Digital Diary Research Articles

The choices and consequences of seeking care for chronic conditions for disadvantaged populations in Malaysia and the Philippines

Abstract Disadvantaged populations in LMICs suffering from chronic conditions are often forced to make care choices that increase the risk of receiving substandard care and facing catastrophic bills. These negative impacts widen health disparities across social, economic and urban-rural lines. This study aimed to understand the economic consequences of the choices made by those living with NCD in disadvantaged communities in Malaysia and the Philippines. Using hypertension as a tracer condition, we analysed longitudinal data from surveys of 1200 hypertensive adults from low-income communities in both countries to estimate the prevalence and drivers of catastrophic health expenditure and the coping strategies employed. Interviews and digital diary data from a sub-sample of 80 participants was analysed thematically to elicit how such choices lead to sub-optimal management of their condition. More Filipino households with at least one hypertensive adult experienced catastrophic health spending (40% threshold) than in Malaysia (14.3% vs. 0.4%). Although the average cost of clinic visits in the Philippines was much higher than what was observed in the public sector-dominated system in Malaysia, consultation fees were main drivers of costs in Malaysia, while medication costs predominated in the Philippines (accounting for 38.6% and 70.5% of typical household health expenditure respectively). In both countries, nearly all diagnosed participants were taking antihypertensive medications, however, levels of adherence varied. Participants cited the unavailability, cost and adverse effects of antihypertensives as reasons for poor adherence, delaying treatment and substituting prescriptions. Understanding the barriers faced by disadvantaged populations in LMICs and the ways that they overcome them as they seek care for a chronic disorder may challenge the assumptions of decision makers, and is crucial for designing responsive and equitable health systems that leave none behind.

Short fatigue questionnaire: Screening for severe fatigue.

Objective. To determine psychometric properties, a cut-off score for severe fatigue and normative data for the 4-item Short Fatigue Questionnaire (SFQ) derived from the multi-dimensional fatigue questionnaire Checklist Individual Strength (CIS).Methods. Data of previous studies investigating the prevalence of fatigue in ten chronic conditions (n = 2985) and the general population (n = 2288) was used to determine the internal consistency (Cronbach's alpha) of the SFQ, its relation with other fatigue measures (EORTC QLQ-30 fatigue subscale and digital fatigue diary), a cut-off score for severe fatigue (ROC analysis) and to examine whether the four SFQ items truly measure the same construct. Norms were calculated for ten patient groups and the Dutch general population.Results. Cronbach's alpha of the SFQ were excellent in almost all groups. Pearson's correlations between the SFQ and the EORTC-QLQ-C30 fatigue subscale and a fatigue diary were respectively 0.76 and 0.68. ROC analysis showed an area under the curve of 0.982 (95% CI: 0.979–0.985) and cut-off score of 18 was suggested which showed a good sensitivity (0.984) and specificity (0.826) as well as excellent values for the positive and negative prediction values within all groups using the CIS as golden standard. Factor analysis showed a one factor solution (Eigenvalue: 3.095) with factor loadings of all items on the factor being greater than 0.87.Conclusion. The SFQ is an easy to use, reliable and valid instrument to screen for severe fatigue in clinical routine and research.

Capturing the psychological well-being of Chinese factory workers

PurposeBusinesses are under pressure to ensure social responsibility in their globalised supply chains. However, conventional factory audits are not providing adequate data about production workers’ well-being. Industry attempts to measure working conditions have shown bias and inconsistency, and there is no consensus on what to measure, or how. Well-being can be intangible and difficult to capture without appropriate theoretical and methodological frameworks. This paper investigates factors influencing the well-being of a Chinese factory’s workers, tests an innovative research method, and proposes interventions to improve well-being in factories.Design/methodology/approachThis is a longitudinal study using the diaries of production workers at a large assembly manufacturing site in China. Workers left daily digital voice diaries about their day, which were analysed to identify factors related to their well-being at work.FindingsThe picture is more complex than the concerned Western narrative suggests. Workers’ personal and professional concerns extend beyond the criteria currently measured in audits, tending to be more relational and less about their physical state.Practical implicationsThe current approach of auditing management practices neglects workers’ well-being. This study offers a more comprehensive view of well-being and tests a new method of investigation.Originality/valueThis is the first study to use diary methods in a Chinese factory. It addresses an issue supported by little empirical evidence. It is the first longitudinal study to hear from factory workers themselves about how they are and what impacts their well-being daily.

Survey of production animal veterinarians' prescription practices, factors influencing antimicrobial drug use, and perceptions of and attitudes toward antimicrobial resistance.

To assess production animal medicine veterinarians' prescription practices and identify factors influencing their use of antimicrobial drugs (AMDs) and their perceptions of and attitudes toward antimicrobial resistance (AMR). 157 production animal veterinarians in the United States. An online cross-sectional survey and digital diary were used to gather information regarding perceptions on AMD use and AMR and on treatment recommendations for production setting-specific disease scenarios. Results were compared across respondents grouped by their selected production setting scenarios and reported years as veterinarians. The most commonly selected production setting disease scenarios were dairy cattle (96/157 [61.1%]), backgrounding cattle (32/157 [20.4%]), and feedlot cattle (20/157 [12.7%]). Because few respondents selected swine (5/157 [3.2%]) or poultry (4/157 [2.5%]) scenarios, those responses were excluded from statistical analysis of AMD prescription practices. Most remaining respondents (147/148 [99.3%]) reported that they would recommend AMD treatment for an individual ill animal; however, responses differed for respondents grouped by their selected production setting scenarios and reported years as veterinarians when asked about AMD treatment of an exposed group or high-risk disease-free group. Most respondents reported that government regulations influenced their AMD prescribing, that owner and producer compliance was a veterinary-related factor that contributed to AMR, and that environmental modifications to prevent disease could be effective to mitigate AMR. Results of the present study helped fill important knowledge gaps pertaining to prescription practices and influencing factors for AMD use in production animal medicine and provided baseline information for future assessments. This information could be used to inform future interventions and training tools to mitigate the public health threat of AMR.

Digital narrative medicine for the personalization of epilepsy care pathways

Among neurological conditions, epilepsy is the disorder best suited to a narrative approach. In epilepsy, the disease, i.e., the condition from the clinical and therapeutic point of view, the illness, the personal experience and impact of the condition, and the sickness, the representations, and social imaginary of epilepsy, are strongly interdependent. Within this context, the Italian League Against Epilepsy (LICE) has launched a multiyear narrative program in Italy resulting in the foundation of a specific Study Group on Narrative Medicine in Epileptology. The Epimena Study is part of this program and involves the “Epilepsy Center, Department of Human Neurosciences, Sapienza University of Rome and Umberto 1° Hospital”. The study consists of a pilot project whose aim is to assess the usefulness and feasibility of integrating narrative medicine methodologies into routine clinical practice through a digital platform. The carrying out of the study is based on the acquisition of narrative elements of the patient that the referring doctor uses, integrating them with clinical data, to share and customize the diagnostic–therapeutic pathway of patients. The Epimena Study preliminary results look encouraging. Over 12 months, 57% of the invited patients (37 out of a total of 65) decided to formalize their registration in the digital diary, and 46% responded to one or more narrative prompt generating the story of their experience. Every patient story was then analyzed according to a methodology (Illness Digital StoryMap - IDS) that made it possible to detect the existential impact of the disease and the perception of care. Patients' overall judgment on the project was positive. Through it, they were able to better focus on themselves, bringing out and communicating information to the physician that otherwise would not have been taken into consideration. The majority of patients involved believe that the methodology should be included in the regular clinical practice or in any case would like to continue using it. The data collected confirmed that the time spent on story sharing contributed objectively to a clinical practice of greater quality and effectiveness.

Using Paradata to Evaluate Youth Participation in a Digital Diary Study.

We analyze recruitment, access and longitudinal response paradata from a year-long intensive longitudinal study (mDiary) that used a mobile-optimized web app to administer 25 bi-weekly diaries to youth recruited from a birth cohort study. Analyses investigate which aspects of teen recruitment experiences are associated with enrollment and longitudinal response patterns; whether compliance behavior of teens who require multiple invitations to enroll differs from that of teens who enroll on the first invitation; and what personal and social circumstances are associated with different longitudinal compliance patterns. Latent Class Analysis (LCA) is used to derive longitudinal compliance classes. mDiary's person-survey response rate of 70 percent is noteworthy considering reports that response rates for smartphone studies trail those administered via telephone or personal computers. Conditional on agreeing to participate, teens with texting capability were over six times as likely to enroll as their peers lacking access, and they also completed 6-7 more diaries. Youth who required multiple prods to register not only were less likely to enroll than their peers who registered at the first invitation, but also tended to attrite early. Compared with teens who completed all 25 surveys, those who attrited early had less access to texting capability, home Internet service, and had low-education mothers. Consistent with studies of adults, nonparticipants were disproportionately black males from socioeconomically disadvantaged backgrounds.

Hiking, Sense of Place, and Place Attachment in the Age of Globalization and Digitization: The Israeli Case

Based on the premise that hiking in Israel is strongly related to constructs of sense of place and place attachment, this study analyzes the motivations and experiences of hikers along the Israel National Trail. To this end, it employs diverse methods, including ethnographic methods such as participant observations and informal interviews, questionnaires, analysis of digital communications, diary analysis, and autoethnography. The findings indicate that the main motivations and experiences of Israeli hikers pertain to “getting to know” the Land of Israel “with their feet,” becoming connected to the land, and feeling a strong sense of Israeli identity. They also indicate that the current relationships among different concepts of “sense of place,” “place identity,” “place dependence,” and “place attachment” in the age of globalization and digitization are blurred and unclear, but that they nonetheless play a significant role in hiking in Israel and Israeli leisure activities in general.

1011 Sleep Duration Moderates the Association Between Next-Day Physical Activity and Pain Intensity Among Women with Fibromyalgia

Abstract Introduction Suboptimal sleep has been consistently associated with greater next-day pain intensity among women with fibromyalgia. In contrast, associations between physical activity and same-day pain in this population are contradictory. Given this inconsistency, we aimed to determine whether the daily physical activity-pain association is modified by sleep parameters. Methods This micro-longitudinal study used data collected using wrist-worn triaxial accelerometers over seven consecutive days by 44 adult women with fibromyalgia. Derived variables included sleep duration, sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) and maximum daily physical activity count. Participants also completed digital diaries of refreshed sleep upon awakening (scale 0-100), and pain intensity (5x/day, scale 0-100). Multilevel linear regression models with interaction terms were used to investigate moderating effects of sleep on the next-day person-centered maximum physical activity-average pain intensity association. Results The sample mean age was 44 (SD 14). A total of 304 days of data were available for analysis. Mean sleep duration was 471min(SD 66); mean SOL 10min(SD 10); mean WASO 31min(SD 17), and mean SE 90%(SD 5). Sleep duration moderated the next-day maximum physical activity-pain association (Wald statistic p=0.01). After nights of both shorter (<7 hours) and longer sleep (>8 hours), higher levels of next-day maximum physical activity (compared to the participant’s overall study average) were associated with days of greater average pain. In contrast, after nights of 7-8 hours of sleep, higher levels of next-day maximum physical activity were associated with days of lower average pain. Conclusion An association between higher maximum physical activity and lower levels of pain was only observed after nights of 7-8 hours sleep. Engaging in physical activity is recommended for fibromyalgia-related pain management. Optimizing sleep duration may be useful in minimizing physical activity-related pain in this clinical population. Support DW is supported by a Foundation Fellowship Versus Arthritis. The study that provided data was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number K01AR064275;PI:ALK). The Michigan Institute for Clinical & Health Research provided subject recruitment support through the UMHealthResearch.org website (MICHR:NIH award number UL1TR002240).

Unraveling the Relationship Between Itching, Scratch Scales, and Biomarkers in Children With Alagille Syndrome.

Pruritus is a debilitating symptom for patients with Alagille syndrome (ALGS). In a previously reported trial of maralixibat, an investigational antipruritic agent, itching was assessed using a digital diary based on twice‐daily caregiver observation of itching severity (Itch Reported Outcome, ItchRO[Observer]). The goal of this study was to characterize pruritus in participants with ALGS at baseline in this trial, as assessed by the ItchRO instrument and the physician‐observed clinician scratch scale (CSS), relative to biomarkers putatively associated with pruritus and health‐related quality of life assessment. Thirty‐seven participants with ALGS (median age of 6 years; range 1‐17 years) were enrolled. No association was identified between CSS and ItchRO(Obs) (r = 0.22, P = 0.2). Neither CSS nor ItchRO were associated with serum bile acids (r = −0.08, P = 0.6 for both) or autotaxin (r = 0.22, P = 0.2; r = 0.28, P = 0.12). There was no significant association between Pediatric Quality of Life Inventory total parent scores and CSS or ItchRO (r = −0.23, P = 0.2; r = −0.16, P = 0.36). There was a significant association between ItchRO and Multidimensional Fatigue Scale and Family Impact Module total scores (Pearson correlation coefficient −0.575, P = 0.0005; 0.504, P = 0.002). In exploratory analysis, selected questions relating to fatigue and sleep disturbance (n = 12) from Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale, and Family Impact Module were correlated with pruritus scores; positive associations were identified. Conclusion: Itching scores did not correlate with each other, nor with putative serum biomarkers of pruritus, and further, did not correlate with quality of life. Hypothesis‐generating analyses implicate sleep disturbance and fatigue as key associations with caregiver observations of itching. This is highly relevant to the selection of surrogate endpoints for clinical trials of pruritus therapies.

Efficacy of the Ascure Smoking Cessation Program: Retrospective Study.

BackgroundSmoking cessation helps extend a healthy life span and reduces medical expenses. However, the standard 12-week smoking cessation program in Japan has several notable problems. First, only 30% of participants complete this program. Second, participants may choose not to participate unless they have a strong motivation to quit smoking, such as health problems. Third, the program does not provide enough support during the period between clinical visits and after 12 weeks.ObjectiveThis study examined the efficacy of the 24-week ascure program to address the problems of accessibility and continuous support. The program combines online mentoring, over-the-counter pharmacotherapy, and a smartphone app.MethodsUsing a retrospective study design, we investigated data for 177 adult smokers who were enrolled in the ascure smoking cessation program between August 2017 and August 2018. The primary outcomes were continuous abstinence rates (CARs) during weeks 9-12 and weeks 21-24. To confirm smoking status, we performed salivary cotinine testing at weeks 12 and 24. We also evaluated the program adherence rate. Finally, we performed exploratory analysis to determine the factors associated with continuous abstinence at weeks 21-24 to provide insights for assisting with long-term continuous abstinence.ResultsThe CARs of all participants for weeks 9-12 and weeks 21-24 were 48.6% (95% CI 41.2-56.0) and 47.5% (95% CI 40.0-54.8), respectively. Program adherence rates were relatively high throughout (72% at week 12 and 60% at week 24). In the analysis of the factors related to the CAR at weeks 21-24, the number of entries in the app’s digital diary and number of educational videos watched during the first 12 weeks were significant factors.ConclusionsThe ascure program achieved favorable CARs, and participants showed high adherence. Proactive usage of the smartphone app may help contribute to smoking cessation success in the long-term.

The Digital Story of Science: Experiences of Pre-Service Science Teachers

The purpose of the study is examination of the quality of digital stories developed by pre-service science teachers and deeply investigating pre-service teachers’ experiences related to scientific concepts, the characteristics of scientific knowledge and the ways of reaching scientific knowledge in the stages of exploration, storytelling and digitalization. A case study design is used in the research. Criterion sampling was used from the purposeful sampling methods. The research was carried out with the 3th year 36 pre-service teachers who study at a public university in Turkey during the fall semester of 2018-2019. Rubric for Evaluation of Digital Stories, semi-structured reflection form and digital diaries form developed by researchers were used for data collection. Content analysis technique was applied to analyze the reflections and dairies, and the digital stories prepared by the participants were evaluated using the Digital Storytelling in Educational Context Rubric (DSECR) form. According to the findings, most of the digital stories prepared by pre-service science teachers were at high quality level. Participants stated that they used scientific concepts in their digital stories and transferred the characteristics of scientific knowledge to digital environment and scenarios. Additionally, science teachers' experience of preparing digital stories supported 21st century skills.

The relationship between sleep disturbance, symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology

Objective/backgroundSleep disturbance is common in individuals with psoriasis and appears to be related to both physical and psychological factors. We sought to examine whether psoriasis symptoms, night-time arousal and low mood predicted subsequent objective and self-reported sleep; and whether objective and self-reported sleep predicted next-day psoriasis symptoms and day-time functioning. Participants/MethodsA total of 19 individuals (Female: 11 [57.9%], median age: 39 years) with chronic plaque psoriasis and poor sleep quality (mean Pittsburgh Sleep Quality Index, PSQI = 9.11) participated. Momentary assessments of psoriasis symptoms, mood and daytime functioning were completed at five pseudo-random intervals each day for 15 days using time-stamped digital diary entry. Objective sleep was estimated using wrist-worn actigraphy. Self-reported sleep and night-time arousal were assessed each morning using validated measures. Results and conclusionsTwo-level random intercept models showed that increased night-time arousal was associated with poorer diary-reported sleep. Neither self-reported nor objective sleep parameters were associated with daytime psoriasis symptoms in bi-directional analyses. Diary-reported sleep predicted next-day functioning, specifically sleepiness, concentration, and fatigue. Actigraphy-defined total sleep time predicted next-day fatigue. Night-time arousal is associated with poorer self-reported sleep in people with psoriasis, and sleep predicts next-day functioning. Contrary to our hypothesis, sleep disturbance does not appear to be associated with momentary assessments of psoriasis symptoms.

Application of narrative medicine in oncological clinical practice: impact on health care professional.

Narrative medicine makes explicit the experience of disease and enhances the subjective view in the cure. In addition, the narrative approach involves personal experience and emotional resonances of the health care professional leading him to redefine the values in terms of health and disease. The IMPERO study aims to explore the personal "life experience" of health care professionals involved in studies exploring a new methodological clinical approach: the use of a digital narrative diary in collecting and integrating theme-oriented narration in clinical practice. Qualitative study based on the interviews of three health care professionals (two oncologists and one nurse) involved in the AMENO study. The main topic of the interviews was the "perceived" and the intimate experience of each health care professional, particularly on the meaning and the role regarding their personal and professional experience while coping with patients narration. The analysis of data focuses on three aspects: a) the health care professionals' point of view using the diary as a tool for narrative-based medicine; b) the work environment as a framework for the use of the digital diary; c) the mental construction concerning the meaning of the tool and its preliminary use in clinical practice. The diary is appreciate as a tool for the application of narrative-based medicine; the reading/writing format is considered of high quality and suitable for clinical practice processes. The narration drives a change in the patient-health care professional relationship: the patient is valued as an "individual". An atmosphere of empathy and greater intimacy is created. The perceptions developed over the years of clinical practice, which reflect personal and professional concepts (knowledge and individual believes in illness, health, healing, etc.), influence the perception of the narrative instrument and its clinical use. The work context influences the use of the diary, limiting its potential. Narrative medicine is a way of reorganizing the criteria that contribute in defining the quality of patient care by focusing on the patient-health care professional relationship. The approach of narrative medicine must be reviewed in the light of the relational systemic theory which allows us to understand several aspects: the training in narrative medicine itself, the acquisition of professional skills by practitioners, and the organizational development of the institutions (the organizational structures but also the values and professional culture of work).

Coping with Fears in Everyday Urban Mobility

The paper is focused on the interrelations between citizens’ everyday mobilities and the ways they cope with urban fears. It describes situations when people expect and experience security threats that trigger their fears, while moving in the city. To deal with fears urban citizens develop coping strategies - a set of actions that helps them to manage their emotional experiences. Coping strategies transform various elements of everyday urban mobility and, thus, rearrange and redefine it. The paper is based on semi-structured interviews with Moscow residents and digital diaries of emotions.

Users\u2019 acceptability of a mobile application for persons with type 2 diabetes: a qualitative study

BackgroundThe use of mobile health apps is now common in diabetes self-management and acceptability of such tools could help predict further use. There is limited research on the acceptability of such apps: use over time, the factors and features that influence self-management, how to overcome barriers, and how to use an app in relation to health-care personnel.In this study, we aimed to obtain an in-depth understanding of users’ acceptability of a mobile app for diabetes self-management, and to explore their communication with health-care personnel concerning the app.MethodsThe study had a qualitative descriptive design. Two researchers conducted 24 semi-structured in-depth interviews with adults with type 2 diabetes who had used a digital diabetes diary app for 1 year, during participation in the Norwegian Study in the EU project RENEWING HeALTH. We recruited the participants in a primary health-care setting. The transcripts of the interviews were analyzed using qualitative content analysis on developing themes, which we interpreted according to a theory of acceptability. We used NVivo 11 Pro during the process.ResultsThe users’ acceptability of the app diverged. Overall, the responses indicated that the use of a digital diabetes diary requires hard work, but could also ease the effort involved in following a healthy lifestyle and better-controlled levels of blood glucose. Crucial to the acceptability was that a routine use could give an overview of diabetes registration and give new insights into self-management. In addition, support from health-care personnel with diabetes knowledge was described as necessary, either to confirm the decisions made based on use of the app, or to get additional self-management support. There were gradual transitions between practical and social acceptability, where utility of the app seems to be necessary for both practical and social acceptability. Lack of acceptability could cause both digital and clinical distress.ConclusionsBoth practical and social acceptability were important at different levels. If the users found the utility of the app to be acceptable, they could tolerate some lack of usability. We need to be aware of both digital and clinical distress when diabetes apps form a part of relevant health-care.Trial registrationsSelf-management in Type 2 Diabetes Patients Using the Few Touch Application, NCT01315756, https://clinicaltrials.gov/show/NCT01315756 March 15, 2011.

An Evaluation of Digital Health Tools for Diabetes Self-Management in Hispanic Adults: Exploratory Study

BackgroundAlthough multiple self-monitoring technologies for type 2 diabetes mellitus (T2DM) show promise for improving T2DM self-care behaviors and clinical outcomes, they have been understudied in Hispanic adult populations who suffer disproportionately from T2DM.ObjectiveThe objective of this study was to evaluate the acceptability, feasibility, and potential integration of wearable sensors for diabetes self-monitoring among Hispanic adults with self-reported T2DM.MethodsWe conducted a pilot study of T2DM self-monitoring technologies among Hispanic adults with self-reported T2DM. Participants (n=21) received a real-time continuous glucose monitor (RT-CGM), a wrist-worn physical activity (PA) tracker, and a tablet-based digital food diary to self-monitor blood glucose, PA, and food intake, respectively, for 1 week. The RT-CGM captured viewable blood glucose concentration (mg/dL) and PA trackers collected accelerometer-based data, viewable on the device or an associated tablet app. After 1 week of use, we conducted a semistructured interview with each participant to understand experiences and thoughts on integration of the data from the devices into a technology-facilitated T2DM self-management intervention. We also conducted a brief written questionnaire to understand participants’ self-reported T2DM history and past experience using digital health tools for T2DM self-management. Feasibility was measured by device utilization and objective RT-CGM, PA tracker, and diet logging data. Acceptability and potential integration were evaluated through thematic analysis of verbatim interview transcripts.ResultsParticipants (n=21, 76% female, 50.4 [SD 11] years) had a mean self-reported hemoglobin A1c of 7.4 [SD 1.8] mg/dL and had been diagnosed with T2DM for 7.4 [SD 5.2] years (range: 1-16 years). Most (89%) were treated with oral medications, whereas the others self-managed through diet and exercise. Nearly all participants (n=20) used both the RT-CGM and PA tracker, and 52% (11/21) logged at least one meal, with 33% (7/21) logging meals for 4 or more days. Of the 8 possible days, PA data were recorded for 7.1 [SD 1.8] days (range: 2-8), and participants averaged 7822 [SD 3984] steps per day. Interview transcripts revealed that participants felt most positive about the RT-CGM as it unveiled previously unknown relationships between lifestyle and health and contributed to changes in T2DM-related thoughts and behaviors. Participants felt generally positive about incorporating the wearable sensors and mobile apps into a future intervention if support were provided by a health coach or health care provider, device training were provided, apps were tailored to their language and culture, and content were both actionable and delivered on a single platform.ConclusionsSensor-based tools for facilitating T2DM self-monitoring appear to be a feasible and acceptable technology among low-income Hispanic adults. We identified barriers to acceptability and highlighted preferences for wearable sensor integration in a community-based intervention. These findings have implications for the design of T2DM interventions targeting Hispanic adults.

A Novel Smoking Cessation Smartphone App Integrated With a Mobile Carbon Monoxide Checker for Smoking Cessation Treatment: Protocol for a Randomized Controlled Trial.

BackgroundSmoking cessation treatment programs have been widely available for patients with nicotine dependence. Despite intensive programs, the continuous abstinence rate (CAR) from weeks 9-12 is still about 50%. Recently, a smartphone app emerged as a novel tool for therapeutic interventions, including nicotine dependence. In this study, we developed “CureApp Smoking Cessation” (CASC), which consists of a smartphone app for patients and a Web-based patient management software for doctors with a mobile carbon monoxide (CO) checking device to improve the efficacy of the smoking cessation treatment.ObjectiveThis study aims to evaluate whether the CASC app is effective for individuals with nicotine dependence in addition to standard smoking cessation programs.MethodsThis will be a randomized, sham-controlled, open-label, multicenter trial. We will recruit participants with nicotine dependence, but are otherwise healthy adults. We will randomize and allocate participants 1:1 to the CASC treatment group or a control app group. Both groups will receive a 12-week standard smoking cessation program with pharmacotherapy and counseling. In addition, participants in the treatment group will have the CASC app installed on their smartphone, which will provide video tutorials, advice from an artificial intelligence nurse, a digital diary, and measure daily exhaled CO concentration. In contrast, the control group will have the control app installed on their smartphone, where all the functions that can potentially effect smoking cessation are removed. The primary outcome will be the biochemically validated CAR from weeks 9-24. The success of smoking cessation will be defined as self-reported continuous abstinence from weeks 9-24 and exhaled CO concentration ≤10 ppm both at weeks 12 and 24. The main secondary outcomes will be the CAR from weeks 9-12, weeks 9-52, and 7-day point prevalence abstinence at weeks 4, 8, 12, 24, and 52.ResultsWe will recruit 580 participants with nicotine dependence from October 2017 to September 2018 or until the recruitment process is complete. The final 52-week follow-up will be completed in October 2019. We expect all trial results to be available by the end of 2019. The trial is funded by CureApp, Inc.ConclusionsThis is the first randomized controlled trial to evaluate the efficacy of CASC. We expect that CASC, in addition to standard smoking cessation programs, has a significantly higher CAR during weeks 9-24 than the control app.Trial RegistrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN000031589; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033555International Registered Report Identifier (IRRID)DERR1-10.2196/12252

A escrita-currículo da perspectiva cultural da Educação Física: por que os professores fazem o que fazem?

Na esteira do exemplo de Deleuze-professor, o presente artigo problematiza os elementos a partir dos quais 10 docentes constroem o currículo cultural da Educação Física, ou seja, os aspectos didático-metodológicos que mobilizam e as forças que os atravessam quando pensam as atividades de ensino. Como forma de produção de dados, empregamos o Diário de Bordo Digital e o Grupo de Discussão. Nas análises realizadas mediante o confronto com o referencial deleuze-guattariano, observamos que a “escrita-currículo” é produzida no entrecruzar de infinitas linhas, algumas molares (as leis educacionais, as regras e normas do regimento escolar, o Projeto Político Pedagógico), outras moleculares (a cultura dos alunos, seus desejos, atitudes, falas, as disposições espaciais, temporais e os princípios pedagógicos) e, por fim, as linhas de fuga, que, sendo efêmeras, passam pela “escrita-currículo” como acontecimentos e agenciamentos inesperados, disruptivos e criadores. Atentos e desejando tais agenciamentos, os professores e professoras, sensíveis às linhas de força flexíveis, fazem da “escrita-currículo” um acontecimento sempre traduzido, singular, diferente, especial, raro e único.

InMyDay: a study on input styles for a digital diary for older users

Diary studies are used to gather user information in their natural context. Despite the advantages of digital diaries, older users are not able to fully benefit from them, e.g. due to decreased motor and cognitive abilities, and low digital skills. This work presents InMyDay, a digital diary application specifically designed and implemented for older users. The goal of this work is twofold: first, we research whether older users are able to record activities and reflect on their emotions using a digital diary. Then, using the results of this first phase, we implemented three input styles for the second version of the digital diary: voice, stylus, and keyboard. Overall, 23 older users participated in evaluations aimed at improving the design of the diary and understanding their input style preferences. We found that the older adults used the diary to reflect on their emotions, registering positive as well as negative emotions. We also found that the variety of choices in input styles helped the participants select the option most suited to their particular needs and preferences. Future work will focus on evaluating the digital diary over a longer period of time, to analyze variables such as long-term adoption and motivation, as well as trends in the selection of input styles.

Use of In-Game Rewards to Motivate Daily Self-Report Compliance: Randomized Controlled Trial.

BackgroundEncouraging individuals to report daily information such as unpleasant disease symptoms, daily activities and behaviors, or aspects of their physical and emotional state is difficult but necessary for many studies and clinical trials that rely on patient-reported data as primary outcomes. Use of paper diaries is the traditional method of completing daily diaries, but digital surveys are becoming the new standard because of their increased compliance; however, they still fall short of desired compliance levels.ObjectiveMobile games using in-game rewards offer the opportunity to increase compliance above the rates of digital diaries and paper diaries. We conducted a 5-week randomized control trial to compare the completion rates of a daily diary across 3 conditions: a paper-based participant-reported outcome diary (Paper PRO), an electronic-based participant-reported outcome diary (ePRO), and a novel ePRO diary with in-game rewards (Game-Motivated ePRO).MethodsWe developed a novel mobile game that is a combination of the idle and pet collection genres to reward individuals who complete a daily diary with an in-game reward. Overall, 197 individuals aged 6 to 24 years (male: 100 and female: 97) were enrolled in a 5-week study after being randomized into 1 of the 3 methods of daily diary completion. Moreover, 157 participants (male: 84 and female: 69) completed at least one diary and were subsequently included in analysis of compliance rates.ResultsWe observed a significant difference (F2,124=6.341; P=.002) in compliance to filling out daily diaries, with the Game-Motivated ePRO group having the highest compliance (mean completion 86.4%, SD 19.6%), followed by the ePRO group (mean completion 77.7%, SD 24.1%), and finally, the Paper PRO group (mean completion 70.6%, SD 23.4%). The Game-Motivated ePRO (P=.002) significantly improved compliance rates above the Paper PRO. In addition, the Game-Motivated ePRO resulted in higher compliance rates than the rates of ePRO alone (P=.09). Equally important, even though we observed significant differences in completion of daily diaries between groups, we did not observe any statistically significant differences in association between the responses to a daily mood question and study group, the average diary completion time (P=.52), or the System Usability Scale score (P=.88).ConclusionsThe Game-Motivated ePRO system encouraged individuals to complete the daily diaries above the compliance rates of the Paper PRO and ePRO without altering the participants’ responses.Trial RegistrationClinicalTrials.gov NCT03738254; http://clinicaltrials.gov/ct2/show/NCT03738254 (Archived by WebCite at http://www.webcitation.org/74T1p8u52)