Browsing by Subject "mHealth"

Background

Objective

Methods

Results

Conclusions

Background

Objective

Methods

Results

Conclusions

Trial registration

Problem and Purpose:

Coronary heart disease (CHD) is the second leading cause of death in China. The treatment of CHD typically involves long-term pharmaceutical therapy. For patients with CHD, cardio-protective medications can prevent the enlargement of harmful clots, cardiovascular symptoms, and poor therapeutic outcomes such as uncontrolled high blood pressure, hyperlipidemia, arrhythmia, heart failure, and sudden cardiac death. However, in China, poor adherence to cardio-protective medications has been cited as a public health concern. This poor adherence to cardio-protective medications has been linked to increases in healthcare costs due to poor therapeutic outcomes typically requiring major medical interventions, such as coronary angioplasty and coronary artery bypass grafting.

In China, local primary healthcare clinics are often not the first choice for treatment. Instead, patients with serious illnesses such as CHD prefer to utilize hospitals. Consequently, many of the 100 million people diagnosed with CHD in China receive prescriptions and medication-related knowledge in hospitals only without a primary care clinician to monitor their treatment. Under this healthcare utilization model, patients are often not provided with proper treatment maintenance and knowledge regarding their medication-taking behaviors. This lack of follow-up care decreases patients’ awareness of the importance of taking medications the way they were prescribed.

Mobile health, known as mHealth, is the use of portable electronic devices with software applications to provide healthcare services and manage patient information. China has 1.3 billion mobile phone users, and 97% of Chinese netizens access the Internet by using a mobile phone. These conditions in China are ideal for implementing an mHealth intervention to improve health and practice. The purpose of this study is to develop an mHealth intervention to improve medication adherence among patients with CHD.

Methods:

First, a pilot study with two phases was conducted in the Cardiology Department of West China Hospital, located in Chengdu, China. Phase I was conducted to inform the development of an mHealth intervention by integrating two mobile applications. The content of reminders and educational materials, the frequency and timing of the intervention were developed in this phase. Based on Phase I, the mHealth intervention was refined and an exploratory randomized controlled trial was conducted in Phase II to evaluate the feasibility and acceptability of using mHealth as a tool to assist CHD patients to take their cardio-protective medications. The cohorts of participants in the two phases were mutually exclusive. Next, a larger scale study with 196 participants was conducted to assess if the mHealth intervention could improve medication adherence and relevant health outcomes (systolic blood pressure, diastolic blood pressure, and heart rate) among patients with CHD in comparison to a control group that receives general educational materials over a period of 60 days.

Results:

In the larger scale study, we recruited 230 participants and randomized 116 to the experimental group and 114 to the control group. Of the 230 participants, 34 participants did not provide their baseline data, thus they did not receive the allocated intervention; we collected baseline data from 196 participants. Of the 196 participants, six participants dropped out of the study and nine were lost during the follow-up period. Finally, 181 participants completed the study, 97 in the experiemental group, 84 in the control group. The majority of the participants were married (92.4%), male (80.1%), Han Chinese (93.9%), and living in urban China (82.1%). Participants’ average age was 61 years old, and half were retired (53.9%). Three out of five participants (61.7%) were prescribed at least five medications. The total medication non-adherence score decreased at 60 days and 90 days in both groups when compared to baseline. At 60 days, the mean of the decrease in medication non-adherence score in the experimental group (M = −1.21, SD = 2.59, N = 103) was greater than the decrease in the control group (M = −0.42, SD = 2.63, N = 93), meaning that the medication adherence improved more in the experimental group. Likewise, at 90 days, the mean of the decrease in medication non-adherence score in the experimental group (M = −1.58, SD = 2.49, N = 103) was greater than the decrease in the control group (M = −0.08, SD = 3.15, N = 93). This difference between the two groups was statistically significant at both 60 days (t = 2.04, df = 179, P = 0.04) and 90 days (t = 3.48, df = 155, P < 0.01).

Heart rate decreased at 60 days and 90 days in both groups compared to baseline, but the mean of the decrease was not statistically significant between the two groups at either 60 days (t = -0.28, df = 148, p=0.78) or 90 days (t = 0.32, df = 145, p=0.75). Systolic blood pressure and diastolic blood pressure decreased in the experimental group, but increased in the control group. The mean of the decrease in diastolic blood pressure was statistically significant at both 60 days (t = 2.07, df = 160, p=0.04) and 90 days (t = 2.21, df = 164, p=0.03). The mean of the decrease in systolic blood pressure was statistically significant at 90 days (t = 3.12, df = 165, p < 0.01), but not significant at 60 days (t = 1.92, df = 161, p=0.06). In addition to comparing the mean of the decreases in health outcomes, we also compared the proportional rates of normal systolic blood pressure, diastolic blood pressure, and heart rate between the experimental group and the control group. The proportional rates of normal systolic and diastolic blood pressures in both groups increased at 60 days and 90 days compared to baseline, but the difference between the two groups at both times was not statistically significant. The proportional rate of normal heart rate in both groups decreased at both times, but the difference between the two groups at both times was not statistically significant.

Conclusion:

In this dissertation, a mobile-phone based mHealth intervention was developed for patients with CHD through integrating two mobile applications to improve medication adherence. The intervention delivered medication-taking reminders and educational materials using two mobile applications. The results showed that the mHealth intervention can increase medication adherence, and potentially lower blood pressure among patients with CHD. These findings can serve as a reference for future research to increase medication adherence and lower blood pressure.

Abstract

There are over 250 million children in adversity (CIA) globally; however, insufficient information on prevalence of CIA and their daily needs limits case management of this group by social welfare systems. Recently, mobile technology-based (mHealth) systems have been used successfully to extend health services and information to clients in hard-to-reach, under resourced areas. This study aimed to determine the suitability of mHealth systems for improving case management of CIA in Battambang Province, Cambodia.

Methods used included focus group discussions (FGDs), in depth interview and direct observation with government and NGO social workers, their supervisors and street-based CIA (10-17 years). Data on daily workflows, roles, responsibilities and case management activities of social workers were documented. Mobile phone ownership, use and attitudes among social workers were used to assess suitability of an mHealth tool in the Cambodian context. Daily life experiences and case management needs of CIA were documented.

Our data suggests that routine case management of CIA is limited by low capacity of social workers, logistical constraints, a burdensome paper-based data collection system, scanty resources and poor supportive supervision. All social workers participating in the study owned and used mobile phones, and enthusiasm for further incorporation of these devices into daily work activities was high. Street children came from different situations of adversity, were under-served and had diverse case management needs such as referral to vocational programs, early intervention to prevent violence in the home and continuous follow-up.

An mHealth system could be developed to overcome constraints in case management of CIA by streamlining social worker workflows, facilitating timely data collection, and enabling continuous training of social workers. Such a system, implemented in conjunction with other initiatives to strengthen the social welfare system, could promote better case management for CIA in Cambodia, and globally.

Every day, approximately 800 women die from pregnancy-related complications. Most of these deaths are avoidable. Care from a skilled provider before, during, and after delivery has been shown to prevent a majority of maternal and neonatal deaths. However, time delays in recognizing the need to seek care, accessing health care facilities, and receiving adequate care from a provider of make the delivery of effective maternal healthcare practices very challenging. These three delays disproportionately affect women living in rural and remote regions, where awareness of maternal health problems can be low and health facilities are few and far between. In Kenya, maternal health care in these regions falls upon community health volunteers, who are unpaid and overworked.

In recent years, mobile phones have grown in popularity for improving disease prevention and management, especially in the field of maternal and child health. The intent of this study was to design and pilot a mobile phone-based patient management system intended for use by community health volunteers. Using a human-centered design framework, a system was developed to fit into the CHVs' existing workflows in order to improve the delivery of maternal and child health care at the community level. Integrating both voice and text messaging interfaces, the system was designed to provide the CHVs with a fast and easy method of recording and reporting data, a streamlined approach for tracking patient referrals to a health facility, and a reliable and effective way to report and respond to obstetric emergencies. The system was found to be highly usable based on self-report data from users, who indicated that the system saved them time and helped them complete their responsibilities as CHVs. In all, results of this pilot suggest that such a system may be useful for CHVs in monitoring the health of pregnant women over time and helping to avoid the time delays associated with maternal mortality.

Background

Objective

Methods

Results

Conclusions

Weight bias internalization is considered a chronic discriminatory stressor and a threat to health. Weight bias internalization has known associations with health-depleting behaviors (i.e., disordered eating, social isolation) and avoidance of health-promoting behaviors (i.e., physical activity, adherence to healthcare guidelines). Despite the numerous deleterious health effects of weight bias internalization, relatively few efficacious interventions have been identified for this critical treatment target. Self-compassion training presents itself as a potential intervention, though has not been rigorously tested in those with elevated internalized weight bias. Ruby was a two-arm randomized control designed to reduce internalized weight bias. Ruby tested the efficacy of a 4-week digitally-delivered self-compassion intervention compared to wait list control. Participants in the intervention group received daily text messages which included psychoeducation videos, writing prompts, and guided mindfulness audio files to facilitate daily mindful self-compassion practices ranging from 4-21 minutes per day. The main outcome of this trial was the 4-week reduction in weight bias internalization as measured by the Weight Bias Internalization Scale, compared to wait list control. Trial outcomes were analyzed using linear mixed models and one-way analysis of covariance models using an intent-to-treat framework. Ruby participants were 121 adults with elevated internalized weight bias (i.e., WBIS score > 4.0) and a body mass index over 30 kg/m2. Participants in the intervention demonstrated greater reductions in weight bias internalization compared to the wait list control (Net difference: -0.84, CI: -1.21 to -0.48, p < .0001). Participants in the intervention demonstrated similar reductions in secondary outcomes, including weight self-stigma, weight-related experiential avoidance, and fear of self-compassion (p’s < .05). Additionally, they reported increases in self-compassion, mindfulness, body appreciation, intuitive eating, and physical activity. Mediation analyses suggest that reductions in weight bias internalization are likely partially driven by increases in self-compassion. Ruby was the first digital standalone self-compassion based intervention targeting weight bias internalization. Results suggest that a brief mindful self-compassion intervention can meaningfully reduce internalized weight bias over 4 weeks. Additionally, a mindful self-compassion intervention can reduce several other secondary outcomes related to internalized weight bias. Due to its standalone digital delivery, Ruby may be a highly-scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. Ruby is poised to expand a burgeoning body of literature related to psychological intervention for internalized weight bias.

Background

Objective

Methods

Results

Conclusions

Trial registration