Smartphone apps for improving medication adherence in hypertension: patients’ perspectives

Purpose: Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic conditions. It is important to investigate how patients feel about and engage with these technologies. The aim of this study was to explore patients’ perspectives on smartphone apps to improve medication adherence in hypertension. Methods: This was a qualitative study based in the West of Ireland. Twenty-four patients with hypertension were purposively sampled and engaged in focus groups. Thematic analysis on the data was carried out. Results: Participants ranged in age from 50 to 83 years (M=65 years) with an equal split between men and women. Three major themes were identified in relation to patients’ perspectives on smartphone apps to improve medication adherence in hypertension: “development of digital competence,” “rules of engagement,” and “sustainability” of these technologies. Conclusion: These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering in terms of their understanding of the condition and interactions with their general practitioners. However, the data also revealed that there are concerns about increasing health-related anxiety and doubts about the sustainability of this technology over time. This suggests that the current patient perspective of smartphone apps might be best characterized by “ambivalence.

Patients' views and experiences of technology based self-management tools for the treatment of hypertension in the community: A qualitative study

Background: Patients with hypertension in the community frequently fail to meet treatment goals. The optimal way to organize and deliver care to hypertensive patients has not been clearly identified. The powerful on-board computing capacity of mobile devices, along with the unique relationship individuals have with newer technologies, suggests that they have the potential to influence behaviour. However, little is known regarding the views and experiences of patients using such technology to self-manage their hypertension and associated lifestyle behaviours. The aim of this study was to explore patients' views and experiences of using technology based self-management tools for the treatment of hypertension in the community. Methods: This focus group study was conducted with known hypertensive patients over 45 years of age who were recruited in a community setting in Ireland. Taped and transcribed semi-structured interviews with a purposeful sample involving 50 participants in six focus groups were used. Framework analysis was utilized to analyse the data. Results: Four key inter-related themes emerged from the analysis: individualisation; trust; motivation; and communication. The globalisation of newer technologies has triggered many substantial and widespread behaviour changes within society, yet users are unique in their use and interactions with such technologies. Trust is an ever present issue in terms of its potential impact on engagement with healthcare providers and motivation around self-management. The potential ability of technology to influence motivation through carefully selected and tailored messaging and to facilitate a personalised flow of communication between patient and healthcare provider was highlighted. Conclusions: Newer technologies such as mobile devices and the internet have been embraced across the globe despite technological challenges and concerns regarding privacy and security. In the design and development of technology based self-management tools for the treatment of hypertension, flexibility and security are vital to allow and encourage patients to customise, personalise and engage with their devices

Examining the impact of an mHealth behavior change intervention with a brief in-person component for cancer survivors with overweight or obesity: randomized controlled trial

Background: Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach the recommended physical activity levels and have overweight. This has implications for both physical and psychological health, including an increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology in improving health outcomes in cancer survivors with overweight or obesity. Objective: This study aims to investigate whether a personalized mHealth behavior change intervention improves physical and psychological health outcomes in cancer survivors with overweight or obesity

Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students

Background: The ‘MED-WELL’ programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the ‘MED-WELL’ programme was ofered online instead  of in-person in 2021. The aim of this study is to compare the experiences of participants in the ‘MED-WELL’ programme  online to those that previously participated in the same programme in-person to understand the student experience  and optimize programme delivery. Methods: Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the ‘MED-WELL’ programme when it was ofered in-person, and the other ten  study participants took part in the programme when it was ofered online. All interviews were audio-recorded and  transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive  thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory  of online learning provided the theoretical framework for a deductive approach. Results: Analysis of the data produced fve overarching themes: ‘student-student’, ‘student-teacher’, ‘student-content’,  ‘student-environment’, and ‘efects of a pandemic’. The frst four themes detail distinct types of interaction that participants had with various entities of the 'MED-WELL’ programme and the efects that these interactions had on participant experiences. ‘Efects of a pandemic’ refers to the context of delivering the ‘MED-WELL’ programme online during  a pandemic and how this mode of delivery infuenced participants and the programme. Conclusions: Optimizing the ‘MED-WELL’ programme relies on an understanding of how participants interact with  diferent entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identifed. The fndings from this study can be used to inform similar experiential and educational exercise interventions, and may  help plan for potential future restrictions on in-person educational and exercise-based programmes. </p

Anxiety ratings across conditions.

<p>Anxiety ratings across conditions.</p

Pain ratings across conditions.

<p>Pain ratings across conditions.</p

Means, Standard Deviations, and Score Minima/Maxima for Key Variables.

<p>Means, Standard Deviations, and Score Minima/Maxima for Key Variables.</p

A feasibility study of an exercise intervention to educate and promote health and well-being among medical students: the ‘MED-WELL’ programme

Background: Medical School programme workloads challenge the physical and mental health of students particularly in compressed graduate entry programmes. There is evidence that physical activity (PA) can improve holistic care and help maintain wellness among medical students. We tested the feasibility of introducing an exercise programme to the medical school curriculum which would educate and promote health and well-being among its students. Methods: This study was conducted in a single graduate entry medical school at the University of Limerick (UL). The ‘MED-WELL’ programme was a six-week programme of 1 hour-long weekly sessions, each involving a different type of PA (45 min). These sessions were prefaced by an interactive lecture about how to incorporate exercise theory into daily medical practice (15 min). The study was conducted in a single graduate entry medical school at UL and involved year one and year two graduate entry medical students. Three parameters were used to test feasibility: 1. Recruitment and retention of participants, 2. Acceptability of the programme and 3. Efficacy in terms of health and well-being. The latter was assessed by administering questionnaires pre and post the intervention. The questionnaires used the following validated measurement scales: EQ-VAS; WHO-5 Well-Being Index; 3-item Loneliness Scale; Social Support Measure 3-item scale. Free text boxes also encouraged participants to discuss the merits of the programme Results: In total, 26% (74/286 students) participated in the programme. Of those who participated, 69 students (93%) attended one or more sessions of the programme and completed questionnaires at baseline and at followup. Significant improvements were seen in scores after the programme in the WHO-5 Well-Being Index which increased from 63.2 (95%CI: 48–78.4) to 67.5 (95%CI: 55.1–79.9); (P < 0.01), the sleep scale which increased from 3.1 (95%CI: 2.2–4.0) to 3.5 (95%CI: 2.5–4.5); (P < 0.001), and the loneliness scale which decreased from 4.1 (95%CI: 2.7– 5.5) to 3.5 (95%CI: 2.5–4.5); (P < 0.005). Students level of PA during a typical week also increased from 3.7 (95%CI: 2.1–5.4) to 4.0 (95%CI, 3.5–4.5); (P < 0.05). Conclusion: This study has shown it is feasible to deliver this programme in a medical school’s curriculum. The programme seems to be of benefit and is acceptable to students. Well-designed randomised controlled trials are needed to measure outcomes, durability of effect, and cost effectivenes

Best practice guidance for digital contact tracing apps: a cross-disciplinary review of the literature

Background: Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. Objective: This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. Methods: A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. Results: Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to heir particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. Conclusions: In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature

Sentiment analysis of user feedback on the HSE’s Covid‑19 contact tracing app

Background Digital Contact Tracing is seen as a key tool in reducing the propagation of Covid-19. But it requires high uptake and continued participation across the population to be efective. To achieve sufcient uptake/participation, health authorities should address, and thus be aware of, user concerns. Aim This work manually analyzes user reviews of the Irish Heath Service Executive’s (HSE) Contact Tracker app, to identify user concerns and to lay the foundations for subsequent, large-scale, automated analyses of reviews. While this might seem tightly scoped to the Irish context, the HSE app provides the basis for apps in many jurisdictions in the USA and Europe. Methods Manual analysis of (1287) user reviews from the Google/Apple play stores was performed, to identify the aspects of the app that users focused on, and the positive/negative sentiment expressed. Results The fndings suggest a largely positive sentiment towards the app, and that users thought it handled data protection and transparency aspects well. But feedback suggests that users would appreciate more targeted feedback on the incidence of the virus, and facilities for more proactive engagement, like notifcations that prompt users to submit their health status daily. Finally, the analysis suggests that the “android battery” issue and the backward-compatibility issue with iPhones seriously impacted retention/uptake of the app respectively. Conclusion The HSE have responded to the public’s desire for targeted feedback in newer versions, but should consider increasing the app’s proactive engagement. The results suggest they should also raise the backward compatibility issue, regarding older iPhones, with Apple