Electronic Health Interventions Research Articles

Effectiveness of eHealth interventions for HIV prevention, testing and management: An umbrella review.

Human immunodeficiency virus (HIV) infection has become a major contributor to the global burden of disease. Globally, the number of cases of HIV continues to increase. Electronic health (eHealth) interventions have emerged as promising tools to support disease self-management among people living with HIV. The purpose of this umbrella review is to systematically evaluate and summarize the evidence and results of published systematic reviews and meta-analyses on the effectiveness of eHealth interventions for HIV prevention, testing and management. PubMed, Embase and the Cochrane Library were searched for reviews. The methodological quality of the included studies was assessed using AMSTAR-2. A total of 22 systematic reviews were included. The methodological quality of the reviews was low or critically low. EHealth interventions range from Internet, computer, or mobile interventions to websites, programs, applications, email, video, games, telemedicine, texting, and social media, or a combination of them. The majority of the reviews showed evidence of effectiveness (including increased participation in HIV management behaviours, successfully changed HIV testing behaviours, and reduced risk behaviours). EHealth interventions were effective in the short term. Ehealth interventions have the potential to improve HIV prevention, HIV testing and disease management. Due to the limitations of the low methodological quality of the currently available systematic reviews, more high-quality evidence is needed to develop clear and robust recommendations.

Recruitment strategies for reaching adults aged 50 years and older with low socioeconomic status for participation in online physical activity interventions.

Generally, the health condition of those with higher socioeconomic status (SES) is better compared to those with lower SES. The application of appropriate strategies to reach low SES populations with electronic health (eHealth) interventions is thus of major importance to reduce health inequalities. eHealth-studies providing detailed information on recruitment strategies are scarce, despite the fact that this information is crucial for comparable research and implementation. To provide insight into the reach, sample characteristics and costs of three pre-planned strategies for recruiting adults aged 50 years and older with low SES for participation in an online physical activity intervention, as part of a field study. Recruitment took place via (1) invitation letters via a municipality, (2) gyms and (3) social media advertisements, aiming to include 400 participants. Additional procedures were followed to reach specifically the low SES group. Response rates, sociodemographic characteristics and costs per strategy were assessed. The highest response was shown for the municipality approach (N = 281), followed by social media (N = 71) and gyms (N = 45). Ten participants were recruited via family/friends. The most low-educated participants were reached via the municipality (N = 128) followed by social media (N = 9), gyms (N = 8) and family/friends (N = 5). Recruitment costs were with €2,142.37 the highest for the municipality compared to €96.81 for social media and no costs for gyms. Recruitment via invitation letters through a municipality has the highest potential for reaching low SES participants of the three applied strategies, although the higher recruitment costs need to be taken into account.

Expanding our understanding of digital mental health interventions for Indigenous youth: An updated systematic review.

Past research has examined available literature on electronic mental health interventions for Indigenous youth with mental health concerns. However, as there have recently been increases in both the number of studies examining electronic mental health interventions and the need for such interventions (i.e. during periods of pandemic isolation), the present systematic review aims to provide an updated summary of the available peer-reviewed and grey literature on electronic mental health interventions applicable to Indigenous youth. The purpose of this review is to better understand the processes used for electronic mental health intervention development. Among the 48 studies discussed, smoking cessation and suicide were the most commonly targeted mental health concerns in interventions. Text message and smartphone application (app) interventions were the most frequently used delivery methods. Qualitative, quantitative, and/or mixed outcomes were presented in several studies, while other studies outlined intervention development processes or study protocols, indicating high activity in future electronic mental health intervention research. Among the findings, common facilitators included the use of community-based participatory research approaches, representation of culture, and various methods of motivating participant engagement. Meanwhile, common barriers included the lack of necessary resources and limits on the amount of support that online interventions can provide. Considerations regarding the standards and criteria for the development of future electronic mental health interventions for Indigenous youth are offered and future research directions are discussed.

Electronic health intervention to manage symptoms of immunotherapy in patients with cancer (SOFIA): Results from a randomized controlled pilot trial.

For patients receiving immune checkpoint inhibitors, early detection of immune-related adverse events (irAEs) is critical for one's safety. To this end, a smartphone app (SOFIA) was developed that featured the assessment of electronic patient-reported outcomes (ePROs) focusing on irAEs as well as a set of comprehensive supportive information. Its feasibility and preliminary efficacywere evaluated in a randomized controlled trial (RCT). Patients who received immune checkpoint inhibition therapy were randomly assigned to an intervention group (IG) or a control group (CG; care as usual). During the 12-week intervention period, IG patients used SOFIA to report twice weekly ePROs and receive cancer- and immunotherapy-relevant contents. Before a patient's next clinical visit, the physician in charge was given the ePRO reports. The primary objective was to test the feasibility of SOFIA. Furthermore, the preliminary efficacy of SOFIA for health-related quality of life (HRQOL), psychosocial outcomes, and medical data was examined. Clinical outcomes were assessed at baseline (T0), post-intervention (T1), and a 3-month follow-up (T2). Seventy-one patients were randomized to the IG (n=34) or the CG (n=37). SOFIA showed high feasibility and acceptance. At T1, patients in the IG reported significantly better HRQOL and role functioning and less depression, distress, and appetite loss. No significant differences were revealed regarding medical data, the utilization of supportive care services, or survival. SOFIA showed high feasibility and acceptance and improved HRQOL and psychosocial outcomes. These results suggest further evaluation of efficacy in a large-scale confirmatory multicenter RCT.

Breathing tech: digital health innovations for managing asthma-related psychological dimensions

The paper aimed to provide a comprehensive overview of the use of digital health technologies in the assessment, treatment, and self-management of psychological and psychopathological factors associated with asthma. A collection of research articles and systematic reviews related to asthma, including topics such as outdoor air pollution, early life wheezing illnesses, atopic dermatitis, digital interventions for asthma self-management, psychiatric disorders and asthma, family influences on pediatric asthma, and the use of mobile health (mHealth) applications for asthma management, were analyzed. Eight selected studies were reviewed to assess the potential of digital health technologies in improving asthma psychological-related factors management and treatment outcomes. The reviewed studies suggest that electronic health (eHealth) interventions, mixed reality tools, mHealth technology-enhanced nurse-guided interventions, and smartphone applications integrating Bluetooth-enabled sensors for asthma inhalers can significantly improve symptom self-management, quality of life, and mental health outcomes, especially in children and adolescents with asthma (JMIR Pediatr Parent. 2019;2:e12427. doi: 10.2196/12427; Cochrane Database Syst Rev. 2018;8:CD012489. doi: 10.1002/14651858.CD012489.pub2; Int J Environ Res Public Health. 2020;17:7750. doi: 10.3390/ijerph17217750; J Med Internet Res. 2017;19:e113. doi: 10.2196/jmir.6994; J Med Internet Res. 2021;23:e25472. doi: 10.2196/25472; Ann Allergy Asthma Immunol. 2015;114:341–2.E2. doi: 10.1016/j.anai.2014.12.017; J Med Internet Res. 2022;24:e38030. doi: 10.2196/38030; Int J Qual Methods. 2021;20:16094069211008333. doi: 10.1177/16094069211008333). However, further research is needed to determine their effectiveness and feasibility in different populations and settings. Tailored interventions that address the specific needs and preferences of patients with asthma and associated psychological factors are crucial for ensuring sustained and equitable use of these technologies. The manuscript emphasizes the importance of addressing psychological factors in the management and treatment of asthma and call for continued research and development in this area.

Barriers and facilitators to acceptance and implementation of eMental-health intervention among older adults: A qualitative systematic review.

Electronic mental health interventions are effective but not well promoted currently among older adults. This study sought to systematically review and summarize the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults. We comprehensively retrieved six electronic databases from January 2012 to September 2022: PubMed, Web of Science, Embase, Scopus, PsycINFO, and CINAHL. The JBI-QARI was used to assess the quality of the research methodology of each publication. Eligible studies underwent data coding and synthesis aligned to inductive and deductive methods. The Consolidated Framework for Implementation Research 2.0 was used as a deductive framework to guide a more structured analysis. The systematic review screened 4309 articles, 17 of which were included (eight with mixed methods and nine with qualitative methods). We identified and extracted the barriers and facilitators of accepting and implementing electronic mental health interventions among older adults: (1) innovation: technology challenges, optimized functions, and contents, security and privacy; (2) outer setting: community engagement and partnerships, financing; (3) inner setting: leadership engagement, available resources, incompatibility, intergenerational support, training and guidance; (4) individuals: perceptions, capability, motivation of older adults and healthcare providers; and (5) implementation process: recruit, external assistance, and team. These findings are critical to optimizing, promoting, and expanding electronic mental health interventions among older adults. The systematic review also provides a reference for better evidence-based implementation strategies in the future.

Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis.

Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults. The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time. A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively. In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.

A digital values-based microintervention for chronic back pain patients: lessons learned from a randomised experimental single-case study

BackgroundChronic pain usually lasts several years. During this time, value-oriented aspects of life often fade into the background in favour of coping with the pain, which is associated with a lower quality of life. Psychotherapeutic methods such as Acceptance and Commitment Therapy can alleviate this. However, for those who suffer from chronic pain, access to such therapies is limited. Electronic health interventions provide access to evidence-based methods. The aim of this study was to investigate the effectiveness and feasibility of a brief electronic values-based intervention on patients with chronic back pain.MethodsA study with a replicated AB single-case experimental design was conducted with 28 participants suffering from chronic back pain. Participants answered daily questions concerning their pain intensity and quality of life (wellbeing, pain catastrophising, acceptance of chronic pain, engaged living) for 10 to 17 days. The subsequent mobile intervention on value-oriented activities lasted an additional 10 days. During this time, daily assessments continued. Our analysis was performed using a hierarchical two-level modelling approach as well as visual and descriptive analysis.ResultsThe majority of participants did not measurably benefit from the intervention. Neither model-based inference nor visual analysis indicated plausible intervention effects. The results of one responder and one non-responder are presented. In their qualitative feedback, most participants described being satisfied with the intervention. The perceived usefulness of psychotherapy as a treatment for chronic back pain increased from pre- to post-intervention (p < .001, dz = 1.17).ConclusionsThis study shows that microinterventions for chronic back pain patients are feasible, but should be planned over a longer period of time to enable measurable changes. The electronic mobile format did not cause participants any difficulties.Trial registrationClinicalTrials.gov ID: NCT05205889, date of registration: January 12, 2022.

Feasibility, Acceptability, and Outcomes of a Mobile Health Tool for Radical Cystectomy Recovery.

Postoperative education and symptom tracking are essential following cystectomy to reduce readmission rates and information overload. To address these issues, an internet-based tool was developed to provide education, alerts, and symptom tracking. We aimed to evaluate the tool's feasibility, acceptability, and impact on complication and readmission rates. Thirty-three eligible patients over 18 years old scheduled for cystectomy were enrolled. Patients were asked to use the mobile health (mHealth) tool daily for the first 2 weeks, then less frequently up to 90 days after discharge. Descriptive statistics were used to summarize study variables. Feasibility was defined as at least 50% of patients using the tool once a week, and acceptability as patient satisfaction of > 75%. Use of the mHealth tool was feasible, with 90% of patients using it 1 week after discharge, but engagement declined over time to 50%, with technological difficulties being the main reason for nonengagement. Patient and provider acceptability was high, with satisfaction > 90%. Within 90 days, 36% experienced complications after discharge and 30% were readmitted. Engagement with the mHealth application varied but was not statistically associated with readmission (P = .21). The study showed that the electronic mobile health intervention for patients undergoing cystectomy was feasible, acceptable, and provided valuable educational content and symptom management. Future larger studies are needed to determine the tool's effectiveness in improving patient outcomes and its potential implementation into routine clinical care.

Electronic Health Interventions for Type 2 Diabetes and Obesity in Hispanic or Latino Adults: A Systematic Review of English and Spanish Studies.

The objective of this study was to synthesize English and Spanish literature to determine whether electronic health interventions (EHIs) such as telehealth, telemedicine, digital health, and mobile health (mHealth) improve A1C, blood glucose, BMI, and/or weight among Hispanic/Latino adults with type 2 diabetes or overweight/obesity in the Americas. Searches were conducted in June 2021 using the Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Health Literature, PubMed, and PsycInfo literature databases. Studies were identified that investigated the effect of an EHI on A1C, blood glucose, BMI, or weight in populations that were ≥12% Hispanic/Latino adults with type 2 diabetes or overweight/obesity, were conducted in the Americas, and were published in English or Spanish. Study quality was determined using the Quality Index Score. Data were extracted and synthesized, and themes were identified. Twenty-five studies met inclusion criteria, including 23 in English (from the United States) and two in Spanish (from Chile). A total of 22 investigated type 2 diabetes, and three investigated overweight/obesity. The studies encompassed 6,230 participants, including 3,413 Hispanic/Latino adults. Sixty-three percent of studies demonstrated significant improvements in A1C or blood glucose and 67% in weight. Thirteen studies offered an EHI in both English and Spanish, and six offered the intervention in either English or Spanish alone. All EHIs involving mHealth exclusively and most (90%) involving more than one electronic modality demonstrated a higher number of significant findings compared with those having only one EHI modality, especially telehealth (44.4%). EHIs lasting ≤12 months had more significant findings (72.7%) than those lasting >12 months (50%). Six studies had industry-related funding, with 83.3% of those demonstrating significant improvements in outcomes. EHIs improved A1C and weight in adults (n = 4,355), including 45.5% Hispanic/Latino adults. mHealth and EHIs using more than one electronic modality and those lasting ≤12 months were especially effective. However, overall study quality was modest. Future research should be conducted in Spanish-speaking countries in Latin America and should compare the effectiveness of different EHI modalities.

Clinical Perspectives on the Development of a Gamified Heart Failure Patient Education Web Site.

Heart failure is a complex, chronic disease that requires self-care to manage, and patients need support and education to perform adequate self-care. Although electronic health interventions to support behavior change and self-care in cardiovascular disease are gaining traction, there is little engaging online education specifically designed for heart failure patients. This paper describes the design and development of a heart failure self-care patient education Web site that integrated gamification, meaning the use of game design elements in a non-game context. We sought feedback on the Web site from a group of heart failure clinicians in a focus group using a semi-structured interview guide, and data were analyzed thematically. Clinician input during the design phase touched on themes such as patients' decision-making in heart failure and older adults' adoption of technology. Clinicians recommended that a narrative gamification technique should reflect real-life dilemmas patients encounter in their self-care. Clinicians also discussed the need to carefully plan reward-based gamification techniques to avoid unintended effects. Overall, a gamified Web site has the potential to support heart failure self-care, but efforts are needed to address the disparity of those with limited computer literacy or access.

Virtual avatars as a new tool for human immunodeficiency virus prevention among men who have sex with men: a narrative review.

Human immunodeficiency virus (HIV) continues to affect sexual and gender minorities, predominantly men who have sex with men (MSM). Stigma, medical mistrust, and apprehension towards discussing sexual health with one's medical provider are significant barriers in seeking or accessing preventive services. Those obstacles could be surpassed through novel digital and electronic health interventions, specifically with virtual avatar technology. Avatars are digital self-representative agents that are controlled with an interactive electronic device. Avatars allow for virtual self-immersion within infinitely customizable environments to practice skill building, fostering relationships and more, through an optional incognito approach. The objective of this narrative review is to examine recent uses of and developments in avatar technology, highlight the personalization attribute of this technology, and evaluate its strengths and limitations as a tool for HIV prevention among MSM. We reviewed recent scientific literature generated by PubMed that use virtual avatar technology in HIV prevention and treatment among populations put at risk. Articles that met the inclusion criteria were then categorized on how the avatar technology was used. We identified eleven studies that met inclusion criteria. Avatar technology was found to create a comfortable environment for participants to address and discuss their sexual behaviors with less hesitation. Avatars can build rapport with populations put at high risk, creating an opportunity for reevaluation of their sexual behavior while assisting them in being able seek information, preventive services, or treatment for HIV or other sexually transmitted infections (STIs). Given the increased use of digital technology in health and prevention, avatars might be useful in sexual health education and HIV prevention among populations put at risk. The benefits and potential in utilizing this technology for HIV prevention are highlighted.

A Meta-Analysis of eHealth Interventions on Ischaemic Heart Disease Health Outcomes.

Electronic Health (eHealth) interventions as a secondary prevention tool to empower patients' health in decision-making and behaviour. With the growing body of evidence supporting the use of eHealth interventions, the intention is to conduct a meta-analysis on various health outcomes of eHealth interventions among ischaemic heart disease (IHD) patients. Based on PRISMA guidelines, eligible studies were searched through databases of Web of Science, Scopus, PubMed, EBSCOHost, and SAGE (PROSPERO registration CRD42021290091). Inclusion criteria were English language and randomised controlled trials published between 2011 to 2021 exploring health outcomes that empower IHD patients with eHealth interventions. RevMan 5.4 was utilised for meta-analysis, sensitivity analysis, and risk of bias (RoB) assessment while GRADE software for generating findings of physical health outcomes. Non-physical health outcomes were analysed using SWiM (synthesis without meta-analysis) method. This review included 10 studies, whereby, six studies with 895 participants' data were pooled for physical health outcomes. Overall, the RoB varied significantly across domains, with the majority was low risks, a substantial proportion of high risks and a sizeable proportion of unclear. With GRADE evidence of moderate to high quality, eHealth interventions improved low density lipoprotien (LDL) levels in IHD patients when compared to usual care after 12 months of interventions (SMD -0.26, 95% CI [-0.45, -0.06], I2 = 0%, p = 0.01). Significance appraisal in each domain of the non-physical health outcomes found significant findings for medication adherence, physical activity and dietary behaviour, while half of the non-significant findings were found for other behavioural outcomes, psychological and quality of life. Electronic Health interventions are found effective at lowering LDL cholesterol in long-term but benefits remain inconclusive for other physical and non-physical health outcomes for IHD patients. Integrating sustainable patient empowerment strategies with the advancement of eHealth interventions by utilising appropriate frameworks is recommended for future research.

Effects of Face-to-Face and eHealth Blended Interventions on Physical Activity, Diet, and Weight-Related Outcomes among Adults: A Systematic Review and Meta-Analysis.

An increasing number of studies are blending face-to-face interventions and electronic health (eHealth) interventions to jointly promote physical activity (PA) and diet among people. However, a comprehensive summary of these studies is lacking. This study aimed to synthesize the characteristics of blended interventions and meta-analyze the effectiveness of blended interventions in promoting PA, diet, and weight-related outcomes among adults. Following the PRISMA guidelines, PubMed, SPORTDiscus, PsycINFO, Embase, and Web of Science were systematically searched to identify eligible articles according to a series of inclusion criteria. The search was limited to English language literature and publication dates between January 2002 and July 2022. Effect sizes were calculated as standardized mean difference (SMD) for three intervention outcomes (physical activity, healthy diet, and weight-related). Random effect models were used to calculate the effect sizes. A sensitivity analysis and publication bias tests were conducted. Of the 1561 identified studies, 17 were eligible for the systematic review. Studies varied in participants, intervention characteristics, and outcome measures. A total of 14 studies were included in the meta-analyses. There was evidence of no significant publication bias. The meta-analyses indicated that the blended intervention could lead to a significant increase in walking steps (p < 0.001), total PA level (p = 0.01), and diet quality (p = 0.044), a significant decrease in energy intake (p = 0.004), weight (p < 0.001), BMI (p < 0.001), and waist circumferences (p = 0.008), but had no influence on more moderate-to-vigorous physical activity (MVPA) or fruit and vegetable intake among adults, compared with a control group. The study findings showed that blended interventions achieve preliminary success in promoting PA, diet, and weight-related outcomes among adults. Future studies could improve the blended intervention design to achieve better intervention effectiveness.

EHealth to improve psychological functioning and self-management of people with chronic kidney disease: a randomized controlled trial.

Psychological distress is common among patients with chronic kidney disease (CKD), and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL eHealth care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with CKD not on dialysis ( N = 121). Primary outcome of the open two-arm parallel randomized controlled trial in 4 Dutch hospitals was psychological distress at post-test directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life (HRQoL), self-efficacy, chronic disease self-management, and personalized outcomes, i.e., perceived progress compared to the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, HRQoL, self-efficacy, and chronic condition self-management, whereas ANCOVAs showed significantly more perceived progress in the intervention group at post-test on personally prioritized areas of functioning, b = 0.46, 95%CI[0.07, 0.85], and self-management, b = 0.55, 95%CI[0.16, 0.95], with Cohen's d s of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. Compared to regular care only, the eHealth intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly post-intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments.Trial Registration: Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).

Improving physical and psychological outcomes of cardiac patients using the Naluri app: A study protocol for a randomized controlled trial

Background: Coronary artery disease (CAD) continues to be a significant burden to public health. Poor treatment and management can lead to more severe cardiac events that could result in death or disability. Early interventions like cardiac rehabilitation programs can provide patients the required knowledge, skills and support to recover from and prevent more cardiac events. Electronic health (eHealth) interventions have potential to complement hospital-based rehabilitation programs. This study aims to investigate the effectiveness of the Naluri app in improving health behaviours, clinical and psychological outcomes in a sample of cardiac patients in Malaysia. Methods: This study is a two-arm, parallel, superiority randomized control trial to be conducted at the Malaysian National Heart Institute. A total of 200 patients will be randomly assigned to either a 16-week theory-based Naluri app in addition to usual care (treatment) or to usual care only (control). Outcomes will be measured at baseline and at 16 weeks. Health behaviour outcomes include physical activity and diet. Clinical outcomes include BMI, hemoglobin A1c (HbA1c), and lipid levels. Psychological outcomes include anxiety, depression, and health related quality of life (HRQOL). The Naluri app theoretical framework is based on the Health Action Process Approach (HAPA) theory. Risk perception, self-efficacy, planning, intentions, outcome expectancies, illness perceptions and psychological outcomes will be measured using self-reported measures. Discussion: This trial will determine the effectiveness of the Naluri app intervention in improving various outcomes of cardiac patients after four months. It will provide data on the applicability of the HAPA theory in Mobile health (mHealth) intervention and the acceptance and efficacy of mHealth as a cardiac rehabilitation program for patients in Malaysia. The results may inform the potential implementation of the app for use with patients with other chronic illnesses like diabetes, stroke, and depression. Registration: Australia New Zealand Clinical Trials Registry (14/01/2019, ACTRN12619000104156).

Discrepant Perceptions of Biopsychosocial and Active Care Recommendations Between Doctors of Chiropractic and Midlife and Older Adult Patients: A Descriptive Survey

ObjectiveThe purpose of this study was to assess perceptions about the inclusion of biopsychosocial and active care recommendations during chiropractic clinical encounters between doctors of chiropractic (DCs) and their midlife and older adult patients and to identify whether there were any discrepancies between their recollections. MethodsThis descriptive cross-sectional survey was part of a mixed-methods research project designed to gather information about the role of electronic health interventions for midlife and older adults who use chiropractic care. For this study, a convenience sample of 29 DCs and 48 chiropractic patients aged 50 years and older from 2 metropolitan areas in the United States completed online surveys between December 2020 and May 2021. The survey matched questions about components of chiropractic care discussed by patients and providers over 12 months. We used descriptive statistics to explore congruence in perceptions between groups and qualitative content analysis to describe DC perceptions of working with this population. ResultsDoctors of chiropractic and patients agreed (>90%) that pain management was the top reason midlife and older adults seek chiropractic care, yet differed in their prioritization of maintenance/wellness care, physical function/rehabilitation, and injury treatment as care drivers. While DCs reported frequent discussions about psychosocial recommendations, fewer patients reported talking about treatment goals (51%), self-care (43%), stress reduction (33%), or the impact of psychosocial factors (23%) and beliefs/attitudes (33%) on spinal health. Patients reported varied recollections about discussing activity limitations (2%) and exercise promotion (68%), being taught exercises (48%), or reassessing exercise progress (29%), which differed from higher levels reported by DCs. Qualitative themes from DCs included psychosocial considerations in patient education, importance of exercise/movement, role of chiropractic in lifestyle changes, and reimbursement limitations for older patients. ConclusionDoctors of chiropractic and their patients reported discrepant perceptions about biopsychosocial and active care recommendations during clinical encounters. Patients reported modest emphasis on exercise promotion and limited discussion on self-care, stress reduction, and psychosocial factors related to spine health compared to the recollections of DCs who reported frequent discussions of these topics.

Impact of the first COVID–19 lockdown on the lifestyle of elementary school children

Abstract COVID-19 lockdown affects people's daily routine and has an impact on their lifestyle. Recent studies documented associations between body weight changes and children's lifestyle during social isolation. Childhood obesity is associated with a higher risk of COVID-19 severity and mortality. Our aim was to assess the effects of lockdown due to the COVID-19 pandemic on children's sleep, screen time, physical activity, and eating habits. 387 parents of five elementary school students between 16 and 26 June 2020 were interviewed through an online questionnaire. Physical activity level decreased (63.8%), sleep (60.9%) and screen (5.64 ± 3.05 h/day) times and food intake (39.8%) increased. 80.6% of parents reported changes in children's diet: increased consumption of fruits and vegetables (32.4%), breakfast (15.5%), water and sugar-free beverages (17.6%), snacks (40.4%), sugary drinks (9.9%) was observed. Body weight increased in 44.4% of children. The results of the survey conducted under GYERE®-Children's Health Program are in line with the international literature findings: body weight change during the quarantine is significantly associated with food intake, snacking, sugary drinks, and we also found association with fruit and vegetable consumption and lack of breakfast. Effective strategies and electronic health interventions are needed to prevent sedentary lifestyle and obesity during lockdown.

Access to and use of health information technology among obese and non-obese Americans: Analysis of the Health Information National Trends Survey data

Introduction: Health information technology (HIT) is essential in the prevention, management, and treatment of obesity due to the medical data and information available to health care providers and patients. However, exploration of HIT access and use among obese individuals remains limited. Objective: The purpose of this study was to compare access to and use of HIT among obese and non-obese Americans. Methods: We considered cross-sectional secondary data from 3,865 United States adults that were collected through the Health Information National Trends Survey in 2020. Contingency tables were performed stratifying between men and women to assess whether they differed according to body mass index (BMI) levels with respect to HIT categories. Results: Elevated BMI in women was associated with the use of a computer, smartphone, or other electronic device to e-mail or use the Internet to communicate with a doctor or a doctor’s office. In addition, elevated BMI in both genders was associated with sharing information from a smartphone/electronic device with a health professional. Finally, the use of an electronic device to monitor or track health or activity was found to be more prevalent among women with elevated BMI compared to those with normal BMI. Conclusion: Future studies should expand research in terms of interventions linked to health information technology in adults with obesity by considering the gender factor. Moreover, the expansion of research into electronic health (eHealth) interventions is particularly important because it would favour the prevention, management, control, and treatment of obesity.

Assessing health electronically for adolescent and young adult oncology patients (AHEAD Study).

1568 Background: Screening and counseling for health risk behaviors (RB) are recommended but infrequently performed, particularly in individuals undergoing cancer therapy. Unmet needs among adolescents and young adults (AYAs) with cancer translate to poor physical and psychosocial outcomes. The authors aimed to 1) modify an existing RB electronic health assessment (eHA) and intervention tool and 2) determine the feasibility and acceptability of the RB eHA and intervention tool among AYAs with cancer and their oncology providers. Methods: The internally developed HRB eHA and intervention tool Check Yourself was adapted by a multidisciplinary healthcare professional panel for an AYA oncology population and informed by literature review and AYA stakeholder feedback. “Check Yourself Oncology” assesses risk and health domains including home, education, sexual health, safety, alcohol/drugs, mental health and medication adherence. Optional feedback is provided for sexual health, safety, alcohol/drugs and mental health domains. Eligible AYAs were 13 to 29 years old, diagnosed with cancer, receiving cancer directed therapy, follow-up scheduled with a Seattle Children’s Hospital oncology physician or nurse practitioner, and fluent in English. 72 hours prior to their next oncology clinic visit, participants were text messaged or emailed a personalized link to the Check Yourself Oncology tool to be completed prior to their next visit. Upon completion, a detailed report was sent to the primary clinical oncology team prior to the patient’s visit. Feasibility was defined as 1) ≥70% completion of the RB eHA and 2) a Feasibility of Intervention Measure (FIM) mean score &gt;4. Acceptability was defined as an Acceptability of Intervention Measure (AIM) mean score &gt;4 and qualitatively. The FIM and AIM were sent by REDCap survey following the clinical visit; verbal feedback from AYAs and clinicians was analyzed with qualitative content analysis. Results: Of 30 eligible, approached AYAs, 25 (83%) enrolled in the study and 23 (76%) completed the Check Yourself Oncology tool and follow-up assessments. The AYAs had a mean age of 17 years (SD = 2.9 years) and 50% identified as female. Four AYAs declined participation due to lack of interest, 1 due to declined parental consent, 1 passively declined after enrollment, and 1 declined further participation following the confidentiality terms. The mean FIM and AIM scores were 4.1 (SD=0.6) and 4.0 (SD =0.7) respectively. Seventeen AYAs (74%) felt that the feedback provided was relevant and useful. 74% of visits providers reported that they incorporated the results in the care of the patient and 87% reported the results positively impacted care. Conclusions: Risk behavior screening with motivational feedback though the modified eHA tool Check Yourself Oncology is feasible and acceptable in AYAs undergoing cancer directed therapy. Clinical trial information: NCT04484194.