Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis

Please cite as: Mercer K, Li M, Giangregorio L, Burns C, Grindrod K Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis JMIR Mhealth Uhealth 2016;4(2):e40 DOI: 10.2196/mhealth.4461 PMID: 27122452 PMCID: 4917727Background: Wearable activity trackers are promising as interventions that offer guidance and support for increasing physical activity and health-focused tracking. Most adults do not meet their recommended daily activity guidelines, and wearable fitness trackers are increasingly cited as having great potential to improve the physical activity levels of adults. Objective: The objective of this study was to use the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy to examine if the design of wearable activity trackers incorporates behavior change techniques (BCTs). A secondary objective was to critically analyze whether the BCTs present relate to known drivers of behavior change, such as self-efficacy, with the intention of extending applicability to older adults in addition to the overall population. Methods: Wearing each device for a period of 1 week, two independent raters used CALO-RE taxonomy to code the BCTs of the seven wearable activity trackers available in Canada as of March 2014. These included Fitbit Flex, Misfit Shine, Withings Pulse, Jawbone UP24, Spark Activity Tracker by SparkPeople, Nike+ FuelBand SE, and Polar Loop. We calculated interrater reliability using Cohen's kappa. Results: The average number of BCTs identified was 16.3/40. Withings Pulse had the highest number of BCTs and Misfit Shine had the lowest. Most techniques centered around self-monitoring and self-regulation, all of which have been associated with improved physical activity in older adults. Techniques related to planning and providing instructions were scarce. Conclusions: Overall, wearable activity trackers contain several BCTs that have been shown to increase physical activity in older adults. Although more research and development must be done to fully understand the potential of wearables as health interventions, the current wearable trackers offer significant potential with regard to BCTs relevant to uptake by all populations, including older adults

Evaluation of a microlearning module on hypertension in Canada

Objectives: To use a microlearning platform to evaluate pharmacists’ knowledge and behaviour related to hypertension. Methods: Pharmacy 5in5 is an online microlearning platform designed to help pharmacy professionals develop skills and acquire a deeper understanding of a variety of clinical and professional practice topics. Each topic includes a fact-based quiz, six case-based quizzes, six reflection questions, animated videos, infographics and flash cards. In April 2019, a hypertension module was released to engage pharmacists in managing hypertension and improving current practice behaviours. The module was developed using Canadian and American hypertension guidelines, landmark trials, and tertiary drug resources. The hypertension module was accessible on the Pharmacy5in5 website. Preliminary data were collected over 8 weeks between April-June 2019. User performance was analyzed with a binomial regression model. Results: Overall, 600 users accessed the Pharmacy 5in5 platform in the first two months, 81% of which were in Ontario. Licensed pharmacists performed significantly better than other registered users (β = −0.56, t (3362) =−2.15, p = 0.03), with users working in hospitals performing the best. The quiz resulting in the highest average focused on proper techniques for home blood pressure monitoring (mean score of 87%; SD 17%), while the quiz resulting in the lowest average focused on choosing medication therapy (mean score of 59%; SD 22%). In the reflection questions for behaviour in the last three months, 68% of users reported counselling a patient on home blood pressure monitoring and 62% had educated patients on their blood pressure targets, but only 18% had contacted a prescriber to optimize pharmacotherapy. Conclusion: The Pharmacy5in5 hypertension module is an engaging method of continuing education which can be used to rapidly reach many healthcare professionals in a short time. More education is needed to support pharmacists in working with prescribers to proactively optimize hypertension therapy

Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation

Please cite as: Mercer K, Giangregorio L, Schneider E, Chilana P, Li M, Grindrod K Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation JMIR Mhealth Uhealth 2016;4(1):e7 DOI: 10.2196/mhealth.4225 PMID: 26818775 PMCID: 4749845Background: Physical inactivity and sedentary behavior increase the risk of chronic illness and death. The newest generation of “wearable” activity trackers offers potential as a multifaceted intervention to help people become more active. Objective: To examine the usability and usefulness of wearable activity trackers for older adults living with chronic illness. Methods: We recruited a purposive sample of 32 participants over the age of 50, who had been previously diagnosed with a chronic illness, including vascular disease, diabetes, arthritis, and osteoporosis. Participants were between 52 and 84 years of age (mean 64); among the study participants, 23 (72%) were women and the mean body mass index was 31 kg/m2 . Participants tested 5 trackers, including a simple pedometer (Sportline or Mio) followed by 4 wearable activity trackers (Fitbit Zip, Misfit Shine, Jawbone Up 24, and Withings Pulse) in random order. Selected devices represented the range of wearable products and features available on the Canadian market in 2014. Participants wore each device for at least 3 days and evaluated it using a questionnaire developed from the Technology Acceptance Model. We used focus groups to explore participant experiences and a thematic analysis approach to data collection and analysis. Results: Our study resulted in 4 themes: (1) adoption within a comfort zone; (2) self-awareness and goal setting; (3) purposes of data tracking; and (4) future of wearable activity trackers as health care devices. Prior to enrolling, few participants were aware of wearable activity trackers. Most also had been asked by a physician to exercise more and cited this as a motivation for testing the devices. None of the participants planned to purchase the simple pedometer after the study, citing poor accuracy and data loss, whereas 73% (N=32) planned to purchase a wearable activity tracker. Preferences varied but 50% felt they would buy a Fitbit and 42% felt they would buy a Misfit, Jawbone, or Withings. The simple pedometer had a mean acceptance score of 56/95 compared with 63 for the Withings, 65 for the Misfit and Jawbone, and 68 for the Fitbit. To improve usability, older users may benefit from devices that have better compatibility with personal computers or less-expensive Android mobile phones and tablets, and have comprehensive paper-based user manuals and apps that interpret user data. Conclusions: For older adults living with chronic illness, wearable activity trackers are perceived as useful and acceptable. New users may need support to both set up the device and learn how to interpret their data

“My pharmacist”: Creating and maintaining relationship between physicians and pharmacists in primary care settings

The final publication is available at Elsevier via https://doi.org/10.1016/j.sapharm.2019.03.144. © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Background Pharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care. Objectives This paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship. Methods Thematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other. Results We found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care. Conclusion The findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.TelusHealth and the Canadian Institute for Health Research for grant suppor

Using a collaborative research approach to develop an interdisciplinary research agenda for the study of mobile health interventions for older adults.

Licensed under Creative Commons Attribution cc-by 2.0Background: Seniors with chronic diseases are often called on to self-manage their conditions. Mobile health (mHealth) tools may be a useful strategy to help seniors access health information at the point of decision-making, receive real-time feedback and coaching, and monitor health conditions. However, developing successful mHealth interventions for seniors presents many challenges. One of the key challenges is to ensure the scope of possible research questions includes the diverse views of seniors, experts and the stakeholder groups who support seniors as they manage chronic disease. Objective: Our primary objective was to present a case-study of a collaborative research approach to the development of an interdisciplinary research agenda. Our secondary objectives were to report on the results of a nominal group technique (NGT) approach used generate research questions and to assess the success of including non-academic researchers to enrich the scope, priority, and total number of possible research questions. Methods: We invited researchers and stakeholders to participate in a full day meeting that included rapid-style presentations by researchers, health care professionals, technology experts, patients and community groups followed by group discussions. An NGT was used to establish group consensus on the following question: In your opinion, what research needs to be done to better understand the effectiveness, usability and design of mobile health apps and devices for older adults? Results: Overall, the collaborative approach was a very successful strategy to bring together a diverse group of participants with the same end goal. The 32 participants generated 119 items in total. The top three research questions that emerged from the NGT were related to adoption, the need for high quality tools and the digital divide. Strong sub-themes included privacy and security, engagement and design. The NGT also helped us include the perspectives information from non-academic researchers that would not have been captured if the process had been limited to the research team. Conclusions: Developing ways for patients and other stakeholders to have a voice when it comes to developing patient awareness as related to mHealth may guide future research into engagement, ownership, usability and design. It is our intention that our paper be used and adapted by other researchers to engage small or vulnerable populations often excluded from mHealth research and design.None Declare

Appendix to "Characteristics, predictors, and reasons for regulatory body disciplinary action in health care: A scoping review"

In this appendix to the manuscript "Characteristics, predictors, and reasons for regulatory body disciplinary action in health care: A scoping review”, the studies included in the scoping review are summarized.Ai-Leng Foong-Reichert was funded by the Ontario Graduate Scholarship and the Canadian Institutes of Health Research Canada Graduate Scholarships - Doctoral

Death Literacy Index: A Report on its Development and Implementation

The Death Literacy Index (DLI) provides a means to measure and research public health palliative care initiatives, including those under the umbrella of Compassionate Communities, by exploring the ways in which community members’ knowledge and practice are enhanced through these initiatives. Within public health palliative care, the Compassionate Communities approach views the community as equal partners in the long and complex task of providing quality health care at end of life. Over the past decade there has been growing acknowledgement that communities have been marginalised in the increasingly professionalised EOL care service sector. In contrast Compassionate Communities draw upon the social connections, reciprocity and trust available when social capital is present in a community. Thus, the DLI is designed to be used by community practitioners and researchers alike. This report provides an overview of the concept of death literacy and the development of the DLI. The DLI was developed from personal narratives of carers, with input from a wide range of professionals and experts and was tested on a national sample of Australians. The report includes detailed information about the development of the Index, reliability and validity statistics, four case studies demonstrating the uses of the DLI and a series of data tables for understanding the norms and baseline data about death literacy in Australia

Unintended consequences of communicating rapid COVID-19 vaccine policy changes– a qualitative study of health policy communication in Ontario, Canada

Background The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. Methods Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. Results Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. Conclusions Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities’ access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines

Community efforts to promote vaccine uptake in a rural setting: a qualitative interview study

Vaccine hesitancy has been identified as one of the top 10 threats to global health. The causes of low vaccine uptake are many and vary at micro and macro levels. However, rural and remote coastal areas in the UK experience unique vaccine inequalities due to high levels of deprivation and their unique and complex access-related problems. This study aimed to explore community efforts to promote vaccine uptake during the COVID-19 pandemic and understand how the COVID-19 vaccination campaign was experienced by the public. We conducted an exploratory descriptive qualitative study using semi-structured interviews with decision-makers, health professionals and community members in Lincolnshire, a predominantly rural county with a long coastline, a large population of white minority ethnicities, and those living in caravan and temporary housing. Data were analysed using conventional content analysis. Overcoming the various access barriers to vaccination uptake involved working with local media stations, local communities and local community groups, translation of information, bringing vaccines closer to the people through pop-up and mobile clinics and provision of transport and ensuring confidentiality. There is a need to employ inclusive targeted non-conventional care interventions whilst dealing with complex problems as occur in rural and remote coastal regions

A Matter of Trust: Building COVID-19 Vaccine Confidence among Diverse Communities in Canada and the United Kingdom - Final Full Report to The British Academy

Over the course of the COVID-19 pandemic, the virus has undergone many mutations. Governments must continually update their health policies – often in seemingly contradictory terms – to protect the public from illness and death, and health systems from collapsing. This means persuading millions of people, not just once, but twice and three times each, to be vaccinated, while the virus and the messaging about it are in flux. The purpose of our ongoing research, in Canada and the United Kingdom (UK), is to learn what methods to date have worked to improve COVID-19 vaccine confidence among the public throughout the pandemic and to share this information with policymakers, public health officials, community decision-makers and contributors to public discourse. Our goal is to better understand how policy changes and mis/disinformation are experienced in communities with low vaccine confidence and to identify community level interventions that can be used to develop vaccine confidence. For this multiple methods study, our teams analysed and compared societal reception to COVID-19 vaccination policies, in particular the communication of those policies, across two distinct areas and populations, one in the UK and the other in Canada. Both areas studied had areas with lower vaccination rates and similar kinds of demographic subpopulations. We have characterized the evolution of relevant public health policies in terms of their content, context, actors and processes, seeking to learn more about how people understood and acted – or not – on COVID-19 health policy changes over time. We wanted to study which communication channels were used and how various populations responded to public health information and regulations; what other “unofficial” channels they may have used, for better or worse; and what community efforts might have built vaccine confidence among rural and urban communities. We, firstly, examined the policy evolution through a desk review. Our data sources included government websites and official social media, which were used to identify operational COVID-19 policy documents, guidelines, laws and regulations. Search results were indexed, extracted and inserted into a spreadsheet for each country, then policy categories were devised based on how the policies were framed. Secondly, we characterised response to these policies through a series of individual interviews conducted in the East Midlands region of England and in Waterloo, a small, southern-Ontario city in central Canada. Finally, we compared our policy review to our qualitative analysis to gain insights into the influence of policy on vaccine programme equity and coordination. Findings from the desk review indicated that Canada and the UK were able withstand uncertainty and fluctuations created by the global COVID-19 pandemic through adopting a proactive stance. They ensured that their respective populations were able to access vaccines through creating actors dedicated to overseeing vaccine specific policy, such as the vaccine task forces, and by adopting a multisectoral response with targeted funding. However, our findings also indicate that both Canada and the UK would have benefitted from more co-ordinated, consistent, and clear vaccine communications. When health policy makers tried to find the “perfect” way to communicate complex, changing information to the public, they tended to sow confusion and mistrust, creating vaccine hesitancy. Communicating evidence and data in widely accessible ways was important for engendering trust in the policies and processes. The believability of vaccine messages depended on the level of trust in who the messenger was. This varied between Canada and the UK and among different population groups, depending on the level of trust that was shown for politicians vs scientists vs public health doctors. Messaging had to be adapted and targeted for different communities, considering cultural and language differences. While community understanding mattered, approaches that explained the evidence and adopted a compassionate approach that emphasized individual benefits, as well as benefits for those close to an individual, were perceived as being more effective over the longer term than emphasizing community benefits to vaccination. In both countries, adopting an approach that was open, responsive, shared information and created autonomy was seen as more effective than handing policies down from a traditional, rigid hierarchy. In the UK, the framing of vaccination policy as “protect the NHS” had the unintended consequence of worsening access to health care in already deprived communities; doctors abandoned routine activities to prioritise the vaccination programme. Funding of “community championship” schemes in the UK was not proactive, undermining the effort needed to keep vaccine acceptance levels high. At the same time, the UK commissioned key studies that were very valuable in informing vaccine schedules, booster programmes and vaccination of pregnant people, among others, including in other countries such as Canada. With trust for the source and spokesperson at the centre of whether an individual would accept vaccine advice, we see a need for investment in public health outreach work that promotes good relationships with, and among, communities that may have low engagement with vaccination and other health care opportunities. Governments need to have transparent policies on vaccine approval processes that lay people can access and understand. Authentic, ethical statements about what vaccines can and cannot deliver need to be conceived and delivered in good faith. Transparency and open dialogue between the government and historically excluded groups must also be ongoing, as the sudden prioritizing of vaccination raised worries and mistrust in some. We suggest that further study is needed to interrogate the role of trust, especially trust in policy actors. Specifically, how can we expand our understanding of who is a trustworthy leader, especially if they are not in health care, the civil service or elected government? Which potentially important community actors are missing from the COVID-19 story? We have seen in this study that religious leaders can be trusted by many, for example, but what about the influence of women on health care action in communities? And at what point do people switch from wanting to do their duty as citizens of a country, to making a vaccine decision about themselves as individuals? We also suggest that health policy makers prioritise the widest possible global sharing of the best, clearest and most up-to-date scientific information about COVID-19 – and whatever virus comes next – to help reduce the mis/disinformation that spreads like wildfire on social media, creates mistrust and limits vaccine uptake. COVID-19 continues to show us that no individual is immune, even if they are vaccinated