Personal Action Plans Research Articles

СУЧАСНІ ПІДХОДИ ЛІКУВАННЯ БРОНХІАЛЬНОЇ АСТМИ ЗГІДНО GINA 2023

In 1993 there was initiated the Global Initiative for Asthma Management and Prevention. Each year GINA is revised and each subsequent revision contains updated recommendations based on new data. It’s underlined in red throughout GINA 2023 the significance of ICScontaining therapy. The best treatment approach for adults and adolescents remains Track 1 with ICS/formoterol as needed. Track 2 now also includes an ICS/SABA combination as needed as an Anti-inflammatory Reliever (AIR), but Track 1 remains the “preferred” regimen. Although inhaled SABA are highly effective for rapid relief of asthma symptoms, patients whose asthma is treated with SABA alone (compared with ICS) have an increased risk of death and asthma-related emergency medical care needs. For safety reasons, GINA does not recommend SABA alone for the treatment of asthma in adults, adolescents, or children 6–11 years of age. Is it possible to treat asthma without SABA? In an asthma center in Argentina, since 2014, a treatment strategy with ICS-containing symptom relievers has been implemented: using only budesonide/formoterol in a single inhaler across all spectrums of asthma severity and completely excluding the use of SABA. As a result, the level of hospitalization decreased by 92%. The 2023 revision of GINA proposed new terminology for anti-asthma drugs: Maintenance therapy, controller drugs, reliever drugs, anti-inflammatory reliever, Maintenance and Reliever Therapy - MART. Clarifications have been made for the treatment of asthma exacerbations. Added details on drugs and doses of ICS/formoterol on demand and ICS/SABA as needed, MART regimen in individual asthma action plan, how and when to modify these drugs as the disease worsens. The inhaler prescription algorithm is written in more details, considering its impact on the environment. Conclusions: The GINA 2023 updates highlight the most significant role of ICS-containing therapy in achieving asthma control and preventing exacerbations. However, patient adherence to therapy remains quite low, so an approach that allows for the management of both symptoms and exacerbations simultaneously is simpler and remains the preferred way of asthma therapy. Global approaches to asthma management - limiting, where possible, the use of SABA and favoring delivery devices and treatment regimens with less environmental impact. Managing the patient according to his personal action plan and creating local protocols can limit the use of SABA, improve the patient’s asthma outcomes and environmental impact. Key words: asthma, GINA, inhalers, asthma control, exacerbation

Transition from pediatric to adult care in chronic respiratory diseases: The cystic fibrosis model

Increased life expectancy in cystic fibrosis has made transition from pediatric to adult cystic fibrosis centers a crucial step for patients, their families and caregivers. This transition must be gradual and carefully prepared. A formalized process, early discussion with patients and families about transition, patient's empowerment prior to transfer, and close links between pediatric and adult teams are key points to succeed. Therapeutic education, validated questionnaires, personalized action plans or connected tools can help. Transfer will take place at the appropriate time for each patient, ideally during a period of disease stability, in a progressive manner, with joint or alternating consultations between pediatric and adult cystic fibrosis center teams. Other chronic respiratory diseases with pediatric onset may benefit from similar transition processes.

Three Cooperative Extension initiatives funded to address Michigan's opioid crisis.

People living with opioid use disorder and those experiencing other types of substance misuse are part of a public health crisis in the United States. Rates of opioid misuse, overdose, and opioid-related deaths within different subpopulations show where prevention efforts must focus. Through concerted efforts, aligned with common goals, a statewide community-based educational organization (Michigan State University Extension) has demonstrated ability to acquire multi-year funding from varied sources of state and federal funds that has produced robust support for statewide projects and collaborations. Researchers, educators, public health program managers, and other practitioners can benefit from learning how three funded initiatives in one state resulted in improved awareness and access for individuals and healthcare organizations. By sharing our implementation of health educational programs and presentations, other states' can adopt these evidence-based strategies for similar outreach. Cooperative Extension in Michigan delivers program series and one-time education to the public on the self-management of chronic conditions and pain, mindfulness for stress reduction, anger management, and opioid misuse prevention, treatment, and recovery. These evidence- and research-based health programs implemented by Extension staff teach participants common aspects of prevention such as self-management care, communication skills, self-efficacy, and goal setting or personal health action plans. Education aims to reduce dependency on opioids, prevent opioid misuse and share non-pharmacological solutions to pain management for those living with chronic conditions or at risk for developing dependence. The funded initiatives targeted rural residents, older adults, health care providers, and people living with chronic pain who may have access to prescription opioids. In addition to direct education, projects supported local communities with the development of coalitions, including the training of community partners to become program facilitators thereby increasing community capacity for prevention programs, and through the creation of patient referrals from healthcare settings to community-based education. In rural areas, Cooperative Extension plays a crucial role in connecting community resources to address healthy aging, and chronic disease or chronic pain self-management education. Community partners engaged in public health education and promotion, and healthcare providers alike may not be aware that Cooperative Extension plays a vital role in providing community-based health education.

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: study protocol for the RETURN randomised controlled trial

BackgroundPeople with disadvantaged backgrounds are less likely to visit the dentist for planned care, even though they have disproportionately poorer oral health. They are correspondingly more likely to experience dental problems and use urgent dental care, general practices and Accident and Emergency departments, which not only makes meeting their needs expensive, but, since these services often rely on prescriptions rather than addressing the clinical cause, can contribute to antimicrobial resistance.MethodsThe RETURN intervention has been developed with substantial community co-production, to be delivered opportunistically in urgent dental care settings. This brief intervention is delivered by dental nurses and involves material relevant to the ‘in-group’ targeted. The material includes booklets relating to barriers to planned dental visiting with corresponding short video clips featuring local people and including a modelling element. Dental nurses are trained to have supportive and non-judgemental conversations, assisting patients to set personal goals and action plans, which are reinforced in a follow-up text within a few weeks. A randomised controlled trial will be undertaken in 3 types of sites: dental practices delivering urgent care (a) within working hours, (b) out of hours, and (c) in a Dental Hospital. The trial will recruit 1180 adult urgent dental care users over 12 months, who have not visited a dentist for a planned care appointment for 2 years or more and do not have a dentist who they visit for routine care. It aims to investigate the effectiveness and cost-effectiveness of the intervention and to explore whether the intervention has different effects across the socio-economic gradient. Participants will be followed up at 6, 12 and 18 months after randomisation. Co-primary outcomes are attendance at a dental practice for planned care within 12 months and self-reported oral health-related quality of life at 12 months.DiscussionThis is a pragmatic trial, evaluating the effectiveness of the intervention under the usual condition in which it might be applied. Since dental practices work as independent contractors to the NHS, this brings implementation and fidelity challenges which will be explored and described in embedded qualitative work.Trial registrationISRCTN registry identifier ISRCTN84666712. Registered 12/04/2021.

THE EFFECT OF A DIGITAL HEALTH INTERVENTION ON THE CONTROL OF HYPERTENSION AMONG PEOPLE LIVING WITH CANCER

Objective: To examine the effectiveness of a digital health intervention on the control of hypertension among people living with cancer. Design and method: This was a retrospective study of 101 participants (average age of 67 years old) living with cancer and hypertension enrolled on mDoc’s digital CompleteHealthô platform between February 2020 to November 2021. The people were connected with a coach-led multidisciplinary team that provided self-care support and encouragement via CompleteHealthô. The multidisciplinary team engaged the people with regular digital nudges on monitoring their blood pressure, health education, nutritional advice, virtual exercise classes and co-created personalised action plans with them. Specialised support for their cancer diagnosis included ensuring adherence to their oncology treatment regimens. The change in blood pressure was calculated as the difference between their initial blood pressure value and the average of all subsequent blood pressure values entered on CompleteHealthô. Results: Of the 101 people with cancer and hypertension enrolled on the CompleteHealthô, 98 (97.0%) had at least one interaction with a health coach and 84 (83.2%) entered at least 1 subsequent blood pressure value after their baseline while 57 (56.4%) of them had entered at least 5 subsequent values. Of those with at least 1 value, 63 (75%) had a controlled BP while 48 (84.2%) of those with at least 5 values had controlled BP at the end-line. People with at least 1 subsequent value saw a change of 0.3 mmHg and 1.3 mmHg in their systolic and diastolic blood pressure respectively while people with at least 5 values saw a 2 mmHg and 1.7mmHg reduction in their systolic and diastolic blood pressures respectively. Conclusions: Our findings show that a digital health intervention was able to help people living with cancer and hypertension reduce their blood pressure via the use of a web platform, digital nudges, encouragement on the need to check blood pressure at home, exercise, and modification of lifestyles. It also showed that a greater number of interactions with the health coaches led to a greater reduction in blood pressure.

REducing delay through edUcation on eXacerbations for people with chronic lung disease: Study protocol of a single‐arm pre‐post study

AimThis study protocol aims to examine the effectiveness and preconditions of a self‐management program—named REducing Delay through edUcation on eXacerbations (REDUX)—in China.BackgroundThe high disease burden in people with chronic lung disease is mainly due to exacerbations. There is a need for effective exacerbation‐management interventions. A nurse‐led program, REDUX, helped patients self‐manage exacerbations.DesignA single‐arm pre‐post study.MethodsFifty‐four patients and 24 healthcare professionals (HCPs) in Chinese primary care will be included. The core element of the program is a personalized action plan. HCPs will receive training in using the action plan to help patients manage exacerbations. The intervention will start when a patient is referred to the nurse for a post‐exacerbation consultation and ends when the patient presents for the second post‐exacerbation consultation. During the first post‐exacerbation consultation, the patient and nurse will create the action plan. The primary outcomes in patients will include the delays between the onset of exacerbation and recognition, between exacerbation recognition and action, between exacerbation recognition and consultation with a doctor, and when the patients feel better after receiving medical help from HCPs. The secondary outcomes will include preconditions of the program. The ethics approval was obtained in September 2021.DiscussionThis study will discuss a culturally adapted nurse‐led self‐management intervention for people with chronic lung disease in China. The intervention could help Chinese HCPs provide efficient care and reduce their workload. Furthermore, it will inform future research on tailoring nurse‐led self‐management interventions in different contexts.ImpactThe study will contribute to the evidence on the effectiveness and preconditions of REDUX in China. If effective, the result will assist the nursing of people with chronic lung disease. Trial registration: Registered in the Chinese clinical trial registry (ID: 2100051782).

Implementation of a Children's Safe Asthma Discharge Care Pathway Reduces the Risk of Future Asthma Attacks in Children-A Retrospective Quality Improvement Report.

BackgroundMany children attend Emergency Departments (ED) and Out of Hours (OoH) frequently for acute asthma. Follow up care is often suboptimal leaving these children at risk of a future attacks. We report on the development, implementation and evaluation of a safe asthma discharge care pathway (SADCP).MethodsThis is a retrospective report on the development, implementation and evaluation of outcomes of a SADCP. The pathway was based on the Teach-to-goal educational methodology that supported the mastery correct inhaler technique and ability to action the personalized asthma action plan (PAAP). Children with frequent asthma attacks were entered as they were discharged from the Emergency Department or ward. The first training session occurred within 1–3 weeks of the index asthma attack with 2 further sessions in the following 8 weeks. Children exiting the pathway were discharged either back to primary care or to a hospital clinic.Results81 children entered the pathway (median age 5 years) with 72 discharged from the ED and 9 from the medical wards of the Royal Belfast Hospital for Sick Children. At pathway entry 13% had correct inhaler technique, 10% had a Personalized Asthma Action Plan (PAAP), and 5% had >80% (45% >50%) repeat refill evidence of adherence to inhaled corticosteroid over the previous 12 months. On pathway exit all children demonstrated correct inhaler technique and were able to action their PAAP. One year later 51% and 95% had refill evidence of >80% and >50% adherence. Comparisons of the 12 months before and 12 months after exit from the pathway the median number of emergency ED or OoH asthma attendances and courses of oral corticosteroids reduced to zero with >75% having no attacks requiring this level of attention. Similar findings resulted when the SADCP was implemented in a district general hospital pediatric unit.ConclusionImplementing an asthma care pathway, using Teach-to-Goal skill training methods and frequent early reviews after an index asthma attack can reduce the future risk of asthma attacks in the next 6 to 12 months.

Tackling antimicrobial resistance in practice: dental students’ evaluation of university teaching supplemented by an online course

BackgroundAntimicrobial resistance (AMR) presents a global threat to public health. Engaging all healthcare professionals including undergraduates in efforts to tackle AMR is vital. Sharing and spreading good practice in teaching on AMR and antimicrobial stewardship (AMS) is a key ambition in Scotland. In 2020, the University of Glasgow Dental School supplemented teaching with mandatory completion by final year undergraduates of an online education programme on the essential role of dental teams in reducing AMR.ObjectivesTo evaluate final year dental students’ knowledge and experience of utilizing an online international educational, interactive resource to supplement university teaching: Tackling Antibiotic Resistance: What Should Dental Teams Do?MethodsCross-sectional qualitative evaluation using a self-administered questionnaire with open questions about course content, learning and personal action planning. Data were thematically analysed using NVivo12 Pro software.ResultsA total of 88 students completed a questionnaire, which indicated online training had increased their understanding of AMR and AMS from a global perspective and confirmed these topics were an integral part of their undergraduate education programme. Their action plans demonstrated enthusiasm for creating an AMS culture in clinical practice and an understanding of the need for ongoing education of themselves, their colleagues and patients.ConclusionsEducation delivery using a variety of media to support teaching and learning in Glasgow Dental School was effective in ensuring that students understand their role in tackling AMR. Students were positive about the addition of an online education programme to supplement university teaching. This approach may be beneficial for other undergraduate dentistry programmes.

Patient Education in Spa Resorts: Experience from a French National Program for Patients with Chronic Venous Insufficiency.

The prognosis of chronic venous insufficiency (CVI) is greatly depending upon the ability of the patients to optimize their health-related behaviors (mainly compliance to compression stockings, physical activity and diet). As this is usually challenging for the patients, we developed a therapeutic education program (TEP) aiming at helping them to achieve these optimizations. We report here the preliminary results obtained with this program. This structured TEP was developed by a working group of 15 health professionals to be used during the regular French spa 3-week treatment course for CVI patients. The program included three interactive workshops aiming at improving the patients’ knowledge, skills and motivation, two educational consultations allowing to set and follow-up their personal action plans and a built-in evaluation. It was implemented in spa resorts specialized in CVI. Among the first 150 patients (116 women and 34 men, mean age 69 years old (SD 8 years), 49% had post-thrombotic disease. Compliance to the education workshops was 98%. After a 3-month follow-up, 83% of the patients fully achieved at least one behavioral objective. Quality of life, as assessed by the CIVIQ 2 auto-questionnaire, improved at 3 months (p = 0.0024) and 9 months (p = 0.018). These results demonstrate the feasibility of a TEP for CVI patients and its ability to improve their health-related behaviors, opening the way for the development of similar programs for other chronic diseases in the setting of spa resorts.

Поточний перегляд GINA (основні положення) для дорослих та особливості ведення хворих на бронхіальну астму в умовах соціальних катастроф

Abstract. The main document that forms the basis of international and national guidelines for the management of patients with bronchial asthma (BA) — the Global Initiative for the Management of Patients with Bronchial Asthma (GINA) — is revised every year. The clarifications of the current year concern both the diagnosis of primary asthma and the confirmation of this diagnosis in patients, who already receive controller therapy. The diagnostic algorithm for patients already receiving control therapy is presented (approaches for initial diagnosis and for diagnosis verification in patients on basic control therapy are different). Emphasis is placed on the need to carry out functional pulmonary tests in the diagnosis and monitoring of asthma patients, their high informativeness. There is an ongoing debate and calls for its continuation regarding the definition of severity of asthma, especially mild. Asthma treatment pathways (Tracks) are clearly defined, they are distinguished by drugs that are used to relieve symptoms (if necessary): fixed combinations of low-dose inhaled corticosteroids with formoterol — Track 1, or short-acting beta2 -agonists — Track 2. Emphasis is placed on the role of education and self management of patients with BA in conditions of limited access to medical care. Providing an agreed, written, personalized action plan that advises on the use of basic therapy, recognition of signs of worsening, and what appropriate interventions the patient can take on their own is a critical component of effective asthma self-management. Effective implementation requires a whole system approach that combines the active involvement of patients in training with the motivation of professionals who have to conduct this training and monitor its process. Our task is to bring this information to the widest circles of doctors and asthma patients, to widely implement patient education and self-management skills. Key words: bronchial asthma, medical care, treatment, difficult life situations, emergency, crisis

Quality of primary care delivered to children with asthma in South London before the introduction of integrated child focused care model: a population cohort study of primary care records

BackgroundAsthma is one condition being evaluated in a randomised control trial (RCT) of the Children and Young People's Health Partnership (CYPHP) model of care across two boroughs in South London. The integrated, specialist nurse lead service aims to deliver focused, age appropriate, good quality care to improve child health, within an ethnically diverse and deprived population. Providing good quality, evidence-based care is vital to keep children with asthma healthy. This study aimed to determine the quality of asthma care provided to children in primary care before the introduction of CYPHP in May, 2018. MethodsWe examined primary care health records of children registered within GP practices in Southwark and Lambeth. We identified children aged 5–15 years between April 1, 2014, and March 31, 2018, with asthma by a coded asthma diagnosis or three or more asthma medications in a 12-month period, and with more than 400 days of continuous GP registration after their asthma was identified. Child asthma quality measures were determined from guidelines and published literature, as follows: children aged 5 years and older with asthma have a personalised action plan; an annual asthma review; asthma control monitored at review; documented height at review; and a prescribed spacer device (which optimises medication delivery). FindingsOf the 7995 children identified with asthma, 44% (n=3508) were from the most deprived fifth of the national population. 36% (n=2868) had a coded annual asthma review record, and 15% (n=1219) had a personalised asthma action plan. Of the 2868 children with a coded annual review, 98% (n=2806) had evidence of asthma control being monitored, while only 2% (n=70) had a coded height documented. 80% (n=6381) had ever been prescribed a spacer. InterpretationCoding of primary care quality measures for child asthma was poor before the CYPHP service. This finding does not mean that the care was not provided, because information could have been recorded as uncoded text. An audit of primary care records is needed to determine the uncoded care provided. Prescription data are complete for the period a child is registered at a given practice. The fact that 20% of children were never prescribed a spacer needs further investigation. FundingGuy's and St Thomas' Charity.

Managing asthma in primary healthcare.

Asthma brings considerable challenges for family doctors because of its variety of shapes, different levels of severity, a wide age range, and the fact that in the last decades clinicians are able to offer much better treatment options with a better level of disease control and a higher quality of life. The objectives of the current review article are to provide an up-to-date review by primary care respiratory leaders from different countries of the most significant challenges regarding asthma diagnosis and management, the importance of team work and the problems in recognizing and dealing with difficult-to-manage and severe asthma in primary care. The article provides a short review of the main challenges faced by family physicians and other primary health care professionals in supporting their patients in the management of asthma, such as asthma diagnosis, promoting access to spirometry, the importance of a multiprofessional team for the management of asthma, how to organize an asthma review, the promotion of patient autonomy and shared decision-making, improving the use of inhalers, the importance of the personalized asthma action plan, dealing with difficult-to-manage and severe asthma in primary care and choosing when, where and how to refer patients with severe asthma. The article also discusses the development of an integrated approach to asthma care in the community and the promotion of Asthma Right Care.

A feedback journey: employing a constructivist approach to the development of feedback literacy among health professional learners

BackgroundFeedback, if effectively provided by the teacher and utilised by the learner, enables improvement in academic performance. It is clear from current literature that the provision of feedback by teachers is not sufficient on its own to guarantee improvements as early university entrants may not be sufficiently equipped to effectively engage with feedback. Nonetheless, it is critical for health professional students to develop feedback literacy early, in order to prepare them for a professional career of lifelong learning and critical thinking. The overarching aim of this study was to identify a feasible, sustainable approach to improve feedback literacy among students on pre-qualifying health professional programmes.MethodsThe study was divided into two phases. A mixed-methods approach grounded in constructivism was employed. Participants included teachers and learners from the School of Allied Health at X University, and two internationally acclaimed educationalists. In phase 1, first year students were encouraged to use an established online platform to upload modular feedback and develop personal learning action plans aimed at improving academic performance. A follow-up survey highlighted poor engagement with this method. Thus, the second phase focused on the co-construction of a suite of modules to develop these skills, supported by academic staff. Interviews were conducted with participants to review and refine this initiative.ResultsLearners’ engagement with the first phase of the study was poor. Thus, the second phase provided all stakeholders with the opportunity to feed into the development of a suite of modules, designed to encourage teachers and learners to work in partnership to nurture these skills. All stakeholder groups reported short- and long-term benefits with this approach, but also highlighted challenges towards its implementation.ConclusionThe development of feedback literacy among health professional learners is essential. The transferability of such skills has been highlighted in the literature and by all stakeholder groups involved in this study. Finding a balance between introducing these skills at a time early enough to highlight their importance among university entrants is challenging. Further balance must be achieved between the workload required to achieve these skills and current programme demands for both teachers and learners.

Understanding personal asthma action plans

Personal asthma action plans (PAAPs) are written plans that help people with asthma to self-care and keep themselves as well as possible. PAAPs are usually developed in partnership with the patient or carer in primary care. PAAPs aim to ensure that people with asthma know how to manage their asthma and when to seek help if their condition deteriorates. To manage their asthma adequately at home, patients will need regular education about what asthma is, an understanding of their triggers, how their medications work and managing their devices. The practice nurse can play a key role in developing the PAAP, monitoring asthma control, and subsequently modifying the PAAP if necessary to maintain control of the condition.

Quality Assessment of Personalized Action Plans in Andalusia: supporting the Chrodis-Plus integrated care model for multimorbidity

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study

BackgroundEarly detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team.ObjectiveThis qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users’ point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management.MethodsWe have been conducting a multicenter pilot study involving 36 patients with CF aged ≥12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a “React to PEx” educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients’ personalized alert thresholds by reviewing the data collected during phase 1 and their patients’ clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients’ experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International).ResultsThe study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users’ experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care.ConclusionsThis study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management.Trial RegistrationClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028International Registered Report Identifier (IRRID)DERR1-10.2196/14552

Ontology-Based Personalized Cognitive Behavioural Plans for Patients with Mild Depression.

Cognitive Behavioural Therapy (CBT) is an action-oriented psychotherapy that combines cognitive and behavioural techniques for psychosocial treatment for depression, and is considered by many to be the golden standard in psychotherapy. More recently, computerized CBT (CCBT) has been deployed to help increase availability and access to this evidence-based therapy. In this vein, a CBT ontology, as a shared common understanding of the domain, can facilitate the aggregation, verification, and operationalization of computerized CBT knowledge. Moreover, as opposed to black-box applications, ontology-enabled systems allow recommended, evidence-based treatment interventions to be traced back to the corresponding psychological concepts. We used a Knowledge Management approach to synthesize and computerize CBT knowledge from multiple sources into a CBT ontology, which allows generating personalized action plans for treating mild depression, using the Web Ontology Language (OWL) and Semantic Web Rule Language (SWRL). We performed a formative evaluation of the CBT ontology in terms of its completeness, consistency, and conciseness.

Understanding personal asthma action plans

Personal asthma action plans are an essential tool to keep people with asthma as well as possible. Heather Henry explains the role of the practice nurse in developing them Personal asthma action plans (PAAPs) are written plans that help people with asthma to self-care and keep themselves as well as possible. PAAPs are usually developed in partnership with the patient or carer in primary care. PAAPs aim to ensure that people with asthma know how to manage their asthma and when to seek help if their condition deteriorates. To manage their asthma adequately at home, patients will need regular education about what asthma is, an understanding of their triggers, how their medications work and managing their devices. The practice nurse can play a key role in developing the PAAP, monitoring asthma control, and subsequently modifying the PAAP if necessary to maintain control of the condition.

A Smartphone App to Support Sedentary Behavior Change by Visualizing Personal Mobility Patterns and Action Planning (SedVis): Development and Pilot Study.

BackgroundProlonged sedentary behavior is related to a number of risk factors for chronic diseases. Given the high prevalence of sedentary behavior in daily life, simple yet practical solutions for behavior change are needed to avoid detrimental health effects.ObjectiveThe mobile app SedVis was developed based on the health action process approach. The app provides personal mobility pattern visualization (for both physical activity and sedentary behavior) and action planning for sedentary behavior change. The primary aim of the study is to investigate the effect of mobility pattern visualization on users’ action planning for changing their sedentary behavior. The secondary aim is to evaluate user engagement with the visualization and user experience of the app.MethodsA 3-week user study was conducted with 16 participants who had the motivation to reduce their sedentary behavior. Participants were allocated to either an active control group (n=8) or an intervention group (n=8). In the 1-week baseline period, none of the participants had access to the functions in the app. In the following 2-week intervention period, only the intervention group was given access to the visualizations, whereas both groups were asked to make action plans every day and reduce their sedentary behavior. Participants’ sedentary behavior was estimated based on the sensor data of their smartphones, and their action plans and interaction with the app were also recorded by the app. Participants’ intention to change their sedentary behavior and user experience of the app were assessed using questionnaires.ResultsThe data were analyzed using both traditional null hypothesis significance testing (NHST) and Bayesian statistics. The results suggested that the visualizations in SedVis had no effect on the participants’ action planning according to both the NHST and Bayesian statistics. The intervention involving visualizations and action planning in SedVis had a positive effect on reducing participants’ sedentary hours, with weak evidence according to Bayesian statistics (Bayes factor, BF+0=1.92; median 0.52; 95% CI 0.04-1.25), whereas no change in sedentary time was more likely in the active control condition (BF+0=0.28; median 0.18; 95% CI 0.01-0.64). Furthermore, Bayesian analysis weakly suggested that the more frequently the users checked the app, the more likely they were to reduce their sedentary behavior (BF−0=1.49; r=−0.50).ConclusionsUsing a smartphone app to collect data on users’ mobility patterns and provide real-time feedback using visualizations may be a promising method to induce changes in sedentary behavior and may be more effective than action planning alone. Replications with larger samples are needed to confirm these findings.

Development and Feasibility of an App to Decrease Risk Factors for Type 2 Diabetes in Hispanic Women With Recent Gestational Diabetes (Hola Bebé, Adiós Diabetes): Pilot Pre-Post Study.

BackgroundHispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mobile health (mHealth) interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking.ObjectiveThis study aimed to (1) develop a mobile app (¡Hola Bebé, Adiós Diabetes!) to pilot test a culturally tailored, bilingual (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine the acceptability and usability of the app; and (3) assess the short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight.MethodsSocial cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app’s acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study.ResultsIn total, 11 Hispanic women, receiving care at a federally qualified community health center, aged 18-45 years, and with GDM in the last 5 years, participated in four focus groups to evaluate the app’s acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight-tracking graphics, and recipes. Suggested modifications included adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a “how-to tutorial.” To assess short-term effectiveness, 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in both self-efficacy for physical activity (P=.003) and self-efficacy for healthy eating (P=.007). Weight decreased but not significantly. Backend process data revealed a high level of user engagement.ConclusionsThese data support the app’s acceptability, usability, and short-term effectiveness, suggesting that this mHealth program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized controlled trial.Trial RegistrationClinicalTrials.gov NCT04149054; https://clinicaltrials.gov/ct2/show/NCT04149054