eHealth Tools Research Articles

The televideoconsultation in support of home management of the patient with CoViD-19 by general practitioner: the results in some municipalities of the Marche Region.

The lockdown of Italy, the re-orientation of many hospital departments into CoViD-19 patient care wards, the need to prevent the general practitioners from being infected has been arising the need of access to medical care in patients isolated at their homes. The specialists of the De Martinis Telemedicine Panel, addressing e-health issues, have been responding to the requests of general practitioners in 14 municipalities of Marche region, by implementing the televideoconsultation to 98 patients, 68 of whom with, certain, probable or supposed to be CoViD-19 infection. The patients were managed from remote until the symptoms were over. Sixty-five patients adhere the televideoconsultation completely and were cured, also with home oxygen therapy and other treatments additional to the standard anti-inflammatory and antibiotic drugs. However, they got stuck to full isolation while making use of no external human resources for health and relying entirely on the electronic prescription of their general practitioner and the help of the cohabiting family members. Two patients abandoned, including one owing to the lack of support from the cohabiting family member, and addressed themselves to the hospital care. However, they required no mechanical ventilation and were discharged being recovered within shortly. One over 90 years' old patient was hospitalised in agreement with the general practitioner for management problems. The results are discussed in relationship to the procedures put in practice, to the perspectives in the use of clinical televideoconsultation in the Italian health system, mainly in support to the primary health care, and to the limitations due to the poor development of other e-health tools such as the citizen's electronic health record.

Study protocol: CareAvenue program to improve unmet social risk factors and diabetes outcomes- A randomized controlled trial

Despite the burdens costs can place on adults with diabetes, few evidence-based, scalable interventions have been identified that address prevalent health-related financial burdens and unmet social risk factors that serve as major obstacles to effective diabetes management. In this study, we will test the effectiveness of CareAvenue – an automated e-health tool that screens for unmet social risk factors and informs and activates individuals to take steps to connect to resources and engage in self-care. We will determine the effectiveness of CareAvenue relative to standard care with respect to improving glycemic control and patient-centered outcomes such as cost-related non-adherence (CRN) behaviors and perceived financial burden. We will also examine the role of patient risk factors (moderators) and behavioral factors (mediators) on the effectiveness of CareAvenue in improving outcomes. We will recruit 720 patients in a large health system with uncontrolled Type 1 diabetes mellitus (T1DM) or Type 2 diabetes mellitus (T2DM) who engage in CRN or perceive financial burden. Participants will be randomized to one of two arms: 1) receipt of a 15–20 min web-based program with routine follow-up (CareAvenue); or 2) receipt of contact information for existing health system assistance services. Outcomes will be assessed at baseline and 6- and 12-month follow-up.Clinical Trial Registration: ClinicalTrials.gov ID NCT03950973, May 2019

Building quality chronic illness care: implementation of a web-based care plan.

Structured, multidisciplinary approaches to chronic disease management (CDM) in primary care, supported by eHealth tools, show improved clinical outcomes, yet the uptake of eHealth tools remains low. The adoption of cdmNet, an eHealth tool for chronic disease management, in general practice settings, was explored. This was a qualitative case study in three general practice clinics in Melbourne, Australia. Methods included non-participant observation, reflexive note taking and semi-structured interviews with GPs, non-GP clinical staff, administrative staff and patients with chronic conditions. Data were analysed iteratively and results were reviewed at regular team meetings. Findings highlighted the significance of clinical and organisational routines in determining practice readiness for embedding innovations. In particular, clinical routines that supported a structured approach to CDM involving team-based care, allocation of resources, training and leadership were fundamental to facilitating the adoption of the eHealth tool. Non-GP roles were found to be key in developing routines that facilitated the adoption of cdmNet within a structured approach to CDM. Practice managers, administrators and clinicians should first focus on routinising processes in primary care practices that support structured and team-based processes for CDM because without these processes, new technologies will not be embedded.

045 Atrial Fibrillation Screen, Management and Guideline Recommended Therapy (AF SMART II) in the Rural Primary Care Setting: Cost-Effective eHealth Tools to Support all Stages of Screening

045 Atrial Fibrillation Screen, Management and Guideline Recommended Therapy (AF SMART II) in the Rural Primary Care Setting: Cost-Effective eHealth Tools to Support all Stages of Screening

Uptake of a primary care atrial fibrillation screening program (AF-SMART): a realist evaluation of implementation in metropolitan and rural general practice

BackgroundScreening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016–June 2019. These studies trialled custom-designed eHealth tools to support all stages of AF screening in general practice.MethodsA realist evaluation of the AF-SMART studies, which aimed to explain the circumstances in which the program worked (or not) to increase the proportion of people screened for AF. The initial program theory was based on our previous research, policy documents and screening studies. To test this, we conducted 45 semi-structured interviews with general practitioners (GPs), nurses and practice managers across all participating practices, and collected observational and quantitative screening data. These data were analysed and interpreted to refine the program theory.ResultsGPs/nurses liked the eHealth tools, although technical problems sometimes disrupted screening. Time was the main barrier to screening for GPs/nurses, so systems need to be very efficient. Practices with leadership from a senior GP ‘screening champion’ had broader uptake, especially from the nursing team. Providing regular feedback on screening data was beneficial for quality improvement and motivation. Clear protocols for follow-up of abnormal results were required for successful nurse-led screening in a hierarchical system. Participation in the program had broader benefits of improving AF knowledge and raising the profile of cardiovascular health in the practice. Screening for a shorter, more intense period (eg during influenza vaccination) worked well for practices where sufficient staff time was allocated.ConclusionsIntroducing an AF screening program is likely to be successful in contexts where there is a senior GP ‘screening champion’, a clear protocol exists for abnormal results, and there is regular data reporting to staff. These contexts link to mechanisms around motivation, leadership, empowerment of nurses, and efficient screening systems. The contexts and mechanisms contribute to the longer-term outcomes of increasing the proportion of people screened and treated for AF, which is recommended by guidelines as a key strategy for the prevention of AF-related stroke.Trial registrationsAF SMART (metropolitan): ACTRN12616000850471 (Australia New Zealand Clinical Trials Registry).AF SMART II (rural): ACTRN12618000004268 (Australia New Zealand Clinical Trials Registry).

An Electronic Health Tool to Prepare for the First Orthopedic Consultation: Use and Usability Study.

BackgroundThe use of electronic health (eHealth) technology to prepare patients with hip or knee osteoarthritis (OA) for their first orthopedic consultation seems promising. Exploration of the use and usability of an educational eHealth tool may highlight potential modifications that could increase patient engagement and effectiveness.ObjectiveThis study aimed to (1) identify the use and usability of a stand-alone educational eHealth tool for patients with suspected hip or knee OA, (2) explore whether the recorded questions in the eHealth tool were in line with an existing widely used question prompt list, and (3) investigate whether user characteristics are related to use and usability.MethodsWe used data from 144 participants in the intervention group of a randomized controlled trial, who were asked to use the educational eHealth tool to prepare for their upcoming first orthopedic consultation. We defined users and nonusers based on whether they had opened the tool at least once. Users were characterized as active or superficial depending on the extent of their use of the tool. The recorded questions for the consultation preparation were categorized into themes fitting 3 predefined questions or in a remaining category. Usability was measured using the System Usability Scale (SUS, 0-100). Data were collected including the patient demographic and clinical characteristics, knowledge of OA, and internet and smartphone usage in daily life. The characteristics associated with users and nonusers were analyzed using a multivariable logistic regression analysis.ResultsA total of 116/144 (80.6%) participants used the educational eHealth tool, of whom 87/116 (75.0%) were active users. Of the three components of the tool (information, my consultation, and medication), medication was the least used (34%). On the basis of recorded questions of the users, the fourth predefined question could be proposed. The mean (SD) SUS score was 64.8 (16.0). No difference was found between the SUS scores of superficial and active users (mean difference 0.04, 95% CI −7.69 to 7.77). Participants with a higher baseline knowledge of OA (odds ratio [OR] 1.2, 95% CI 1.0 to 1.4) and who used the internet less frequently in their daily life (OR 0.6, 95% CI 0.5 to 0.9) were more likely to use the educational eHealth tool. We found no differences between the demographics and clinical characteristics of the superficial and active users.ConclusionsBased on the results of this study, it can be concluded that the use of an educational eHealth tool to prepare patients with hip and knee OA for the first orthopedic consultation is feasible. Our results suggest some improvements that should be made to the content of the tool to improve its usability. No clear practical implications were found to support the implementation of the educational eHealth tool in specific subgroups.Trial RegistrationNetherlands Trial Register NTR6262; https://www.trialregister.nl/trial/6262

Barriers and Enablers Affecting Successful Implementation of the Electronic Health Service Sisom: Multicenter Study of Child Participation in Pediatric Care.

BackgroundChildren’s participation in health care is one of the most important components in the management of their disease. Electronic health (eHealth) services that are adapted to the needs of children have the potential for restructuring how children and professionals work together. Therefore, a digital interactive assessment and communication tool, Sisom, was developed to give children aged between 6 and 12 years a voice in their own health care. However, the implementation of eHealth services such as Sisom in daily practice in pediatric health care is rarely investigated.ObjectiveThe aim of this study was to explore the process of implementing Sisom for children in pediatric care in Sweden. More specifically, the study aimed to (1) evaluate whether the implementation strategy was conducted as planned, (2) understand the barriers and facilitators of the implementation strategy in pediatric care settings, (3) gain insight into how professionals work with the specific intervention, and (4) gain insight into the usefulness and effects of the intervention from the professionals’ perspectives.MethodsA process evaluation design was used to study the implementation of Sisom at 4 pediatric care centers in Sweden. An extensive amount of qualitative and quantitative data was collected before, during, and after the intervention through self-report checklists, memos, and interviews with professionals. In total, 46 children, aged between 6 and 13 years, participated. The children used Sisom on two occasions during 6 months. When they used Sisom, a printed report formed the basis for a forthcoming dialogue between professionals, children, and their parents.ResultsTo our knowledge, this is the first implementation study of an eHealth communication tool aimed at strengthening children’s participation in pediatric health care. Key factors for successful implementation were alignment of the solution with the values and goals of the organization, health care professionals’ beliefs in the usefulness and usability of the solution, and health care professionals’ willingness to change their professional roles guided by the solution.ConclusionsThe results from the study show that it is possible to restructure health care delivery toward a child-centered approach, if there is a willingness and preparedness in the organization to implement an eHealth solution with the aim of restructuring the way of working with children’s participation.

Using e-health to shorten treatment delay in patients with severe aortic stenosis

Abstract Background Transcatheter aortic valve replacement (TAVR) is a relatively new alternative to open surgery in patients with a severe aortic stenosis at high risk of surgery but there are important variations in treatment delay which can lead to increased morbidity and mortality. Those delays have many causes, including patients’ unawareness of the urgency, delays in obtaining the necessary preoperative tests and organizational factors at the hospital level. The aim of our study was to co-construct an e-health tool for patients and their families to empower them and improve knowledge on the disease and TAVR to ultimately decrease the delay between the medical decision for TAVR and the actual procedure. Methods A prospective study was first carried out to identify organizational factors associated with variations in treatment delay (both at the patient and hospital level). A preliminary survey was sent to all TAVR centers in France to understand and describe their organization. Descriptive analyses were then carried out on the answers. In a second step, two focus groups were carried with, the first with patients and carers and the second with healthcare professionals in order to elaborate the e-health tool. Results A website has been developed for patients and their families. It includes information in video form on aortic stenosis and its different treatments, on TAVR, the necessary tests required prior to TAVR (with a geolocalisation of available facilities nearby so that patients may know where to go), and what they can expect during the hospital admission and after their release. Patients undergoing TAVR will be informed of the website’s existence by their cardiologist. Web pages intended for healthcare professionals who are not TAVR specialists (general practitioners…) will also be available on the website. Conclusions A cluster randomized controlled trial will now test the efficacy and efficiency of the e-health tool in reducing TAVR treatment delay. Key messages We built a e-health tool in collaboration with patients, carers and healthcare professionals to increase patients’ knowledge on aortic stenosis and TAVR. The website will provide information through videos to empower patients and ultimately decrease treatment delay and its associated morbi-mortality.

The Nordic @geing Online project: Co-creating a social application together with older adults

Abstract Background Online resources present various possibilities for health promotion, also in the growing older adult population. Tailored online services aiming to support social participation among users could potentially promote older adults’ psychosocial health. In the @geing Online project an online application is developed, focusing on access to meaningful social activities among older adults in rural areas in Finland and Sweden. The innovation project (2017-2020) is funded by the Interreg Botnia-Atlantica programme (European Regional Development Fund). Methods A collaborative, user-centred design approach is applied when developing the online application, allowing older potential users and personnel groups from the social and health care sector to evaluate application features in a step-wise process. The inclusion of personnel groups allows for the exploration of the feasibility of introducing the tool in home care services and similar relevant contexts from an organizational perspective. Further, the inclusion of regional IT-companies presents opportunities for them to develop their competence regarding eHealth tools and older adults as a target group. Results An advanced prototype of the application and its core features is presented. Promising approaches and outcomes regarding the co-creation methods applied to ensure the involvement of stakeholders in the development process are elaborated upon. Challenging issues related to the project theme, such as stereotypical and negative views of older adults’ competences and motivation related to application use are also discussed. Conclusions The project highlights possibilities - but also challenges - when co-creating a social application together with older adults, some of whom have no experience in internet use. The gathered project outcomes will provide lessons on the potential of new technologies for delivering health promotion initiatives among older adults. Key messages Tailored online services aiming to support social participation among users provide possibilities for promoting psychosocial health in the growing population of older adults. Application development utilizing a user-centered design approach can be implemented even if the end-users are not familiar with the internet or application use.

Workshop: Health Literacy in the workplace: from health literate organizations to resilient individuals

Abstract This workshop aim is to explore the call that is proposed by the WHO declarations of Nairobi and Shangai, that institutions should move forward to become health literate organizations. This workshop addresses qualitative and quantitative health literacy research work settings of health and non-health professionals. Health literacy has evolved into a significant public health and health promotion goal which is especially influenced by the social and cultural background, the availability of resources, and the settings in which it is practised. Basically, health literacy can be defined as the knowledge and skills to access, understand, appraise and apply health information in order to promote health and well-being. For a long period most research had focused on adult patients in clinical settings, but in the recent past there have been significant efforts from research, practice, and policy towards citizens in other organizational settings, which is due to findings stating that effective health literacy promotion begins and continues across all settings in a whole society approach since health is mostly shaped outside the health care setting. Such approaches can also be influential when addressing the reduction of health inequalities. The main objective of this workshop is to present first time empirical findings and developments from ongoing research projects of the Health Literacy in workplace (ProLiSa). Thereby, it will shed light on the health literacy of professionals, and link the current debate with contemporary public health approaches to advance the field of health literacy. The workshop will include 5 presentations with up to 15 minutes input followed by discussions. The first presentation is a tentative to understand health literacy and ehealth tools to improve quality of life. From Brazil a second presentation will consider health care organizations (hospitals) and the perspective to move to health literate organizations. From Portugal a third presentation will consider migration and integration and the case of health literacy as a foundation to promote cultural sensitiveness in the organizational setting. A forth presentation will consider how communicating with migrants can be a challenge and how children’s health literacy, digital technology can become and critical help. Finally the last presentation considers the role of health literacy and physical activity as buffers to counter act work related stress. This workshop offers a forum for researchers, practitioners and policy-makers interested in health literacy. By dialogue and two-way communication lively interaction and vivid discussions will be facilitated. This will allow discussing results with regard to their benefit for improving health literacy research, practice, and policy-making, support further synergies, break down barriers between research infrastructures, facilitate networking and collaboration, and support international capacity building. Key messages There is need for empirical health literacy research in work settings. It will allow informing sustainable and effective interventions and the development and application of better tools. Addressing the social environment will have impact on public health research & practice, will facilitate the development of health literate organizations, new concepts/strategies for health promotion.

Health literacy and ehealth tools to improve quality of life

Abstract Introdution The use of smartphones and apps to achieve numerous goals, has reached a vast number of citizens today in the world. Health related apps (HAPPS) (estimated to be 318.500 in 2017) have become popular, but little is known about their real impact in public health. The goal of this research is to understand what are the most common used HAPPS, how health literacy (HL) mediates their use and to what extent do they contribute to quality of life. Metods The study is observational, cross-sectional and includes both quantitative and qualitative data from an adult population working in the financial corporation. By the means of a survey (CAWI) data was collected about HL (using the European Health Literacy Survey validated to Portugal ((HLS-EU-PT), the use of apps and their influence on quality of life. The sample (n = 748) includes participants from the different offices of the company in Portugal main land and its autonomous territories. Results In this study (58.7% males) 40% of the individuals have between 36 and 45 years old, and 9.2% refer the use of health promotion apps. Of the participants, 7.1% have inadequate, 39.0% problematic, 36.6% sufficient and 17.3% excellent HL (HLS-EU-PT). Content analysis showed the categories most common in this sample were apps for running 44.9% (58.1% males) and health monitoring 26.1% (with 55.6% males). Those who use apps have a slightly higher value of HL than those who don’t use, but this difference is not statistically significant. Conclusions In this sample not more than 10% of individuals are using apps to promote their wellbeing. Implementing research focusing HL, quality of life and the use of mhealth tools is a new field in public health and allow researchers to identify trends that may trigger strategies to implement health promoting strategies in the work setting. More research is needed to understand how mhealth shape the everyday lives of prosumers in their quest for wellbeing.

Development and usability testing of the e-EXCELS tool to guide cancer survivorship follow-up care.

The aim of this study is to describe a user-centered (e.g., cancer survivors and clinicians) development process of an eHealth tool designed to facilitate self-management of cancer survivorship follow-up care. Guided by Cognitive-Social Health Information Processing (C-SHIP) model and informed by core self-management skills, we engaged in a user-centered design process. In phase I, we conducted in-depth interviews with survivors of breast (n = 33), prostate (n = 4), and colorectal (n = 6) cancers, and (n = 9) primary care providers to develop content and design of the web tool. Phase II utilized iterative user testing interviews (n = 9) to test the web-based tool prototype. Data from both phases were independently coded using a template/content analytic approach. The top 5 functions identified in phase I for the web-based platform included: (a) educational materials to learn and prepare for health encounters (80%); (b) questions for health providers (74%); (c) ability to track contact information of providers (67%); (d) provide general information (64%); and, (e) support information (62%). Users of the prototype reported patient burden, tool fatigue, introduction timing of the tool, relevance, and security/privacy as concerns in phase II. This study demonstrates the value of using a theoretically informed and user-centered design process to develop relevant and patient-centered eHealth resources to support cancer survivorship. A larger study is needed to establish the efficacy of this eHealth tool as an intervention to improve adherence to follow-up care guidelines.

New Software for Gluten-Free Diet Evaluation and Nutritional Education.

Following a gluten-free diet (GFD) is the only treatment for celiac disease. This diet must ensure the absence of gluten but also needs to be nutritionally balanced. Dietitians working in this field cannot properly evaluate energy and nutrient intake of celiac people because dietary programs available on the market do not contain the nutritional composition of gluten-free products (GFP). Here we present a new GFD evaluation software that contains more than 700 gluten-free rendered foodstuffs and their macronutrient composition. Apart from diet evaluation and design, the software represents a tool for nutritional education as well, since it shows diet appropriacy and indicates how to promote balanced self-care. Moreover, anthropometric and biochemical data or symptoms presence and diet adherence can be recorded and evaluated. This open free software, can be downloaded in its app format for mobiles and tablets. Software evaluation indicated its correct functionality and the importance of assessing a GFD with GFP instead of with their gluten-containing analogues. Thus, this software represents an essential e-Health tool, not only for proper GFD evaluation, but also for improving life quality of celiac and gluten sensitive people.

Scaling Up: The Challenges of eHealth Systems in Developing Countries

Clinicians want a very useful, portable, and handy tool to use in their practice, which improves workflow and becomes a convenient connectivity channel for applications and information resources. Mobile devices respond to this need by allowing physicians anywhere and anytime, but there are few guidelines to help decide on the acquisition and implementation of large-scale technology in healthcare systems. Upon review of the literature on eHealth, a critical question is raised: why has eHealth projects not been scaled-up across several developing countries? Although research has established that eHealth tools have the potential to affect the healthcare outcomes positively. Using the case of Mobile Technology for Community Health (MOTECH) in Ghana, a theoretical model is used to appraise the critical factors affecting the scalability of eHealth systems. This study focused on the problems from medical officers, community health nurses, volunteers and beneficiary patients’ perspective and tried to bring out the issues that are fundamental in rolling out a successful eHealth solution to the public. The study did not focus only on the technological aspect, but also on the behavioural aspect of eHealth technology, in which the Technology Acceptance Model (TAM) was extended to appreciate the challenges. The model identified technical support, resistance to change and financial constraints as the main obstacles to the adoption and scalability of eHealth systems. The research contributes to the literature by identifying important areas where results can have a positive effect or can be used by health policymakers in Ghana and other developing countries. This can help them understand their concerns and weaknesses when planning the adoption and implementation of e-health systems.

Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study.

BackgroundFor the World Health Organization, electronic health (eHealth) is seen as an effective way to improve therapeutic practices and disease prevention in health. Digital tools lead to major changes in the field of mental medicine, but specific analyses are required to understand and accompany these changes.ObjectiveOur objective was to highlight the positions of the different stakeholders of the mental health care system on eHealth services and tools, as well as to establish professional and user group profiles of these positions and the uses of these services.MethodsIn order to acquire the opinions and expectations of different categories of people, we carried out a qualitative study based on 10 focus groups (n=70, from 3-12 people per group) composed of: general practitioners, psychiatrists, psychologists, social workers, occupational therapists, nurses, caregivers, mental health services users, user representatives, and the general public. The analyses of focus group discussions were performed independently by four investigators through a common analysis grid. The constant comparative method was adopted within this framework.ResultsThe interviewees expressed different problems that new technologies engender in the field of mental health. What was previously strictly under the jurisdiction of physicians now tends to be fragmented and distributed over different groups and locations. New technologies reposition care in the field of domestic, rather than therapeutic, activities, and thus the conception of care as an autonomous activity in the subject’s life is questioned. The ideal of social autonomy through technology is part of the new logic of health democracy and empowerment, which is linked to a strong, contemporary aspiration to perform. Participants emphasized that there was the potential risk of a decrease in autonomy for the digitally engaged patient, while personal empowerment could become a set of obligations.ConclusionsThis qualitative research highlights the heterogeneity of opinions among the groups and within each group. It suggests that opinions on electronic mental health devices are still far from being stabilized, and that a change management process should be set up to both regulate the development and facilitate the use of these tools.

Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy.

BackgroundPublic policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients’ use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized.ObjectiveThis study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized.MethodsWe used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods—preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)—controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers’ use of EMRs explained disparities.ResultsFrom 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P<.001) and 22 additional points postincentive (P<.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (P=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers’ use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models.ConclusionsDisparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients’ use of messaging.

Multidisciplinary Software Design for the Routine Monitoring and Assessment of Pain in Palliative Care Services: The Development of PainCheck

PURPOSEThe use of health information technology (HIT) to support patient and health professional communication is emerging as a core component of modern cancer care. Approaches to HIT development for cancer care are often underreported, despite their implementation in complex, multidisciplinary environments, typically supporting patients with multifaceted needs. We describe the development and evaluation of an e-health tool for pain management in patients with advanced cancer, arising from collaboration between health researchers and a commercial software development company.METHODSWe adopted a research-led development process, involving patients with advanced cancer and their health professionals, focusing on use within real clinical settings. A software development approach (disciplined agile delivery) was combined with health science research methods (ie, diary studies, face-to-face interviews, questionnaires, prototyping, think aloud, process reviews, and pilots). Three software iterations were managed through three disciplined agile delivery phases to develop PainCheck and prepare it for use in a clinical trial.RESULTSFindings from development phases (inception, elaboration, and construction) informed the design and implementation of PainCheck. During the transition phase, where PainCheck was evaluated in a randomized clinical trial, there was variation in the extent of engagement by patients and health professionals. Prior personal experience and confidence with HIT led to a gatekeeping effect among health professionals, who were reluctant to introduce PainCheck to patients. Patients who did use PainCheck seemed to benefit, and no usability issues were reported.CONCLUSIONHealth science research methods seemed to help in the development of PainCheck, although a more rigorous application of implementation science methodologies might help to elucidate further the barriers and facilitators to adoption and inform an evidence-based plan for future implementation.

Preferences for a self-management e-health tool for patients with chronic kidney disease: results of a patient-oriented consensus workshop.

Electronic health (e-health) tools may support patients' self-management of chronic kidney disease. We aimed to identify preferences of patients with chronic kidney disease, caregivers and health care providers regarding content and features for an e-health tool to support chronic kidney disease self-management. A patient-oriented research approach was taken, with 6 patient partners (5 patients and 1 caregiver) involved in study design, data collection and review of results. Patients, caregivers and clinicians from across Canada participated in a 1-day consensus workshop in June 2018. Using personas (fictional characters) and a cumulative voting technique, they identified preferences for content for 8 predetermined topics (understanding chronic kidney disease, diet, finances, medication, symptoms, travel, mental and physical health, work/school) and features for an e-health tool. There were 24 participants, including 11 patients and 6 caregivers, from across Canada. The following content suggestions were ranked the highest: basic information about kidneys, chronic kidney disease and disease progression; reliable information on diet requirements for chronic kidney disease and comorbidities, renal-friendly foods; affordability of medication, equipment, food, financial resources and planning; common medications, adverse effects, indications, cost and coverage; symptom types and management; travel limitations, insurance, access to health care, travel checklists; screening and supports to address mental health, cultural sensitivity, adjusting to new normal; and support to help integrate at work/school, restrictions. Preferred features included visuals, the ability to enter and track health information and interact with health care providers, "on-the-go" access, links to resources and access to personal health information. A consensus workshop developed around personas was successful for identifying detailed subject matter for 8 predetermined topic areas, as well as preferred features to consider in the codevelopment of a chronic kidney disease self-management e-health tool. The use of personas could be applied to other applications in patient-oriented research exploring patient preferences and needs in order to improve care and relevant outcomes.

Changing Sodium Knowledge, Attitudes and Intended Behaviours Using Web-Based Dietary Assessment Tools: A Proof-Of-Concept Study.

Despite public health efforts to reduce dietary sodium, sodium intakes in most countries remains high. The purpose of this study was to determine if using novel web-based tools that provide tailored feedback, the Sodium Calculator and Sodium Calculator Plus, improves users’ sodium-related knowledge, attitudes, and intended behaviours (KAB). In this single arm pre- and post-test study, 199 healthy adults aged 18–34 years completed a validated questionnaire to assess changes to sodium-related KAB before and after using the calculators. After using the calculators, the proportion of participants who accurately identified the sodium adequate intake and chronic disease risk reduction level increased (19% to 74% and 23% to 74%, respectively, both p = 0.021). The proportion accurately self-assessing their sodium intake as ‘high’ also increased (41% to 66%, p = 0.021). Several intended behavioural changes were reported, i.e., buying foods with sodium-reduced labels, using the Nutrition Facts table, using spices and herbs instead of salt, and limiting eating out. Evidence-based eHealth tools that assess and provide personalized feedback on sodium intake have the potential to aid in facilitating sodium reduction in individuals. This study is an important first step in evaluating and optimizing the implementation of eHealth tools to help reduce Canadians’ sodium intakes.

Ecological momentary assessment in posttraumatic stress disorder and coping. An eHealth study protocol

ABSTRACT Background: It is well known from cross-sectional studies that individual coping strategies significantly influence the pathogenesis of posttraumatic stress disorder (PTSD). Equally, undisputed is the role of biological processes, e.g. of the so-called ‘stress hormone’ cortisol for the trajectory of PTSD. Ecological momentary assessment (EMA), the repeated collection of self-reported momentary states via smartphones, is ideal for shedding light upon symptom fluctuations and coping strategies. EMA may also constitute a promising approach to provide closer associations to biomarkers than retrospective self-report. The mobile application ‘CoachPTBS’, created to facilitate transition into health-care systems, bridges waiting periods for trauma-specific psychotherapy. CoachPTBS offers tools akin to EMA that could elucidate coping with stress symptoms. Moreover, the app’s self-management tools may improve coping strategies. However, these processes have never been examined in a combined, longitudinal fashion. Objective: The aim of the current study is to assess symptom fluctuations, coping strategies and long-term endocrine correlates of PTSD by a longitudinal, multimodal approach, combining traditional, online and EMA self-report with hair cortisol data and CoachPTBS as a possible novel mHealth tool. Method: 120 participants waiting for PTSD psychotherapy will be randomly grouped. After in-situ assessment and hair sample collection, 40 will receive CoachPTBS, using it daily throughout 4 weeks. A parallel group of 40 will participate in EMA, completing daily questionnaires on symptoms and coping. In between, online surveys will be conducted. After 6 weeks, a final interview and another hair sample collection will follow. Comparisons between these groups and waitlist-control, also consisting of 40 PTSD participants, and 40 non-traumatized participants assessed via EMA regarding aversive emotions and coping are planned. Discussion: Novel insights into the interplay of biological and coping strategies in PTSD are expected due to the innovative multimodal study design. Results will further explore benefits of eHealth tools on coping with PTSD.