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Basilika Mariatrost und Bildungshaus Mariatros

Behavior change techniques in apps for medication adherence: A Content Analysis

INTRODUCTION: There are a vast number of smartphone applications (apps) aimed at promoting medication adherence on the market; however, the theory and evidence base in terms of applying established health behavior change techniques underpinning these apps remains unclear. This study aimed to code these apps using the Behavior Change Technique Taxonomy (v1) for the presence or absence of established behavior change techniques.METHODS: The sample of apps was identified through systematic searches in both the Google Play Store and Apple App Store in February 2015. All apps that fell into the search categories were downloaded for analysis. The downloaded apps were screened with exclusion criteria, and suitable apps were reviewed and coded for behavior change techniques in March 2015. Two researchers performed coding independently.RESULTS: In total, 166 medication adherence apps were identified and coded. The number of behavior change techniques contained in an app ranged from zero to seven (mean=2.77). A total of 12 of a possible 96 behavior change techniques were found to be present across apps. The most commonly included behavior change techniques were "action planning" and "prompt/cues," which were included in 96% of apps, followed by "self-monitoring" (37%) and "feedback on behavior" (36%).CONCLUSIONS: The current extent to which established behavior change techniques are used in medication adherence apps is limited. The development of medication adherence apps may not have benefited from advances in the theory and practice of health behavior change.</p

Effectiveness and content analysis of interventions to enhance medication adherence and blood pressure control in hypertension: A systematic review and meta-analysis

Objective: The objective of this systematic review is to evaluate the effectiveness of medication adherence interventions on blood pressure control in hypertensive patients. In addition, we aim to explore what barriers and facilitators in the interventions may have been targeted and how these might be related to the effect size on blood pressure (BP). Design: This review is a hypertension-specific update to the previous Cochrane Review by Nieuwlaat et al. (2014) on interventions to enhance medication adherence. A systematic literature search was carried out and two authors independently screened titles and abstracts for their eligibility for inclusion and independently extracted data from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool. A meta-analysis was conducted and additionally, theoretical factors in interventions were identified using the Theoretical Domains Framework. Results: The meta-analysis found a modest main effect of adherence interventions on SBP (MD −2.71 mm Hg, 95% CI −4.17 to −1.26) and DBP (MD −1.25 mm Hg, 95% CI −1.72 to −.79). However, there was substantial significant heterogeneity across both outcomes. A narrative review on adherence outcomes was conducted. In terms of the theoretical analysis, the relationship between the total number of times the domains were coded within an intervention and change of SBP (r  =  −.234, p = .335) and DBP was not significant (r  =  −.080, p = .732). Similarly, the relationship between the total number of times different domains were coded within an intervention and change of SBP (r  =  .080, p = .746) and DBP was not significant (r  =  −.188, p = .415). Discussion: This review and meta-analysis of interventions documented significant but modest post-intervention improvements in BP outcomes among hypertensive patients. However, this is a tentative finding as substantial heterogeneity and potential biases were present. One of the greatest challenges of this review was assessing risk of bias, extracting sufficient data to calculate effect size and coding interventions with the amount of information provided in papers. It is imperative that future adherence research comprehensively reports methodology

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.

Supporting self-management and clinic attendance in young adults with type 1 diabetes: development of the D1 now intervention

Background: Self-management of type 1 diabetes (T1D) is complex and can be particularly challenging for young adults. This is reflected in the high blood glucose values and rates of clinic non-attendance in this group. There is a gap for a theory-based intervention informed by key stakeholder opinions to support and improve self management in young adults with T1D. Purpose: The aim of the work was to systematically co-develop an evidence-based and stakeholder-led intervention to support self-management and clinic engagement in young adults living with T1D in Ireland. Co-development was led by the Young Adult Panel. Methods: The Behaviour Change Wheel was used to guide the development. Five evidence sources were used to inform the process. An iterative co-design process was used with the Young Adult Panel. Initial intervention components were refined and feasibility tested using qualitative methods. Results: Environmental restructuring, education and training were selected as appropriate intervention functions. The co-design process, along with qualitative refinement and feasibility work, led to the final intervention content which consisted of 17 behaviour change techniques. The final D1 Now intervention consists of three components: a support worker, an agenda setting tool and an interactive messaging service. Conclusions: The D1 Now intervention is now at pilot evaluation stage. Its transparent and systematic development will facilitate evaluation and future replications

Characterising processes and outcomes of tailoring implementation strategies in healthcare: A scoping review

Background: Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. Aim: The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare to, answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps. Methods: The review will be conducted in accordance with best practice guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches will be conducted of Medline, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction will be conducted by two members of the research team, with any discrepancies resolved by consensus discussion with a third reviewer. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. Conclusions: The findings will serve a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies

Characterising processes and outcomes of tailoring implementation strategies in healthcare: a protocol for a scoping review

Background: Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. Aim: The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare to answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps. Methods: The review will be conducted in accordance with best practice guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches will be conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction will be conducted by two or more members of the research team, with any discrepancies resolved by consensus discussion with a third reviewer. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. This scoping review is pre-registered with the Open Science Framework. Conclusions: The findings will serve a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations

To accelerate an end to diabetes stigma and discrimination an international multi-disciplinary expert panel (N=51 members, 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. They achieved Consensus on 25 Statements of Evidence and 24 Statements of Recommendations. The Consensus is that diabetes stigma is driven primarily by blame, perceptions of burden/sickness, (in)visibility, and fear/disgust. People with diabetes often encounter sigma (negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental and physical health, self-care, access to optimal healthcare, and social and professional opportunities. Up to one-in-three experience discrimination (unfair and prejudicial treatment) due to diabetes, e.g., in healthcare, education and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical and counterproductive. Collective leadership is needed to pro-actively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, the panel achieved unanimous consensus on a pledge to end diabetes stigma and discrimination