the growing availability of data and the advancement of algorithms, AI has now become an umbrella term for some of the most transformational technological breakthroughs of this age. The importance of AI stems from both the opportunities that it offers and the challenges that it entails. While AI applications hold the promise of economic growth and efficiency gains, they also create significant risks and uncertainty. The potential and perils of AI have thus come to dominate modern discussions of technology and ethics – and although AI was initially allowed to largely develop without guidelines or rules, few would deny that the law is set to play a fundamental role in shaping the future of AI. As the debate over AI is far from over, the need for rigorous analysis has never been greater. This book thus brings together contributors from different fields and backgrounds to explore how the law might provide answers to some of the most pressing questions raised by AI. An outcome of the Católica Research Centre for the Future of Law and its interdisciplinary working group on Law and Artificial Intelligence, it includes contributions by leading scholars in the fields of technology, ethics and the law.info:eu-repo/semantics/publishedVersio

    Information about cancer on the internet : comparative analysis of the institutional website of AECC, GEPAC and FEFOC

    Get PDF
    La búsqueda de información sobre salud en internet está asociada fundamentalmente al diagnóstico de una enfermedad del usuario o de un familiar y puede considerarse la primera fuente a la que acuden tras una consulta médica (Marín-Torres et al., isanidad.com, 2015; 2012; III Barómetro PIC, 2019; INE, 2019;). Las principales barreras para el acceso y uso de la eSalud (eHealth en su terminología inglesa) tienen que ver con la legibilidad del contenido y con una pobre usabilidad de los sitios (Cline y Haynes, 2001; Kim y Xie, 2017). A esto se suma en el contexto actual el enorme volumen de datos disponible en la red que hace imprescindible desarrollar protocolos de análisis que permitan a los usuarios identificar de un modo comprensible los sitios que ofrecen información de calidad tanto en sus contenidos como en su presentación. Esta investigación plantea un análisis de las páginas web corporativas de tres instituciones españolas de reconocido prestigio —y naturaleza diversa— en el ámbito de la divulgación y prevención del cáncer: la Asociación Española Contra el Cáncer, el Grupo Español de Pacientes con Cáncer y la Fundación para la Educación Pública y la Formación en Cáncer; abordando tanto la usabilidad como el tipo de información ofrecida, con el objetivo de conocer el estado de la información en la red sobre el cáncer en España y de identificar buenas prácticas en la comunicación sobre la enfermedad.The search for health information on the Internet is fundamentally associated with the diagnosis of a disease of the user or a relative and it can be considered the first source to which they come after a medical consultation(Marín-Torres et al., isanidad.com, 2015; 2012; III Barómetro PIC, 2019; INE, 2019;).The main barriers to the access and use of eHealth have to do with the readability of the content and with a poor usability of the sites (Cline and Haynes, 2001; Kim and Xie, 2017). Added to this, the enormous volume of data available on the network in the current context is what makes it essential to develop analysis protocols that allow users to identify in a comprehensible way the sites that offer quality information both in their content and in their presentation.This research proposes an analysis of the corporate sites of three Spanish institutions of recognized prestige -and diverse nature- in the field of cancer promotion and prevention: Asociación Española Contra el Cáncer, Grupo Español de Pacientes con Cáncer and Fundación para la Educación Pública y la Formación en Cáncer; addressing both the usability and the type of information offered, in order to know the status of online information on cancer in Spain and to identify good practices in comvbmunication about the disease

    Combined Nutrition and Exercise Interventions in Community Groups

    Get PDF
    Diet and physical activity are two key modifiable lifestyle factors that influence health across the lifespan (prevention and management of chronic diseases and reduction of the risk of premature death through several biological mechanisms). Community-based interventions contribute to public health, as they have the potential to reach high population-level impact, through the focus on groups that share a common culture or identity in their natural living environment. While the health benefits of a balanced diet and regular physical activity are commonly studied separately, interventions that combine these two lifestyle factors have the potential to induce greater benefits in community groups rather than strategies focusing only on one or the other. Thus, this Special Issue entitled “Combined Nutrition and Exercise Interventions in Community Groups” is comprised of manuscripts that highlight this combined approach (balanced diet and regular physical activity) in community settings. The contributors to this Special Issue are well-recognized professionals in complementary fields such as education, public health, nutrition, and exercise. This Special Issue highlights the latest research regarding combined nutrition and exercise interventions among different community groups and includes research articles developed through five continents (Africa, Asia, America, Europe and Oceania), as well as reviews and systematic reviews

    The association between pre-operative pain experience and post-operative pain in patients undergoing elective gastrointestinal surgery: a descriptive-comparative study

    Get PDF
    Aims: The purpose of the rapid review was to summarize and aggregate information for researchers and clinicians about predisposing factors for post-operative pain in laparoscopic patients and the prevalent management approaches post-operatively. The purpose of the descriptive-comparative study was to explore the associations between previous pain experiences and medication on the intensity of pain post-operatively in patients undergoing elective gastrointestinal surgery, using data collected by the Smart Pain Assessment Tool Based on Internet of Things. Methods: For the rapid review, the databases of PubMed, Web of Science and Embase were searched. ROBINS-I tool was used to evaluate the quality of non-randomized studies while ROB 2 tool was used for randomized controlled trials. For the descriptive-comparative study, 50 patients after gastrointestinal operations at Turku University hospital were included. The data collection of the study was done by a researcher belonging to Turku University staff at Turku University hospital. The data analysis was done by using descriptive and comparative methods of analysis. Descriptive statistics were used for the presentation and analysis of participants outcomes, diagnoses, procedures, and groupings based on variables related to the experience of pain (e.g., graphical measurement maximal pain levels using the numeric rating scale). Comparative statistics were used for associations and correlations regarding previous pain levels, medications, fear, and expectation of pain on maximal pain levels after gastrointestinal operations at Turku University Hospital. Results: The result of the rapid review suggest many predisposing factors for post-operative pain are influenced by the psychological profile of the patient. Among these factors are anxiety, fear, depression, expectation of pain, and other factors related to gastrointestinal surgery. Nevertheless, the results of this review also describe acute pre-operative pain, surgical factors, genetics, age, gender, obesity, and previous experiences of pain as relevant predisposing factors to pain following gastrointestinal surgery. Pain care strategies following gastrointestinal surgery include the use of pharmacological and non-pharmacological interventions. The literature suggests, non-pharmacological interventions are under-utilized and should be encouraged as an adjunct to pharmacological pain control strategies following elective gastrointestinal surgery. The results of the descriptive-comparative study somewhat contradict the results of the rapid review. Previous pain experiences or the recollection of preceding painful events were not associated with the administration of supplemental pain medication post-operatively (p = 0.741). Fear related to the upcoming pain following surgery was not associated with the level of invasiveness of the surgery (p = 0.662). In addition, the relationship between expectation of pain (p = 0.698), fear of pain related to the upcoming surgical procedure (p = 0.637) and medication post-operatively (p = .481) on the intensity of maximal post-operative pain was found to be negligible. The results of this study suggest patient expectation as a possible domain of intervention for better pain outcomes post-operatively. The administration of pain medication in the recovery room and the amount of pain medication in the recovery room were significant predictors of maximal post-operative pain (p = .001). Discussion: The results of the rapid review suggest a high to critical risk of bias in the studies included. The predisposing factors for post-operative pain differed widely across studies, but mainly included psychological factors as factors for post-operative pain. Pain management strategies should include an individualized approach and be implemented before, during and after the operation. For the descriptive-comparative study, there are substantial difficulties in discerning the effect of pain history or experience on post-operative pain using physiological or subjective reporting for conscious individuals due to risk of bias and using a unidimensional approach. Conclusion: Predisposing factors for post-operative pain should be screened in the pre-operative phase if possible, focusing on addressable factors whereas management of pain care strategies should include careful screening of participants biopsychosocial profile for elective surgery. The descriptive-comparative study suggests a possible, yet minimal benefit for managing patients’ expectation of pain related to the upcoming gastrointestinal surgery. The amount of pain medication in the recovery room is a significant predictor of maximal post-operative pain. Future research should include a larger sample, more variables related to pain and continue with a follow-up. Keywords: gastrointestinal, post-operative, pain, analgesia, anesthesiaTavoitteet: Katsauksen tarkoituksena oli tiivistää ja koota yhteen tutkijoille ja kliinikoille tietoa laparoskooppisten potilaiden postoperatiiviselle kivulle altistavista tekijöistä ja vallitsevista postoperatiivisista hoitokeinoista. Kuvailevan-vertailevan tutkimuksen tarkoituksena oli tutkia aiempien kipukokemusten ja lääkityksen välisiä yhteyksiä postoperatiivisen kivun voimakkuuteen potilailla, joille tehdään elektiivinen ruoansulatuskanavan leikkaus, käyttäen tietoja, jotka on kerätty esineiden internetiin perustuvalla älykkäällä kivunarviointityökalulla. Menetelmät: Katsausta varten tehtiin hakuja PubMed-, Web of Science- ja Embase-tietokannoista. ROBINS-I-työkalua käytettiin satunnaistamattomien tutkimusten laadun arviointiin, kun taas satunnaistettujen kontrolloitujen tutkimusten osalta käytettiin ROB 2-työkalua. Kuvailevaan-vertailevaan tutkimukseen otettiin mukaan 50 potilasta Turun yliopistollisessa sairaalassa tehtyjen ruoansulatuskanavan leikkausten jälkeen. Tutkimuksen aineistonkeruun suoritti Turun yliopiston henkilökuntaan kuuluva tutkija Turun yliopistollisessa sairaalassa. Aineiston analysoinnissa käytettiin kuvailevia ja vertailevia analyysimenetelmiä. Kuvailevia tilastoja käytettiin osallistujien tulosten, diagnoosien, toimenpiteiden ja kivun kokemiseen liittyvien muuttujien perusteella tehtyjen ryhmittelyjen esittämiseen ja analysointiin (esim. maksimaalisen kiputason graafinen mittaaminen numeerisella arviointiasteikolla). Vertailevia tilastoja käytettiin yhdistelmiin ja korrelaatioihin, jotka koskivat aiempia kiputiloja, lääkkeitä, pelkoa ja kivun odotusta maksimaalisen kiputason suhteen ruoansulatuskanavan leikkausten jälkeen Turun yliopistollisessa sairaalassa. Tulokset: Katsauksen tulokset viittaavat siihen, että potilaan psykologinen profiili vaikuttaa moniin leikkauksen jälkeiselle kivulle altistaviin tekijöihin. Näihin tekijöihin kuuluvat ahdistus, pelko, masennus, kivun odotus ja muut ruoansulatuskanavan leikkaukseen liittyvät tekijät. Tämän katsauksen tuloksissa kuvataan kuitenkin myös akuutti preoperatiivinen kipu, kirurgiset tekijät, genetiikka, ikä, sukupuoli, lihavuus ja aiemmat kokemukset kivusta merkityksellisinä altistavina tekijöinä ruoansulatuskanavan leikkauksen jälkeiselle kivulle. Ruoansulatuskanavan leikkauksen jälkeisiin kivunhoitostrategioihin kuuluu farmakologisten ja ei-farmakologisten toimenpiteiden käyttö. Kirjallisuuden mukaan ei-farmakologisia toimenpiteitä käytetään liian vähän, ja niitä olisi edistettävä farmakologisten kivunhoitostrategioiden lisänä elektiivisen ruoansulatuskanavan leikkauksen jälkeen. Kuvailevan ja vertailevan tutkimuksen tulokset ovat jossain määrin ristiriidassa nopean katsauksen tulosten kanssa. Aiemmat kipukokemukset tai aiempien kivuliaiden tapahtumien muistaminen eivät olleet yhteydessä ylimääräisen kipulääkityksen antamiseen leikkauksen jälkeen (p = 0,741). Leikkauksen jälkeiseen tulevaan kipuun liittyvä pelko ei ollut yhteydessä leikkauksen invasiivisuuteen (p = 0,662). Lisäksi kivun odotuksen (p = 0,698), tulevaan kirurgiseen toimenpiteeseen liittyvän kivun pelon (p = 0,637) ja leikkauksen jälkeisen lääkityksen (p = 0,481) välinen yhteys maksimaalisen leikkauksen jälkeisen kivun voimakkuuteen todettiin merkityksettömäksi. Tämän tutkimuksen tulokset viittaavat siihen, että potilaan odotukset ovat mahdollinen interventioalue, jolla voidaan parantaa leikkauksen jälkeistä kiputilannetta. Kipulääkityksen antaminen heräämössä ja kipulääkityksen määrä heräämössä olivat merkittäviä postoperatiivisen maksimaalisen kivun ennustajia (p = .001). Pohdinta: Katsauksen tulokset viittaavat siihen, että mukana olleissa tutkimuksissa on suuri tai kriittinen harhan riski. Postoperatiiviselle kivulle altistavat tekijät vaihtelivat suuresti eri tutkimuksissa, mutta niihin sisältyi pääasiassa psykologisia tekijöitä postoperatiivisen kivun tekijöinä. Kivunhoitostrategioihin olisi sisällyttävä yksilöllinen lähestymistapa, ja niitä olisi sovellettava ennen leikkausta, sen aikana ja sen jälkeen. Kuvailevassa ja vertailevassa tutkimuksessa on huomattavia vaikeuksia havaita kipuhistorian tai -kokemuksen vaikutusta leikkauksen jälkeiseen kipuun fysiologisen tai subjektiivisen raportoinnin avulla tietoisten yksilöiden osalta, koska on olemassa harhan riski ja koska käytetään yksiulotteista lähestymistapaa. Johtopäätökset: Kivunhoitostrategioihin olisi kuuluttava osallistujien biopsykososiaalisen profiilin huolellinen seulonta valintaleikkausta varten. Kuvaileva-vertaileva tutkimus viittaa siihen, että potilaiden tulevaan ruoansulatuskanavan leikkaukseen liittyvien kipuodotusten hallinnasta on mahdollista, joskin vähäistä hyötyä. Kipulääkkeiden määrä heräämössä on merkittävä leikkauksen jälkeisen maksimaalisen kivun ennustaja. Tulevaan tutkimukseen olisi sisällytettävä suurempi otos, enemmän kipuun liittyviä muuttujia ja jatkettava seurantaa

    Trends, challenges, and priorities for shared decision making in mental health: The first umbrella review

    Get PDF
    BACKGROUND: Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental health. AIMS: (1) Provide the first systematic analysis of global development trends and challenges of SDM research; (2) clarify the meaning, role, and measurement of SDM in mental health; (3) create a theoretical framework for key effective SDM components to guide future development and implementation of SDM interventions. METHODS: A comprehensive search strategy was conducted in CINAHL, PubMed, Scopus, MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, and PsycInfo. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measurement tools, comparisons, and outcomes. RESULTS: Ten10 systematic reviews of SDM in mental health were included with 100 nested studies spanning from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions include treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported. CONCLUSIONS: The current landscape of SDM in mental health is overwhelmingly disconnected from the needs and experiences of potential end-users; clients, clinicians, and family members. Most SDM interventions and tools were adapted from physical health and are mainly geared to psychopharmacological decision-making. The SDM in Mental Health Framework (SDM-MH), developed here, expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes of SDM in mental health to reduce heterogeneity across studies

    Healthcare professionals’ digital health competence and its core factors; development and psychometric testing of two instruments

    Get PDF
    Background Healthcare professionals’ digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals’ competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. Objectives The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. Methods The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument’s content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach’s alpha was used to assess the internal consistency of the instruments. Results The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors’ Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors’ Cronbach alpha values varied between 0.76 and 0.88. Conclusions The two instruments gave valid and reliable results in psychometric testing. The instruments could be used to evaluate healthcare professionals’ digital health competence and associated factors

    “Have patients with chronic skin diseases needs been met?”:A thesis on psoriasis and eczema patient care in dermatology service

    Get PDF
    Background: Common chronic skin diseases such as eczema and psoriasis usually require long term medical care. They are often associated with psychological and metabolic comorbidities, which can impact on patient quality of life (QOL) and on the self-management of these diseases. Regular assessment of patient needs, comorbidities and feedback is a critical step in the development of decision-analytic models. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in the decision-making and self-management of their morbidity and comorbidities. The aim of this research is to involve the patients in decision making of their care and to support their self-management by the use of a paper questionnaire (study tool) at each consultation. Objective: To explore the acceptability and potential of a self-developed paper questionnaire that constituted a study tool for addressing the needs, comorbidities, and feedback of patients with psoriasis and eczema and supporting their involvement in decision making and self-management of their chronic conditions. Method: A mixed method study was conducted and included a postal survey on adult male and female patients with psoriasis and eczema, using the study tool, which is a paper questionnaire and contains the Dermatology Life Quality Index (DLQI) and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semi-structured face-to-face interviews with a sample of the patients who had participated in the survey. The aims of the interviews were two-fold: 1. to gain a deeper understanding of their experience of living with and managing their skin disease; and 2. to gather patient feedback on the service they received as well as their views on using the new study tool or any alternative intervention to address and support their self-management. The final study was a pilot which involved presenting a proposal of an online version of the study tool to a group of healthcare experts asking them to critically review the extent to which the online model responded to patients expressed needs. Results: Of the 114 patients who participated in the postal survey 108 (94.7%) of them expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63%) participants. Thirty-three (28.9%) of participants reported that they could not cope with their chronic illness. Eighteen (15.7%) participants suffered from anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25%) participants addressed their needs for support at home, and 16 (14%) of them asked for support at work. In the patient feedback section, 21 (18.4%) and 9 (7.8%) participants rated the service they received from their general practitioner (GP) and dermatologist as poor, respectively. In the interviews, all the participants 22 (100%) welcomed the use of the study tool on a regular basis to address their needs, comorbidities and feedback. Nineteen (86.3%) of them suggested that they would prefer using an online version of the tool or patient portal system as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final pilot study, the healthcare experts agreed that the proposed online version of the study tool could be a convenient platform for such patients to support their self-management. They discussed the potential importance of such a tool if it provided them with access to supportive services such as patient information on skin diseases and self-management, access to local mental health service and other relevant psoriasis and eczema patients’ support groups and charities. Conclusion: This novel mixed method research identified knowledge gaps in managing patients with psoriasis and eczema. It provided a new tool that has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. The tool can involve patients in decision-making and offers them the autonomy to disclose heterogeneous needs that may support their self-management. All the interviewees welcomed regular use of the study tool and the majority of them suggested that they would prefer using an online version of the tool if it was available. Future research is needed to assess the impact of the study tool in filling important gaps in patient self-management and in health service improvement
    corecore