Months Of Engagement Research Articles

The impact of an AI-driven personal health platform on cardiovascular disease risk

Cardiovascular disease (CVD) is a global health concern, particularly among older adults, linked to fat and sugar-rich diet, inactivity, tobacco smoking, as well as genetic factors. Regular exercise and a balanced diet are recommended to reduce CVD risk. Recently, the use of computer of mobile phone application platforms have become promenent tools for personal health interventions and guidance. Although research findings of the efficacy of mobile health apps has had mixed results, improved user health and lowered risk of CVD has been seen with regular engagement. Shae, an AI-driven mobile health platform, offers personalized lifestyle guidance based on an individual's phenotype. The aim of this study is to assess whether engagement with the online platform, Shae, decreases Framingham non-laboratory CVD risk score over time.The study collected data from 1684 participants who engaged with the Shae online platform for at least 3-months between May 2014 and March 2018. After applying exclusion criteria, 5225 complete assessment entries remained for analysis. The Shae platform assessed health, predicted future risks, and recommended personalized interventions. Data included anthropometric measurements and survey responses, converted for standardized analysis. Descriptive statistics were calculated for participants' characteristics and compared across gender and age groups, in alignment with established cardiovascular disease (CVD) risk factors. A linear mixed-effect regression model was employed to assess changes in CVD risk over time. This research aimed to evaluate the impact of personalized health interventions on CVD risk in diverse demographic groups.CVD risk score, when adjusted for age, decreased by 11.2% following 24 months of engagement with the Shae app, with men 45 years and older seeing the largest decrease (16.1%), and the lowest decrease seen in women under 55 years (10%). Use of the Shae app was primarily by women (85%).This study assessed the impact of engagement with the mHealth app, Shae, on reducing CVD risk. Results revealed a significant CVD risk reduction, notably in men over 45. mHealth apps like Shae provide personalized health assessments, activity tracking, nutrition advice, and medication reminders, enabling proactive cardiovascular health management. Increased physical activity and better blood pressure control were key factors in risk reduction. Tailored interventions for high-risk groups align with previous research. Given the importance of preventing CVD, mHealth apps hold promise. This 24-month study offers robust insights, and the focus on individual phenotypes enhances engagement and health outcomes.

Abstract PS02-08: The Effect of a Digital Health Coaching Program on Patient Reported Outcomes of Women with Breast Cancer

Abstract Background Understanding the impact of a digital health coaching (DHC) program on patient-reported outcomes in women with breast cancer is imperative as web-based platforms and mobile phone applications to address health care needs flood the marketplace. This study evaluated the effect of a DHC program on patient-reported outcomes, including global health (primary outcome), symptom burden, quality of life, healthcare utilization, and financial toxicity among women undergoing active treatment for breast cancer. Methods English-speaking adult women undergoing active treatment for breast cancer were randomized to receive usual care or a 6-month DHC program, consisting of weekly telephone calls from a Health Advisor, unlimited patient-initiated communication via phone, text, or email, and digital delivery of additional health-behavior content. Patient-reported outcomes (PROs) were collected using validated measures at baseline, and 1, 3, and 6 months. Summary statistics were used to describe participant characteristics. Linear mixed models were used to assess the effect of the intervention on outcomes. Results Participants (n=254, planned enrollment=440) were enrolled from August 2019 to December 2022 and randomized equally to the control and intervention groups (n=127 each). Demographic data are presented in Table 1. Participants had a mean age of 48 (SD =10.15) years; 74% were White; 19.7% were Hispanic. In both groups, several PRO scores changed over time with some improving (quality of life and symptom severity) and others worsening (symptom interference and financial toxicity) compared to baseline (time effects). Of those enrolled in the intervention group 69% were retained in the DHC program, with an overall average of 4.6 months of engagement for all participants. There were no significant group (intervention versus control) effects or group by time interaction effects observed. Trends within and between groups are presented in Table 2. Though not statistically significant, there were fewer ER visits in the intervention group at each timepoint. Conclusions: While differential improvements in the DHC group were not observed, interesting trends in PROs over the 6-month enrollment period were observed in both groups. Participants reported improvements in quality of life and worsening of financial toxicity. Interestingly, slight improvements in symptom severity over time were observed in both groups while symptom interference worsened. Potential reasons for failure to detect a treatment effect for DHC may include ineffectiveness of DHC on the selected outcomes, the intervention not being strong enough as currently delivered to detect a treatment effect, varying uptake of DHC in the intervention group, heterogeneity of the sample, or the study being underpowered due to COVID restrictions affecting enrollment. Table 1. Demographic and clinical characteristics of the study population (n = 254) Table 2. Trends in Patient Reported Outcomes and Healthcare Utilization Citation Format: Meagan Whisenant, Eileen Hacker, Loretta Williams, Joyce Dains, Bryan Fellman, Trinity Isaac, Valerie Shelton, Austin Barr, Carolyn Harty, Mazi Rasulnia, Kelly Brassil. The Effect of a Digital Health Coaching Program on Patient Reported Outcomes of Women with Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS02-08.

Examining body mass index and health-related fitness marker progression of incarcerated minority youth engaged in a sport-leadership program

PurposeThe purpose of this study was to examine the impact of a sport-leadership program on minority incarcerated young adults’ health-related fitness markers.Design/methodology/approachThis study occurred at an all-male juvenile detention center. A total of 41 participants in this study were obtained from a sample of 103 incarcerated young adults. Data collection entailed body mass index (BMI) evaluation, cardiovascular endurance tests and 1-min pushups and situps at two different time periods (before and after three months). A 2 × 2 mixed factorial analysis of variances was used to test for differences among the within subjects’ factors (time [pre × post]) and between subjects’ factors (groups [flex × control]) for the above-mentioned dependent variables.FindingsOver the course of three consecutive months of engagement, preliminary indications demonstrated participants had a slight reduction in BMI and significant increases in cardiovascular endurance and muscle strength. Contrarily, during this same time period, non-participating young adults exhibited significant increases in BMI and decreases in cardiovascular endurance and muscle strength.Originality/valueIntegration of sport-leadership programs is generally not free but can be a low-cost alternative for combatting many issues surrounding physical activity, weight gain and recreational time for those incarcerated.

Assessing layered HIV prevention programming: optimizing outcomes for adolescent girls and young women.

To assess how exposure to multiple, layered interventions predicts HIV-related outcomes among adolescent girls (15-19 years) and young women (20-24 years) in Kenya. Survey data from adolescent girls and young women (n = 736) with 14-16 months of engagement with DREAMS, a comprehensive HIV prevention program that provides a range of health education, life skills, social protection, and social and behaviour change interventions. Nonparametric recursive partitioning technique - classification and regression tree (CART) - to identify the best predictors (DREAMS interventions) for achieving the desired HIV-related outcomes (consistent condom use and no transactional sex or sexual violence). Among adolescent girls, schooling support reduced the likelihood of engaging in transactional sex, whereas schooling support and exposure to parenting program reduced the likelihood experiencing sexual violence. Likelihood of consistent condom use increased among adolescent girls with exposure to preexposure prophylaxis (PrEP), schooling support, and the violence prevention programming. Among young women, multiple pathways reduced the likelihood of engaging in transactional sex: exposure to the male sexual partner program; exposure to the youth fund program; exposure to the violence prevention program; or exposure/engagement with schooling support, parenting programming, and the youth fund program. For young women, consistent condom use increased with schooling support and male partner engagement. Additionally, engagement in violence prevention program and male partner engagement increased the likelihood of not experiencing sexual violence among young women. Exposure to a combination of DREAMS interventions predicted outcomes that can reduce HIV risk among AGYW, though the pathways differed by outcome and age group.

Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience.

To describe the implementation of multi-criteria decision analysis (MCDA) into a Canadian public drug reimbursement decision-making process, identifying the aspects of the MCDA approach, and the context that promoted uptake. Narrative summary of case study describing the how, when, and why of implementing MCDA. Faced with a fixed budget, a pipeline of expensive but potentially valuable drugs, and potential delays to drug decision making, the Ministry of Health (i.e., decision makers) and its independent expert advisory committee (IAB) sought alternative values-based decision processes. MCDA was considered highly compatible with current processes, but the ability as a stand-alone intervention to address issues of opportunity cost was unclear. The IAB nevertheless collaboratively voted to implement an externally developed MCDA with support from decision makers. After several months of engagement and piloting, implementation was rapid and leveraged strong pre-existing formal and informal communication networks. The IAB as a whole rates new submissions which serves as an input into the deliberative process. MCDA can be a highly adaptable approach that can be implemented into a functioning drug reimbursement setting when facilitated by (i) a truly limited budget; (ii) a shared vision for change by end-users and decision makers; (iii) using pre-existing deliberative processes; and (iv) viewing the approach as a decision framework rather than the decision (when appropriate). Given the current limitations of MCDA, implementing an academically imperfect tool first and evaluating later reflects a practical solution to real-time fiscal constraints and impending delays to drug approvals that may be faced by decision makers.

H3Africa partnerships to empower clinical research sites to generate high-quality biological samples.

BackgroundThe Institute of Human Virology Nigeria (IHVN) – Human Heredity and Health in Africa (H3Africa) Biorepository (I-HAB) seeks to provide high-quality biospecimens for research. This depends on the ability of clinical research sites (CRS) – who provide biospecimens – to operate according to well-established industry standards. Yet, standards are often neglected at CRSs located in Africa. Here, I-HAB reports on its four-pronged approach to empower CRSs to prepare high-quality biospecimens for research.ObjectivesI-HAB sought (1) to assess a four-pronged approach to improve biobanking practices and sample quality among CRSs, and (2) to build human capacity.MethodsI-HAB partnered with two H3Africa principal investigators located in Nigeria and Ghana from August 2013 through to May 2017 to debut its four-pronged approach (needs assessment, training and mentorship, pilot, and continuous quality improvement) to empower CRSs to attain high-quality biospecimens.ResultsClose collaborations were instrumental in establishing mutually beneficial and lasting relationships. Improvements during the 12 months of engagement with CRSs involved personnel, procedural, and supply upgrades. In total, 51 staff were trained in over 20 topics. During the pilot, CRSs extracted 50 DNA biospecimens from whole blood and performed quality control. The CRSs shipped extracted DNA to I-HAB and I-HAB that comparatively analysed the DNA. Remediation was achieved via recommendations, training, and mentorship. Preanalytical, analytical and post-analytical processes, standard operating procedures, and workflows were systematically developed.ConclusionPartnerships between I-HAB and H3Africa CRSs enabled research sites to produce high-quality biospecimens through needs assessment, training and mentorship, pilot, and continuous monitoring and improvement.

Sports participation is inversely associated with C-reactive protein levels in adolescents: ABCD Growth Study.

To analyze the relationship between sports participation and C-reactive protein (CRP) levels in adolescents and to identify the possible role of mediation developed by trunk fatness (TF). Cross-sectional design, part of the longitudinal study entitled "Analysis of Behaviors of Children During Growth" (ABCD Growth Study), Presidente Prudente, SP, Brazil. The sample comprised 259 adolescents (14.7±2.1 [182 boys and 77 girls]) stratified according to sex and engagement in sports in agreement with the inclusion criteria: absence of any known diseases; previous engagement in sports for at least 12months (≥300minutes weekly); no regular engagement in sports in the previous 12months (non-regular sports participation or <300min/wk); written parental consent and adolescents' assent both signed. Engagement in sports was self-reported. CRP levels were used to assess the inflammatory status. TF was estimated by a densitometer scanner. Age, biological maturation, HOMA-IR, and blood pressure were treated as covariates. There was no mediation effect of TF in the association of any indicators of sports practice and CRP. However, a direct effect of sports was observed on CRP levels when considering previous months of engagement, frequency, and volume of sports for boys and also previous months of engagement in sports for girls. Previous sports participation and the amount of engagement in sports per week (≥300min/wk) presented an inverse relationship with CRP levels; however, trunk fatness did not mediate this process.

Baseline Body Composition Affects Exercise Training Outcomes

When adults initiate an exercise prescription, approximately 51% do so with a declared goal of weight loss. Decreasing adiposity correlates with disease risk reduction and, in some sport contexts, improved performance. However, exercise adherence is typically poor; within 6 months of engagement, expected attrition exceeds 50%. Those who fail to sustain the practice commonly report being discouraged by a lack of progress. Thus, it is important to identify and understand the variables that influence the rate of fat loss at the onset of an exercise program. PURPOSE: To evaluate predictors of body composition improvement among diverse exercising populations. METHODS: We enrolled subjects from two distinct populations: older diabetic patients with no history of exercise (n=67) and college-aged rugby athletes (n=12). Each population underwent baseline testing to assess body fat percent (BF%) prior to and following a period of exercise. The diabetic population performed structured, supervised exercise for 10 weeks; the athletic population performed unsupervised, unstructured exercise for 4 weeks. Multiple linear regression analyses, holding other explanatory variables constant, tested predictors of BF% change. RESULTS: At baseline, the diabetic patients were 68.3 ± 10.7 years of age, had a body mass index (BMI) of 32.3 ± 6.7 kg/m2, and 39.3 ± 6.9% body fat. The rugby athletes were 19.6 ± 2.0 years of age, had a BMI of 25.2 ± 2.8 kg/m2, and 13.4 ± 4.3% body fat. Among diabetic patients, controlling for potential confounders, each additional point of baseline BF% predicted a 0.18-point reduction in BF% at post-test (p=0.010; 95% CI: -0.32 to -0.05); the overall model was significant (R2=0.395; p=0.002). Among rugby athletes, controlling for potential confounders, each additional point of baseline BF% predicted a 0.33-point reduction in post-test BF% (p=0.042; 95% CI: -0.65 to -0.02). CONCLUSION: Among exercising diabetic and athletic populations, higher baseline BF% corresponded to greater improvements in body composition throughout the exercise intervention. Among athletic populations, this may mean more rapid improvements in sport performance; for diabetic populations, this may lead to greater improvements in glycemic control.

Internet-Delivered Health Interventions That Work: Systematic Review of Meta-Analyses and Evaluation of Website Availability.

BackgroundDue to easy access and low cost, Internet-delivered therapies offer an attractive alternative to improving health. Although numerous websites contain health-related information, finding evidence-based programs (as demonstrated through randomized controlled trials, RCTs) can be challenging. We sought to bridge the divide between the knowledge gained from RCTs and communication of the results by conducting a global systematic review and analyzing the availability of evidence-based Internet health programs.ObjectivesThe study aimed to (1) discover the range of health-related topics that are addressed through Internet-delivered interventions, (2) generate a list of current websites used in the trials which demonstrate a health benefit, and (3) identify gaps in the research that may have hindered dissemination. Our focus was on Internet-delivered self-guided health interventions that did not require real-time clinical support.MethodsA systematic review of meta-analyses was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO Registration Number CRD42016041258). MEDLINE via Ovid, PsycINFO, Embase, Cochrane Database of Systematic Reviews, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched. Inclusion criteria included (1) meta-analyses of RCTs, (2) at least one Internet-delivered intervention that measured a health-related outcome, and (3) use of at least one self-guided intervention. We excluded group-based therapies. There were no language restrictions.ResultsOf the 363 records identified through the search, 71 meta-analyses met inclusion criteria. Within the 71 meta-analyses, there were 1733 studies that contained 268 unique RCTs which tested self-help interventions. On review of the 268 studies, 21.3% (57/268) had functional websites. These included evidence-based Web programs on substance abuse (alcohol, tobacco, cannabis), mental health (depression, anxiety, post-traumatic stress disorder [PTSD], phobias, panic disorders, obsessive compulsive disorder [OCD]), and on diet and physical activity. There were also evidence-based programs on insomnia, chronic pain, cardiovascular risk, and childhood health problems. These programs tended to be intensive, requiring weeks to months of engagement by the user, often including interaction, personalized and normative feedback, and self-monitoring. English was the most common language, although some were available in Spanish, French, Portuguese, Dutch, German, Norwegian, Finnish, Swedish, and Mandarin. There were several interventions with numbers needed to treat of <5; these included painACTION, Mental Health Online for panic disorders, Deprexis, Triple P Online (TPOL), and U Can POOP Too. Hyperlinks of the sites have been listed.ConclusionsA wide range of evidence-based Internet programs are currently available for health-related behaviors, as well as disease prevention and treatment. However, the majority of Internet-delivered health interventions found to be efficacious in RCTs do not have websites for general use. Increased efforts to provide mechanisms to host “interventions that work” on the Web and to assist the public in locating these sites are necessary.

Expanding the Caredoc Community Intervention Team by integrating and cooperating with healthcare providers

Purpose:To expand and develop the Caredoc integrated community intervention team (CIT) to engage with further stakeholders and to empower healthcare services and workers to support coordination and cooperation for patients, general practitioners, community services and the acute hospital. Objectives: To expand the Caredoc CIT model of care to incorporate hospitals and services in the Southeast of Ireland To inform and describe the model of care to hospitals, GPs and patients To support all stakeholders in moving to a new way of care To ensure all stakeholders are comfortable with the transition To empower all stakeholders by ensuring everyone involved is aware of their role and the role of others To securely integrate patient notes across all stakeholders to ensure continuity of care and safety The Caredoc CIT provides an acute nursing service to patients in their own home, treatment centre or care facility in the community who would traditionally be treated in the hospital setting. The service supports patients, primary care and hospital services by utilising and optimising resources to facilitate early hospital discharge and hospital avoidance. Building capacity: The Caredoc CIT service began in September 2011 after months of engagement between hospital, community and primary care services in the Carlow and Kilkenny areas in the Southeast of Ireland. The service has been delivered successfully over the last World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116635– http://www.ijic.org/ number of years and has produced significant benefits to the stakeholder’s involved and cost savings to the health service. Patient surveys have 100% satisfaction ratings with the service. The synergy and enhanced cooperation between services is something the Caredoc CIT team wanted to extend to other areas. The extension began in mid-2013 to Wicklow and is now successfully embedded in the area. The service will now be extended to Waterford, Wexford and South Tipperary. Conclusions: The main objectives were met in the roll out of the CIT model for Wicklow. Throughout the process the key stakeholders were involved from the beginning of the project and encouraged to input to the implementation plan. Individuals were empowered to take responsibility for their assigned role and encouraged to engage with other services providers and personnel. Key lessons learned: Empowering individuals at the initial stages of projects promotes collaboration and cooperation Ensure everyone involved is kept informed of key decisions or any changes Promote the service with patients and stakeholders to ensure no one is excluded The experience gained and all lessons learned are internationally transferrable to other services and organisations.

Abstract A37: Measuring internal consistency of community engagement principle items and calculation of community engagement scores

Abstract Background: Comprehensive cancer centers have been mandated to engage communities in their work; thus measurement of the level of community engagement in projects is a priority area. Siteman Cancer Center's Program for the Elimination of Cancer Disparities (PECaD) works with communities to reduce health disparities through outreach, education, and training. PECaD projects seek to align with 11 engagement principles (EP) that have been previously developed in the literature. The PECaD evaluation team developed items that are designed to assess how well PECaD projects adhere to the 11 engagement principles. While the importance of community engagement in research has been previously established, there are few evidence-based approaches for measuring the level of community engagement in research projects. Methods: 58 community members newly engaged in community-academic research partnerships completed a community engagement survey. The community engagement survey contained 96 items on community engagement pertaining to 11 Engagement Principles (EP) and evaluates how well the project aligns with the PECaD engagement principles. The questions had Likert scale response options; 48 questions measuring quality (how well) and 48 questions measuring quantity (how often). Each Engagement Principle is measured by 3-5 quality items and 3-5 corresponding quantity items. The scores developed assess the level of community engagement with higher scores corresponding to higher quality/frequency of engagement. Cronbach's alpha is used to measure the internal consistency of items to measure a single EP. Quality scores are created using 48 quality items and quantity scores are created using the corresponding 48 quantity items. In order to be included in score calculations of the average sum score on each scale (quality/quantity), each respondent had to have at least 3 answered items for EPs that contained 4-5 items and at least 2 answered items for EPs that contained 3 items. Overall average sum scores for each principle were calculated by summing the quantity average and quality average scores for each engagement principal. The lowest possible EP-specific score was 2, while the highest possible score was 10. Results: Every EP item group had a Cronbach's alpha &amp;gt;.85, which indicates strong internal consistency for all question groups across both the quality and quantity scales. Average EP scores ranged from 6.87 to 8.06; distribution of scores was approximately normal. Survey respondents reported adherence to the 11 PECaD engagement principles between sometime and most of the time on the quantity scale and between good and very good on the quality scale. Conclusion: It's necessary to examine internal consistency in order to develop measures that accurately determine how well PECaD projects align with the engagement principles and develop appropriate measures (scores) for assessing community engagement. The strong results of this analysis suggest that question items are internally consistent with each engagement principle. Engagement scores although not extremely high; are quite good and better than expected considering there has been less than 10 months of engagement. Cronbach's alpha calculations are sufficiently precise for n=30, when at least 2 items are analyzed and have a mean intercorrelation of at least 0.70; which is true for all EP item groups. Despite its limitations, this makes this pilot study valuable even with its overall small sample size. Citation Format: Melody S. Goodman, Renee Gennarelli, Bettina F. Drake, Vetta Thompson, Deborah Bowen. Measuring internal consistency of community engagement principle items and calculation of community engagement scores. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A37. doi:10.1158/1538-7755.DISP13-A37

Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study

Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested. The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not. The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not (OR = 3.53, 95% CI = 1.25-10.00). This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

Predictors of engagement in continuing care following residential substance use disorder treatment

Background Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment. Methods Patients ( n = 3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment. We identified patient characteristics associated with the number of consecutive months of engagement in continuing care. We then consolidated and classified risk factors into an integrated model. Results Being African American, having more SUD and psychiatric symptoms, more resources for recovery, and perceiving the treatment staff as being supportive were associated with longer engagement in continuing care. African Americans’ engagement in continuing care was 17% longer than Caucasians’. The positive effect of being African American was partially mediated by having taken actions toward changing use, and by the presence of psychotic symptoms. Conclusion These results extend previous research on the predictors of continuing care engagement after residential SUD programs. Clinicians can use information about characteristics that put patients at risk for shorter engagement in continuing care to target patients who might benefit from interventions to increase engagement in continuing care.