Evaluating a web-based self-management intervention in patients with heart failure: A pilot study

This pilot study aimed to evaluate the feasibility of a web-based self-management intervention in patients with heart failure. The study consisted of two phases including developing the web-based application and examining its feasibility in a group of heart failure patients. The results of this study were consistent with the current literature which has failed to show the benefits of web-based interventions for chronic disease self-management. In the current thesis, therefore, issues influencing the effectiveness of the web-based interventions were analysed. Recommendations for improving effectiveness of the web-based applications were also provided

Developing a user centred smartphone application for patients with acute coronary syndrome: The MoTER-ACS intervention

Background:Post-discharge interventions are limited for patients with Acute Coronary Syndromes (ACS) due to few scheduled visits to outpatient clinics and traveling from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions.Objective:The aim of this study was to develop a smartphone-based intervention to provide post-discharge support for patients with ACS.Methods:In 2017, a series of small studies (pre-study survey) were conducted in the Prince Charles hospital, Queensland, Australia which consisted of questionnaires with a convenience sample of ACS patients (N=30), a focus group discussion with healthcare professionals (N=10) and an online survey with cardiologists (N=15). The results of the patients’ survey identified the educational topics of the MoTER-ACS intervention. The focus group with healthcare professionals assisted with identifying educational materials, health monitoring and self-management interventions. Monitoring symptoms related to heart failure exacerbation considered as weekly diary based on the results of the online survey with cardiologists.Results:The smartphone application covers multimedia educational materials to adopt a healthy lifestyle and, user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain assisting patients to self-manage their condition. Using the web-portal, clinicians can regularly access to patients’ data and provide support.Conclusions:The feasibility of the MoTER-ACS intervention as a home-based program is tested in a pilot study. If proven valid, this research, would enable clinicians to overcome accessibility barriers of home-based rehabilitation with the clinical expertise, supervision, and coaching that has traditionally been limited to hospital-based services

Evaluating a web-based self-management intervention in heart failure patients: A pilot study

Background - Web-based interventions may have the potential to support self-care in patients with chronic disease, yet little is known about the feasibility of Web-based interventions in patients with heart failure (HF). Objective - The objective of our study was to develop and pilot a Web-based self-care intervention for patients with HF. Methods - Following development and pretesting, we pilot tested a Web-based self-care intervention using a randomized controlled design. A total of 28 participants completed validated measures of HF knowledge, self-care, and self-efficacy at baseline and 1-month follow-up. Results - Change scores and effect size estimates showed that the mean differences in HF knowledge (d = 0.06), self-care (d = 0.32), and self-efficacy (d = 0.37) were small. Despite email reminders, 7 of 14 participants (50%) of the sample accessed the site daily and 4 of 14 (28%) had no record of access. Conclusions - Larger randomized controlled trials are needed that attend to all sources of self-efficacy and include more comprehensive educational tools to improve patient outcomes

Non-wearable human identification sensors for smart home environment : a review

Purpose: This paper aims to provide a review of different types of non-wearable human identification sensors which can be applied for smart home environment. Design/methodology/approach: The authors performed a systematic review to assess and compare different types of non-wearable and non-intrusive human identification sensors used in smart home environment. The literature research adds up to 5,567 records from 2000 to 2016, out of which 40 articles were screened and selected for this review. Findings: In this review, the authors classified non-wearable human identification technologies into four main groups, namely, object-based, footstep-based, body shape-based and gait-based identification technologies. Assessing these four group of identification technologies showed that the maturity of non-wearable identification is not high and most of these technologies are verified in a lab environment. Additionally, footstep-based identification is the most popular identification approach listed in the literature. Originality/value: This study contributes to the literature on human identification technologies in several ways. This paper identifies the state-of-the-art regarding non-wearable technologies which can be used in smart home environment. Moreover, the results of this paper can provide a better understanding of advantages and disadvantages of the non-wearable identification technologies.</p

Self-management education through mHealth: review of strategies and structures

Despite the plethora of evidence on mHealth interventions for patient education, there is a lack of information regarding their structures and delivery strategies.This review aimed to investigate the structures and strategies of patient education programs delivered through smartphone apps for people with diverse conditions and illnesses. We also examined the aim of educational interventions in terms of health promotion, disease prevention, and illness management.We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO for peer-reviewed papers that reported patient educational interventions using mobile apps and published from 2006 to 2016. We explored various determinants of educational interventions, including the content, mode of delivery, interactivity with health care providers, theoretical basis, duration, and follow-up. The reporting quality of studies was evaluated according to the mHealth evidence and reporting assessment criteria.In this study, 15 papers met the inclusion criteria and were reviewed. The studies mainly focused on the use of mHealth educational interventions for chronic disease management, and the main format for delivering interventions was text. Of the 15 studies, 6 were randomized controlled trials (RCTs), which have shown statistically significant effects on patients' health outcomes, including patients' engagement level, hemoglobin A, weight loss, and depression. Although the results of RCTs were mostly positive, we were unable to identify any specific effective structure and strategy for mHealth educational interventions owing to the poor reporting quality and heterogeneity of the interventions.Evidence on mHealth interventions for patient education published in peer-reviewed journals demonstrates that current reporting on essential mHealth criteria is insufficient for assessing, understanding, and replicating mHealth interventions. There is a lack of theory or conceptual framework for the development of mHealth interventions for patient education. Therefore, further research is required to determine the optimal structure, strategies, and delivery methods of mHealth educational interventions

A multidisciplinary smartphone-based application to empower patients with acute coronary syndromes: a qualitative study on healthcare providers' perspectives

Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital.The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group.We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach.The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention.A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital

Digital health interventions for chronic diseases: A scoping review of evaluation frameworks

Background Monitoring and evaluations of digital health (DH) solutions for the management of chronic diseases are quite heterogeneous and evidences around evaluating frameworks are inconsistent. An evidenced-based framework is needed to inform the evaluation process and rationale of such interventions. We aimed to explore the nature, extent and components of existing DH frameworks for chronic diseases. Methods This review was conducted based on the five steps of Arksey and O'Malley's scoping review methodology. Out of 172 studies identified from, PubMed, Embase and Web of Science, 11 met our inclusion criteria. The reviewed studies developed DH frameworks for chronic diseases and published between 2010 and 2018. Results According to WHO guidelines for monitoring and evaluation of DH interventions, we identified seven Conceptual frameworks, two Results frameworks, one Logical framework and one Theory of change. The frameworks developed for providing interventions such as self-management, achieving personal goals and reducing relapse for cardiovascular disease, diabetes, chronic obstructive pulmonary disease and severe mental health. A few studies reported evaluation of the frameworks using randomised clinical trials (n=3) and feasibility testing via Likert scale survey (n=2). A wide range of outcomes were reported including access to care, cost-effectiveness, behavioural outcomes, patient-provider communications, technology acceptance and user experience. Conclusion There is a lack of evidence on the application of consistent DH frameworks. Future research should address the use of evidence-based frameworks into the research design, monitoring and evaluation process. This review explores the nature of DH frameworks for the management of chronic diseases and provides examples to guide monitoring and evaluation of interventions. Author(s) (or their employer(s)) 2020

Digital health for COPD care: the current state of play

Chronic obstructive pulmonary disease (COPD) imposes a huge burden to our healthcare systems and societies. To alleviate the burden, digital health-"the use of digital technologies for health"- has been recognized as a potential solution for improving COPD care at scale. The aim of this review is to provide an overview of digital health interventions in COPD care. We accordingly reviewed recent and emerging evidence on digital transformation approaches for COPD care focusing on (I) self-management, (II) in-hospital care, (III) post-discharge care, (IV) hospital-at-home, (V) ambient environment, and (VI) public health surveillance. The emerging approaches included digital-technology-enabled homecare programs, electronic records, big data analytics, and environment-monitoring applications. The digital health approaches of telemonitoring, telehealth and health support the self-management, post-discharge care, and hospital-at-home strategy, with prospective effects on reducing acute COPD exacerbations and hospitalizations. Electronic records and classification tools have been implemented; and their effectiveness needs to be further evaluated in future studies. Air pollution concentrations in the ambient environment are associated with declined lung functions and increased risks for hospitalization and mortality. In all the digital transformation approaches, clinical evidence on reducing mortality, the ultimate goal of digital health intervention, is often inconsistent or insufficient. Digital health transformation provides great opportunities for clinical innovations and discovery of new intervention strategies. Further research remains needed for achieving reliable improvements in clinical outcomes and cost-benefits in future studies