Public perceptions of diabetes, healthy living and conversational agents in Singapore: a needs assessment

Background: The incidence of chronic diseases such as type 2 diabetes is on the rise in countries worldwide, including Singapore. Health professional-delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. Yet ongoing personalised guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology such as conversational agents are a potential alternative for delivery of healthy lifestyle change behavioural interventions to the public. Objective: We explored Singaporeans’ perceptions on and experience of healthy living, diabetes and mobile health interventions (apps and conversational agents). This survey was done to help inform the design and development of a conversational agent focusing on healthy lifestyle change. Methods: This qualitative study was conducted over Aug and Sept 2019. 20 participants were recruited from relevant healthy living Facebook pages and groups. Semi-structured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analysed in parallel by two researchers using Burnard’s method, a structured approach for thematic content analysis. Results: The collected data was organised into four main themes: (1) use of conversational agents, (2) ubiquity of smartphone applications, (3) understanding of diabetes and (4) barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile applications as well as conversational agents unrelated to healthcare. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. In terms of barriers to healthy living, frequent dining out, high stress levels, lack of work-life balance and dearth of free time to engage in physical activity were mentioned. In contrast, discipline, pre-planning and sticking to a routine were important for enabling a healthy lifestyle. Conclusions: Participants in our study commonly used mobile health interventions and provided important insights into their knowledge gaps and needs in relation to healthy lifestyle behaviour change. Future digital interventions like conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt habits for healthy living

the State of Utah v. Walter Preston Boggess, Jr. : Brief of Respondent

An Appeal from a Judgment of the District Court of the Fourth Judicial District, The Honorable J, Robert Bullock, District Court Judg

Effectiveness of the Austrian disease-management-programme for type 2 diabetes: study protocol of a cluster-randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Due to its rising prevalence type 2 diabetes plays an important role concerning population health in Austria and other western countries. In various studies deficiencies in the care of diabetic patients have been revealed. These deficiencies may be overcome by disease-management-programmes (DMPs), but international experience shows that the effectiveness of DMPs is inconsistent. In particular large programmes designed by state-affiliated public health insurances have not been evaluated in randomized controlled trials (RCTs). We are therefore conducting a large scale RCT of the Austrian DMP for type 2 diabetic patients in the province of Salzburg to evaluate the programme regarding its effects on metabolic control, guideline adherent care and the quality of life of diabetic patients.</p> <p>Methods/Design</p> <p>The study is open for participation to all GPs and internists in the province of Salzburg. Physicians are randomized before recruitment of patients with the districts of Salzburg as clusters of randomisation. A total of over 1200 patients with type 2 diabetes will then be recruited. In the intervention group the DMP is applied for one year. Controls receive usual care. Endpoints are a decrease in HbA1c in the intervention group > 0,5% compared to controls, a higher percentage of patients with required diagnostic measures according to guidelines, improved cardiovascular risk profile and higher quality of life scores within one year.</p> <p>Current status of the study</p> <p>98 Physicians agreed to participate in the study. 96 of them recruited 1494 patients, 654 in the intervention and 840 in the control group.</p> <p>Trail Registration</p> <p>This trial has been registered with Current Controlled Trials Ltd. (ISRCTN27414162).</p

Investigating rewards and deposit contract financial incentives for physical activity behavior change using a smartphone app: randomized controlled trial

Health and self-regulatio

Asuhan Kebidanan Berkelanjutan Pada Ny U.R Puskesmas Sagu Periode 22 April sampai 29 Juni 2019

Latar Belakang : Penyusunan Laporan Tugas Akhir adalah kegiatan belajar mengajar yang memberikan kesempatan kepada mahasiswa untuk mendapatkan pengalaman nyata dalam melaksanakan asuhan kebidanan yang komprehensif dalam lingkup kesehatan reproduksi.Data Puskesmas Sagu diperoleh tidak ada kematian bayi dan kematian ibu dalam 1 tahun terakhir. Sasaran ibu hamil di Puskesmas Sagu sebanyak 178 orang, jumlah persalinan sebanyak 194 orang, jumlah kunjungan nifas sebanyak 193 orang. Tujuan Penelitian : Diharapkan mahasiswa mampu menerapkan asuhan kebidanan berkelanjutan pada Ny.U.R Usia Kehamilan 37 Minggu 2 Hari Janin Hidup Tunggal Letak Kepala Intra Uterine Keadaan Jalan Lahir Normal Keadaan Ibu dan Janin Baik di Puskesmas Sagu Periode 22 April sampai 29 Juni 2019. Metode Penelitian : Jenis penelitian yang digunakan adalah studi penelaahan kasus. Studi kasus dilakukan pada Ny.U.R Usia Kehamilan 37 Minggu 2 Hari Janin Tunggal Hidup Intra Uterine Letak Kepala Keadaan Ibu dan Janin Baik di PuskesmaS Sagu Periode 22 April sampai 29 Juni 2019. Hasil : Setelah dilakukan asuhan kebidanan berkelanjutan pada Ny. U.R Usia Kehamilan 37 minggu 2 Hari Janin Tunggal Hidup Intra Uterine Letak Kepala Keadaan Ibu dan Janin Baik di Puskesmas Sagu Periode 22 April sampai 29 Juni 2019, ibu sudah melewati masa kehamilan, persalinan dan nifas dengan baik tanpa ada penyulit, bayi baru lahir dalam keadaan sehat, ibu belum menggunakan KB karena masih menunggu persetujuan suami. Kesimpulan : Asuhan kebidanan yang dilakukan pada Ny U.R mulai dari hamil, bersalin, BBL dan nifas, serta KB tidak ditemukan adanya kelainan dan penyulit yang menyertai

The effectiveness of the Austrian disease management programme for type 2 diabetes: a cluster-randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Disease management programmes (DMPs) are costly and impose additional work load on general practitioners (GPs). Data on their effectiveness are inconclusive. We therefore conducted a cluster-randomised controlled trial to evaluate the effectiveness of the Austrian DMP for diabetes mellitus type 2 on HbA1c and quality of care for adult patients in primary care.</p> <p>Methods</p> <p>All GPs of Salzburg-province were invited to participate. After cluster-randomisation by district, all patients with diabetes type 2 were recruited consecutively from 7-11/2007. The DMP, consisting mainly of physician and patient education, standardised documentation and agreement on therapeutic goals, was implemented in the intervention group while the control group received usual care. We aimed to show superiority of the intervention regarding metabolic control and process quality. The primary outcome measure was a change in HbA1c after one year. Secondary outcomes were days in the hospital, blood pressure, lipids, body mass index (BMI), enrolment in patient education and regular guideline-adherent examination. Blinding was not possible.</p> <p>Results</p> <p>92 physicians recruited 1489 patients (649 intervention, 840 control). After 401 ± 47 days, 590 intervention-patients and 754 controls had complete data. In the intention to treat analysis (ITT) of all 1489 patients, HbA1c decreased 0.41% in the intervention group and 0.28% in controls. The difference of -0.13% (95% CI -0.24; -0.02) was significant at p = 0.026. Significance was lost in mixed models adjusted for baseline value and cluster-effects (adjusted mean difference -0.03 (95% CI -0.15; 0.09, p = 0.607). Of the secondary outcome measures, BMI and cholesterol were significantly reduced in the intervention group compared to controls in ITT after adjustments (-0.53 kg/m²; 95% CI -1.03;-0.02; p = 0.014 and -0.10 mmol/l; 95% CI -0.21; -0.003; p = 0.043). Additionally, more patients received patient education (49.5% vs. 20.1%, p < 0.0001), eye- (71.0% vs. 51.2%, p < 0.0001), foot examinations (73.8% vs. 45.1%, p < 0.0001), and regular HbA1c checks (44.1% vs. 36.0%, p < 0.01) in the intervention group.</p> <p>Conclusion</p> <p>The Austrian DMP implemented by statutory health insurance improves process quality and enhances weight reduction, but does not significantly improve metabolic control for patients with type 2 diabetes mellitus. Whether the small benefit seen in secondary outcome measures leads to better patient outcomes, remains unclear.</p> <p>Trial Registration</p> <p>Current Controlled trials Ltd., ISRCTN27414162.</p

Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial.

Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels

Conversational agents in healthcare: a scoping review and conceptual analysis

Background: Conversational agents also known as chatbots are computer programs designed to simulate human text or verbal conversations. They are increasingly used in a range of fields, including healthcare. By enabling better accessibility, personalization and efficiency, conversational agents have the potential to improve patient care. Objectives: To review the current applications, gaps and challenges in the literature on conversational agents in healthcare and provide recommendations for their future research, design and application. Methods: We performed a scoping review. A broad literature search was done in Medline (Ovid), EMBASE (Ovid), PubMed, Scopus and Cochrane central with the search terms “conversational agents”, “conversational AI”, “chatbots” and associated synonyms. We also searched grey literature using sources such as OCLC World Cat database and Research Gate in April 2019. Reference lists of relevant articles were checked for further articles. Screening and data extraction were performed in parallel by two review authors. The included evidence was analyzed narratively employing the principles of thematic analysis. Results: The literature search yielded 47 study reports (45 articles and two ongoing clinical trials) which matched the inclusion criteria. The identified conversational agents were largely smartphone applications-delivered (n=23) and used free text only as the main input (n=19) and output (n=30) modality. Case-studies describing chatbot development (n=18) were most prevalent and only 11 RCTs were identified. Three most commonly reported conversational agent applications in the literature were treatment and monitoring, healthcare service support, and patient education. Conclusions: The literature on conversational agents in healthcare is largely descriptive and aimed at treatment and monitoring and health service support. It mostly reports on text-based, AI-driven and mobile application-delivered conversational agents. There is an urgent need for robust evaluation of diverse healthcare conversational agents’ formats focusing on their acceptability, safety and effectiveness