Health Technology Interventions Research Articles

Patient-centered mobile health technology intervention to improve self-care in patients with chronic heart failure: Protocol for a feasibility randomized controlled trial

This randomized controlled trial aims to determine the feasibility and preliminary efficacy of a patient-centered, mobile health technology intervention (iCardia4HF) in patients with chronic Heart Failure (HF). Participants (n = 92) are recruited and randomized 1:1 to the intervention or control group. The intervention group receives a commercial HF self-care app (Heart Failure Storylines), three connected health devices that interface with the app (Withings weight scale and blood pressure monitor, and Fitbit activity tracker), and a program of individually tailored text-messages targeting health beliefs, self-care self-efficacy, HF-knowledge, and physical activity. The control group receives the same connected health devices, but without the HF self-care app and text messages. Follow-up assessments occur at 30 days and 12 weeks. The main outcome of interest is adherence to HF self-care assessed objectively through time-stamped data from the electronic devices and also via patient self-reports. Primary measures of HF self-care include medication adherence and adherence to daily weight monitoring. Secondary measures of HF self-care include adherence to daily self-monitoring of HF symptoms and blood pressure, adherence to low-sodium diet, and engagement in physical activity. Self-reported HF self-care and health-related quality of life are assessed with the Self-care Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire, respectively. Hospitalizations and emergency room visits are tracked in both groups over 12 weeks as part of our safety protocol. This study represents an important step in testing a scalable mHealth solution that has the potential to bring about a new paradigm in self-management of HF.

Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder.

Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention.

Mobile Health Technology Interventions for Suicide Prevention: Systematic Review.

BackgroundDigital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice.ObjectiveThis review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes.MethodsThe following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here.ResultsA total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review.ConclusionsFurther research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice.Trial RegistrationPROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899International Registered Report Identifier (IRRID)RR2-10.2196/resprot.8635

PILOTING A NOVEL DEVICE FOR MONITORING MEDICATION ADHERENCE IN URBAN CHILDREN WITH ASTHMA

Introduction Asthma is the most common chronic disease of childhood. If poorly controlled can considerably lower the quality of life. Medication non-adherence is a major reason for asthma exacerbation. Recent mobile health technology interventions are valid tools that can improve care. We aimed to assess the efficacy of an innovative tracking system for asthma management in children. Methods 26 Patients between the ages of 6 and 17 with a diagnosis of asthma were enrolled for a period of 12 weeks. participants received an electronic monitoring device paired with an app to support adherence to controller inhaler. There were 2 phone call follow-ups at 4 and 8 weeks and a final visit at 12 weeks. Outcomes measured were changes in Asthma Control Test (ACT) score, caregiver satisfaction and medication adherence. Results Our participants were 62% male and 38% female with a mean age of 9.1. Based on ACT scores, 48% of participants with uncontrolled asthma at baseline became controlled at final visit. This improvement was observed at 4 weeks follow up and remained improved until the end of the study. Non-adherence score increased from 1.1 at baseline to 1.9 at final visit (p-value of 0.10). 57% of participants reported no use of rescue medication at final visit vs 36% at baseline. 87% of caregivers reported they will recommend this device to friends. 78% found the device as an effective tool for asthma management. Conclusions This pilot study suggests that the use of an electronic monitoring device may have positive effects on asthma control in children.

Examination of the uses, needs, and preferences for health technology use in adolescents with asthma

Objective: To examine the health technology uses and preferences of adolescents with asthma using a qualitative descriptive individual interview approach. Methods: Twenty adolescents were recruited from regularly scheduled asthma clinic appointments from February to July 2016. Patients were interviewed about their technology use and ways in which health technology could improve their asthma management using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Results: Social media (e.g. Snapchat, Instagram) and general communication (e.g. messaging) were the most common uses of technology while medical reminders (e.g. appointment, refill, medication) were the most common use of health technology. Adolescents identified ways in which health technology could improve their asthma management including (1) tracking symptoms and medication, (2) medical reminders, and (3) asthma and self-management knowledge specifically related to medications and individual action plans. Other themes that emerged included a desire to customize health technology to fit with individual schedules and medical routines and use of health technology data with medical providers. Conclusions: Adolescents and parents experience a number of challenges related to managing asthma, and health technology interventions should focus on ways to improve adherence and self-management. Future research considerations and potential interventions including ways to integrate adolescent preferences with evidence-based interventions are discussed.

Supporting Caregivers of Patients With Cancer: A Summary of Technology-Mediated Interventions and Future Directions.

This paper aims to review literature published on the support of cancer caregivers with health technology. Eighteen articles were reviewed to better understand cancer caregiving and categorized into four different themes: (1) design guidelines, (2) information facilitation, (3) social support, and (4) multicomponent interventions. Analysis of the current articles revealed that there are substantial gaps in knowledge regarding a range of health technologies that facilitate family caregiver support and its distribution to health institutions. Further research is needed in this area, as family caregivers are primary providers of essential elements of care to patients. Future studies should unpack existing barriers that interfere with the development of health technology interventions in cancer care.

Mobile Health Technology Interventions for Suicide Prevention: Protocol for a Systematic Review and Meta-Analysis.

BackgroundPrevious research has reported that two of the major barriers to help-seeking for individuals at risk of suicide are stigma and geographical isolation. Mobile technology offers a potential means of delivering evidence-based interventions with greater specificity to the individual, and at the time that it is needed. Despite documented motivation by at-risk individuals to use mobile technology to track mental health and to support psychological interventions, there is a shortfall of outcomes data on the efficacy of mobile health (mHealth) technology on suicide-specific outcomes.ObjectiveThe objective of this study is to develop a protocol for a systematic review and meta-analysis that aims to evaluate the effectiveness of mobile technology-based interventions for suicide prevention.MethodsThe search includes the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase, PsycINFO, CRESP and relevant sources of gray literature. Studies that have evaluated psychological or nonpsychological interventions delivered via mobile computing and communication technology, and have suicidality as an outcome measure will be included. Two authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, suicidal behavior). Secondary outcomes will be measures of symptoms of depression. Where studies are sufficiently homogenous and reported outcomes are amenable for pooled synthesis, meta-analysis will be performed. A narrative synthesis will be conducted if the data is unsuitable for a meta-analysis.ResultsThe review is in progress, with findings expected by summer 2018.ConclusionsTo date, evaluations of mobile technology-based interventions in suicide prevention have focused on evaluating content as opposed to efficacy. Indeed, previous research has identified mobile applications that appear to present harmful content. The current review will address a gap in the literature by evaluating the efficacy of stand-alone mobile technology tools in suicide prevention. It is imperative that research identifies the evidence base for such tools in suicide prevention in order to inform policy, guide clinical practice, inform users and focus future research.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42017072899; https:// www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42017072899 (Archived by WebCite at http://www.webcitation.org/ 6tZAj0yqJ)

A mobile health technology intervention for addressing the critical public health issue of child mortality

AbstractEvaluations of development initiatives in resource‐poor settings dominate Health Information Technology/Systems research. Yet a dearth of research exists, which documents the design and development of these technological artefacts. Through the lens of Transition Management Framework, this research attempts to address this gap in literature, to describe a particular technology (ie, Supporting LIFE—SL eCCM App) and the way in which its hardware, software, and system configurations interact with the sociocultural and economic context in one rural region of the Malawian community. This study uses a design science perspective to ensure the design and development of a health technology intervention that is relevant and has utility in the context for which it has been built, ie, Malawi Africa. This paper addresses the manner in which the configurations of a mobile Health intervention (known as Supporting LIFE eCCM App) interact within a developing world context. Supporting LIFE eCCM aims to leverage the critical societal issue of reducing child mortality in Malawi, Africa. The design science approach supports the design and build of a health intervention that is a good fit for the “real‐world” health scenario considered. Coupled with Geel's Transition Management Framework, we emphasise the need for a balanced sociotechnical approach to mHealth, placing individuals at the centre of the IT development project while also considering social, economic, and cultural factors. These are key environmental aspects of a development project such as this one.

Switched on or switched off? A survey of mobile, computer and Internet use in a community mental health rehabilitation sample

Background: UK society is undergoing a technological revolution, including meeting health needs through technology. Government policy is shifting towards a “digital by default” position. Studies have trialled health technology interventions for those experiencing psychosis and shown them to be useful.Aims: To gauge levels of engagement with mobile phones (Internet-enabled or cell phone), computers and the Internet in the specific population of community mental health rehabilitation.Method: Two surveys were conducted: with service-users on use/non-use of technologies, and interest in technology interventions and support; and with placements on facilities and support available to service-users.Results: Levels of engagement in this population were substantially less than those recorded in the general UK and other clinical populations: 40.2% regularly use mobiles, 17.5% computers, and 14.4% the Internet. Users of all three technologies were significantly younger than non-users. Users of mobiles and computers were significantly more likely to live in lower support/higher independence placements. Of surveyed placements, 35.5% provide a communal computer and 38.7% IT skills sessions.Conclusions: Community mental health rehabilitation service-users risk finding themselves excluded by a “digital divide”. Action is needed to ensure equal access to online opportunities, including healthcare innovations. Clinical and policy implications are discussed.

Reach Out Churches: A Community-Based Participatory Research Pilot Trial to Assess the Feasibility of a Mobile Health Technology Intervention to Reduce Blood Pressure Among African Americans.

Innovative strategies are needed to reduce the hypertension epidemic among African Americans. Reach Out was a faith-collaborative, mobile health, randomized, pilot intervention trial of four mobile health components to reduce high blood pressure (BP) compared to usual care. It was designed and tested within a community-based participatory research framework among African Americans recruited and randomized from churches in Flint, Michigan. The purpose of this pilot study was to assess the feasibility of the Reach Out processes. Feasibility was assessed by willingness to consent (acceptance of randomization), proportion of weeks participants texted their BP readings (intervention use), number lost to follow-up (retention), and responses to postintervention surveys and focus groups (acceptance of intervention). Of the 425 church members who underwent BP screening, 94 enrolled in the study and 73 (78%) completed the 6-month outcome assessment. Median age was 58 years, and 79% were women. Participants responded with their BPs on an average of 13.7 (SD = 10.7) weeks out of 26 weeks that the BP prompts were sent. All participants reported satisfaction with the intervention. Reach Out, a faith-collaborative, mobile health intervention was feasible. Further study of the efficacy of the intervention and additional mobile health strategies should be considered.

Prioritizing health system and disease burden factors: an evaluation of the net benefit of transferring health technology interventions to different districts in Zimbabwe.

IntroductionHealth-care technologies (HCTs) play an important role in any country’s health-care system. Zimbabwe’s health-care system uses a lot of HCTs developed in other countries. However, a number of local factors have affected the absorption and use of these technologies. We therefore set out to test the hypothesis that the net benefit regression framework (NBRF) could be a helpful benefit testing model that enables assessment of intra-national variables in HCT transfer.MethodWe used an NBRF model to assess the benefits of transferring cost-effective technologies to different jurisdictions. We used the country’s 57 administrative districts to proxy different jurisdictions. For the dependent variable, we combined the cost and effectiveness ratios with the districts’ per capita health expenditure. The cost and effectiveness ratios were obtained from HIV/AIDS and malaria randomized controlled trials, which did either a prospective or retrospective cost-effectiveness analysis. The independent variables were district demographic and socioeconomic determinants of health.ResultsThe study showed that intra-national variation resulted in different net benefits of the same health technology intervention if implemented in different districts in Zimbabwe. The study showed that population data, health data, infrastructure, demographic and health-seeking behavior had significant effects on the net margin benefit for the different districts. The net benefits also differed in terms of magnitude as a result of the local factors.ConclusionNet benefit testing using local data is a very useful tool for assessing the transferability and further adoption of HCTs developed elsewhere. However, adopting interventions with a positive net benefit should also not be an end in itself. Information on positive or negative net benefit could also be used to ascertain either the level of future savings that a technology can realize or the level of investment needed for the particular technology to become beneficial.

Health Technology Intervention After Hospitalization for Schizophrenia: Service Utilization and User Satisfaction.

The authors examined patients' acceptance of the Health Technology Program (HTP), an integrative approach to relapse prevention after hospitalization of adults with schizophrenia or related disorders. The program combines use of digital tools with support from a mental health technology coach (MHTC). Patients with schizophrenia spectrum disorders received six months of treatment that began within 60 days of a psychiatric hospitalization and included the development of a personalized relapse prevention plan, three digital tools, and contacts with MHTCs. A total of 200 patients (mean±SD age=34.6±10.6 years) had 28.2±2.0 contacts with the MHTC that lasted 38.3±14.2 minutes. The most discussed topic was case management (52%), and digital tools were discussed in 45% of meetings. Altogether, 87% of patients used at least one of the digital tools, with 96% of patients rating the HTP as satisfying to at least some extent. These data suggest very high acceptance of the HTP, a program that integrates available human support with digital tools.

Feasibility Study of a Mobile Health Intervention for Older Adults on Oral Anticoagulation Therapy.

Background: Oral anticoagulation treatment (OAT) such as warfarin therapy is recommended for older adults with atrial fibrillation, heart failure, or who are at risk for venous thromboembolism. Despite its proven benefits, older adults report both dissatisfaction with OAT and reduced quality of life that can potentially lead to low adherence to OAT and decreased treatment efficacy. Objective: To test the feasibility of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS), a mobile-based health technology intervention designed to promote independence and self-care. Methods: This pilot study used a single-arm experimental pre–post design to test the feasibility of a 3-month intervention using MASS in 18 older adults (male: n = 14; White: n = 9; Hispanic: n = 7; Other: n = 2; M age = 67). MASS was available in English or Spanish. Participants completed surveys about their OAT knowledge, attitudes, quality of life with OAT, and adherence at baseline and at a 3-month follow-up. Satisfaction with the MASS intervention was also assessed at follow-up. Results: Anticoagulation knowledge significantly improved from baseline to follow-up (Mbase = 12.5 ± 5.51, Mfollow-up = 14.78 ± 3.93, p = .007). Other outcomes were not different, pre- and post-tests. Participants reported they were generally satisfied with MASS, its ease of use and its usefulness. Conclusion: The results showed use of MASS improved older adults’ knowledge of OAT. Using mHealth apps may enhance self-care among older adults with chronic conditions who are also taking oral anticoagulants.

The Role of Mobile Phone Technology in Understanding and Preventing Suicidal Behavior.

In this editorial, we discuss how mobile phone technology has the potential to move the field forward in terms of understanding suicide risk as well as laying foundations for the development of effective treatments/interventions. We have focused on mobile health technology given the rapid growth of mobile health approaches in suicide prevention (De Jaegere & Portzky, 2014; Mishara & Kerkhof, 2013) and psychological research more generally (Myin-Germeys et al., 2009; Nock, Prinstein, & Sterba, 2009; Palmier-Claus et al., 2011) and because mobile phone use is ubiquitous, with 75% of the world having access to a mobile phone (Kay, 2011). (aut. ref.)

Designing a better health technology intervention to support medication management

Our research set out to investigate the potential for a beneficial technology intervention in the area of medication management – an area previously devoid of such support. We chose the design research (DR) method, based on its suitability to handle complexity as evidenced by its use in education and information systems-based research. Our intervention was based on two artefacts – an information model and its implementation as a digital document – which were well accepted by the trial participants. Based on our positive experience, we conclude that DR may very well be a useful and appropriate research approach for studying the application and impact of technology interventions in the health domain.

Poverty, access and immunization in Malawi – a descriptive study

Background: Although a very poor country, Malawi has a good immunisation programme record. But is this programme equitable? If it is, are there lessons to learn for other services that also need to reach the poor? Methods: The performance of the EPI coverage was assessed using DHS and other survey data in relation to socio-economic features and geographical access. Data provided by UNICEF and the Ministry of Health EPI Unit were used to assess coverage. Demographic and Health Surveys of 1992 and 2000 were used to compare immunisation uptake by wealth quintile groups derived from asset scores for each household. Other socio-economic features analysed were the education level of the mother, gender of the child, region of residence, ethnicity, religion and urban or rural residency. Results: The EPI provides an equitable service to rich and poor alike. Coverage is as high in districts with poor access to health facilities as it is in districts with good access. There are no significant differences between ethnic, religious or gender groups. More educated mothers have children with higher immunisation rates. Coverage and inequality have worsened between 1992 and 2000, but not to a significant degree. Conclusions: The EPI in Malawi is both effective and equitable. However, low child survival alongside high immunisation coverage is a reminder that health technology interventions such as EPI may not succeed on their own without improvement in the basic determinants of disease - nutrition, sanitation and mothers\' education. The use of outreach clinics and paid village health workers is an object lesson for other services which need to reach the poor. Malawi Medical Journal Vol. 18 (1) 2006: pp. 19-27

Sample sizes for randomized trials measuring quality of life in cancer patients.

This paper describes the methods appropriate for calculating sample sizes for clinical trials assessing quality of life (QOL). An example from a randomized trial of patients with small cell lung cancer completing the Hospital Anxiety and Depression Scale (HADS) is used for illustration. Sample size estimates calculated assuming that the data are either of the Normal form or binary are compared to estimates derived using an ordered categorical approach. In our example, since the data are very skewed, the Normal and binary approaches are shown to be unsatisfactory: binary methods may lead to substantial over estimates of sample size and Normal methods take no account of the asymmetric nature of the distribution. When summarizing normative data for QOL scores the frequency distributions should always be given so that one can assess if non-parametric methods should be used for sample size calculations and analysis. Further work is needed to discover what changes in QOL scores represent clinical importance for health technology interventions.