Self-management Application Research Articles

Randomised controlled trial of a smartphone application-based dietary self-management program on haemodialysis patients.

Aims and objectivesTo develop a smartphone application‐based dietary self‐management program for haemodialysis patients and to examine its effects on biochemical indicators, self‐efficacy and quality of life.BackgroundLack of dietary management in haemodialysis patients can lead to serious complications such as oedema, hyponatremia, hyperkalaemia, hypertension, uraemia and eventually death; however, studies using smartphone applications for dietary self‐management in haemodialysis patients are rare.DesignA prospective, single‐blind, randomised, controlled design with repeated measures was followed with 75 haemodialysis patients at a haemodialysis centre. Data were collected from 10 January 2017–6 May 2018. The study applied the Consolidated Standards of Reporting Trials statement.MethodsThe 8‐week smartphone application‐based dietary self‐management program was developed through collaboration with a haemodialysis equipment company. The experimental group took this program while the control group took an 8‐week general program. Study variables were serum phosphorus, potassium and albumin, self‐efficacy and quality of life. They were measured at pretest, and 8 weeks and 12 weeks after the programs, and analysed using two‐way repeated measures analysis of variance.FindingsThe smartphone application‐based program significantly improved serum phosphorus, potassium, self‐efficacy and quality of life over time compared with the general program. There was no significant difference in albumin level changes between the groups.ConclusionsThe smartphone application‐based dietary self‐management program is an opportune and effective nursing intervention to lower serum phosphorus and potassium levels in haemodialysis patients over time. Trial registration was performed on www.cris.nih.go.kr (KCT0005366).Relevance to clinical practiceHaemodialysis patients can easily use the smartphone application to manage their diet anytime and anywhere. They can get real‐time feedback and solutions to prevent haemodialysis complications. Nurses can provide tailored high‐quality care based on an individual's lifelog data from the smartphone application.

Electronic Delivery of Pain Education for Chronic Overlapping Pain Conditions: A Prospective Cohort Study.

To examine the impact of educational materials for chronic overlapping pain conditions (COPCs), the feasibility of delivering materials online, and to explore its impact on self-reported self-management applications at 3-month follow-up. Prospective cohort study. Online. Individuals from a university-wide active research repository with ≥1 coded diagnostic COPC by ICD-9/10 in the medical record. We determined the number of COPCs per participant as indicated by diagnostic codes in the medical record. Consenting participants completed self-report questionnaires and read educational materials. We assessed content awareness and knowledge pre- and post-exposure to education. Comprehension was assessed via embedded questions in reading materials in real time. Participants then completed assessments regarding concept retention, self-management engagement, and pain-related symptoms at 3-months. N = 216 individuals enrolled, with 181 (84%) completing both timepoints. Results indicated that participants understood materials. Knowledge and understanding of COPCs increased significantly after education and was retained at 3-months. Patient characteristics suggested the number of diagnosed COPCs was inversely related to age. Symptoms or self-management application did not change significantly over the 3-month period. The educational materials facilitated teaching of key pain concepts in self-management programs, which translated easily into an electronic format. Education alone may not elicit self-management engagement or symptom reduction in this population; however, conclusions are limited by the study's uncontrolled design. Education is likely an important and meaningful first step in comprehensive COPC self-management.

Mobile Applications for Heart Failure Self-management: A Systematic Review

Mobile Applications for Heart Failure Self-management: A Systematic Review

Patients and healthcare workers experience with a mobile application for self-management of diabetes in Qatar: A qualitative study

BackgroundDiabetes mellitus (DM) is highly prevalent in the Middle East and North Africa (MENA) region. Mobile health (m-health) can improve communications between diabetic patients and medical teams, and this, in turn, may enhance engagement and self-management. Droobi is a multi-language mobile application designed to support self-management of patients with DM. ObjectiveThe study aimed to explore experiences of patients and educators about their communication before and after implementation of Droobi, a diabetes management app. MethodsWe interviewed a convenience sample consisting of 9 patients and 5 nurse educators. Before interviews, Droobi was downloaded to participants’ mobile phone, and their profile on the application was created. To ensure optimum usage experience, all participants received education on how to use Droobi. Participants used Droobi for 6 to 12 weeks. All interviews were audio recorded, transcribed by professionals, and thematically analyzed. ResultsTwo main themes were generated from participants’ responses. The first theme relates to experiences of patients and educators about their communication before Droobi and consists of 3 sub-themes: (1) how patients communicated with medical team before Droobi (previous methods), (2) adoption of previous communication methods, and (3) shortcomings of previous communication methods. The second theme relates to experiences of patients and educators about their communication after Droobi and consists of 4 sub-themes: (1) adoption of Droobi, (2) advantages of Droobi, (3) shortcomings of Droobi, and (4) improvements suggested by educators and patients. ConclusionsOur findings suggest that Droobi provided a more efficient and convenient way for communication between health workers and patients, yet multiple shortcomings and several suggestions for improvements were noted. Future work should continue evaluating the Droobi app, they should include a number of different stakeholders when developing the upcoming Droobi version taking into account the limitations and suggestions put forth by the end-users.

Technology Use and Preferences for Minority Diabetes Self-Management Application.

We describe technology use and preferences of minority patients with diabetes who participated in focus groups in order to help design a mobile/online health application (or, app) to assist with diabetes self-management. Self-management apps should include health-related data and suggestions about food. The authors close by recommending additional considerations for future self-management mobile/online apps.

A qualitative study of clinician perceptions regarding the potential role for digital health interventions for the management of COPD.

Effective self-management of chronic obstructive pulmonary disease (COPD) can lead to increased patient control and reduced health care costs. However, both patients and healthcare professionals encounter significant challenges. Digital health interventions, such as smart oximeters and COPD self-management applications, promise to enhance the management of COPD, yet, there is little evidence to support their use and user-experience issues are still common. Understanding the needs of healthcare professionals is central for increasing adoption and engagement with digital health interventions but little is known about their perceptions of digital health interventions in COPD. This paper explored the perceptions of healthcare professionals regarding the potential role for DHI in the management of COPD. Snowball sampling was used to recruit the participants (n = 32). Each participant underwent a semi-structured interview. Using NVivo 12 software, thematic analysis was completed. Healthcare professionals perceive digital health interventions providing several potential benefits to the management of COPD including the capture of patient status indicators during the interappointment period, providing new patient data to support the consultation process and perceived digital health interventions as a potential means to improve patient engagement. The findings offer new insights regarding potential future use-cases for digital health interventions in COPD, which can help ease user-experience issues as they align with the needs of healthcare professionals.

The eHealth self-management application ‘Oncokompas’ that supports cancer survivors to improve health-related quality of life and reduce symptoms: which groups benefit most?

Background Oncokompas is a web-based self-management application that supports cancer survivors to monitor their health-related quality of life (HRQOL) and symptoms, and to obtain personalised feedback and tailored options for supportive care. In a large randomised controlled trial among survivors of head and neck cancer, colorectal cancer, and breast cancer and (non-)Hodgkin lymphoma, Oncokompas proved to improve HRQOL, and to reduce several tumour-specific symptoms. Effect sizes were however small, and no effect was observed on the primary outcome patient activation. Therefore, this study aims to explore which subgroups of cancer survivors may especially benefit from Oncokompas. Materials and methods Cancer survivors (n = 625) were randomly assigned to the intervention group (access to Oncokompas, n = 320) or control group (6 months waiting list, n = 305). Outcome measures were HRQOL, tumour-specific symptoms, and patient activation. Potential moderators included socio-demographic (sex, age, marital status, education, employment), clinical (tumour type, stage, time since diagnosis, treatment modality, comorbidities), and personal factors (self-efficacy, personal control, health literacy, Internet use), and patient activation, mental adjustment to cancer, HRQOL, symptoms, and need for supportive care, measured at baseline. Linear mixed models were performed to investigate potential moderators. Results The intervention effect on HRQOL was the largest among cancer survivors with low to moderate self-efficacy, and among those with high personal control and those with high health literacy scores. Cancer survivors with higher baseline symptom scores benefitted more on head and neck (pain in the mouth, social eating, swallowing, coughing, trismus), and colorectal cancer (weight) specific symptoms. Discussion Oncokompas seems most effective in reducing symptoms in head and neck cancer and colorectal cancer survivors who report a higher burden of tumour-specific symptoms. Oncokompas seems most effective in improving HRQOL in cancer survivors with lower self-efficacy, and in cancer survivors with higher personal control, and higher health literacy.

The efficacy of mobile health interventions used to manage acute or chronic pain: A systematic review.

Chronic pain is a significant health issue that affects approximately 50 million adults in the United States. Traditional interventions are not always an effective treatment strategy for pain control. However, the wide adoption of smartphones and the rapid growth of health information technologies over the past decade have created opportunities to use mobile health (mHealth) applications (apps) for pain tracking and self-management. In this PRISMA-compliant systematic review, we assessed the current U.S.-based research on pain-related mHealth apps to describe the app components and determine the efficacy of these interventions for persons with acute or chronic pain. We conducted a comprehensive search of five databases based on methodological guidelines from the Joanna Briggs Institute. We included articles reporting original data on mHealth interventions with pain intensity as a primary or secondary outcome and excluded articles that utilized multimodal interventions. Of the original 4959 articles, only five studies met the eligibility criteria. Most of the interventions included feasibility or pilot studies, and all studies were published between 2015 and 2018. Two of the five studies used visual analog scales. Only two of the studies reported statistically significant pain intensity outcomes, and considerable heterogeneity between the studies limited our ability to generalize findings or conduct a meta-analysis. Research investigating the components and efficacy of pain-related mHealth apps as interventions is an emerging field. To better understand the potential clinical benefits of mHealth apps designed to manage pain, further research is needed.

Ambulatory Management of Childhood Asthma Using a Novel Self-Management Application

FL Nkoy, BA Fassl, VL Wilkins. Pediatrics . 2019;143(6):e20181711 To examine the effects of a home self-monitoring application (the electronic-AsthmaTracker, or e-AT) for children with asthma on quality of life (QoL), asthma control, and patient and caregiver productivity. 327 pediatric patients with persistent asthma followed at 11 ambulatory clinics owned by a regional not-for-profit integrated health care system were included in the study. The e-AT, an asthma symptom tracker for children, was developed by a team of 6 parents and 7 community stakeholders on an electronic platform. From January 2014 to December 2015, children aged 2 to 17 years with National Institutes of Health–defined persistent asthma were recruited from the 11 participating clinics to adopt the e-AT, with a target sample size of 30 patients per …

Facilitating the Practice of Biofeedback Via Mobile Applications and Wearable Devices for Self-Management of Mental Health

Facilitating the Practice of Biofeedback Via Mobile Applications and Wearable Devices for Self-Management of Mental Health

Self-Management of Rheumatoid Arthritis: Mobile Applications.

To review the self-management of rheumatoid arthritis (RA) using mobile applications. Recent research supports that self-management not only can be an empowering behavior for an individual but also has been shown to improve health outcomes in RA. Mobile health applications are growing in popularity and adoption. Emerging evidence supports that using a mobile application for RA self-management may reduce disease activity and improve health outcomes. This review discusses mobile applications designed to improve self-management of RA as well as applications not specific to RA that also may be useful for self-management in this population. Future research should focus on the efficacy of mobile apps for health outcomes and ways to improve the adoption of and adherence to mobile apps in individuals with RA.

Protocol of the randomized control trial: the WiseApp trial for improving health outcomes in PLWH (WiseApp)

BackgroundPoor adherence to antiretroviral therapy (ART) is one of the primary barriers to viral load suppression. mHealth technology can help overcome challenges with ART adherence. This paper outlines the protocol for the WiseApp randomized control trial. The WiseApp contains real-time medication monitoring linking an electronic pill bottle and fitness tracker to the app, helping persons living with HIV (PLWH) self-manage their medication adherence and improve their overall quality of life. The primary objective of the trial is to test the effect of the WiseApp's medication adherence features on antiretroviral adherence in underserved PLWH in New York City.MethodsThis ongoing study is a two-arm randomized control trial. Participants are randomized 1:1 to the WiseApp intervention arm or the control arm at baseline and followed for 6 months. Eligibility criteria include: 18 years of age, have a diagnosis of HIV, speak and understand English or Spanish, live in the United States, own a smartphone, currently taking ART medications, and report the past 30 days adherence of 80% or less as measured using the Visual Analogue Scale (VAS), or have a viral load of over 400 copies/mL. The sample size for the trial is 200 people. All study participants receive the WiseApp, a CleverCap electronic pill bottle, and a fitness tracker. The intervention group also receives videos and health surveys centered on medication adherence and managing living with HIV as well as medication reminders. In contrast, the control group receives walk step reminders, videos, and surveys focused on overall wellness.DiscussionThe WiseApp Trial has the potential to improve HIV self-management applications, being one of the few randomized controlled trials of a mHealth medication adherence and HIV self-management application in the United States. The trial could also bring new opportunities for advancement in reaching economically disenfranchised and underserved populations in the United States. The real-time monitoring of the WiseApp has the potential to help providers initiate interventions to help patients resume treatment before drug resistance begins.Trial registrationThis trial was registered with ClinicalTrials.gov (NCT03205982) on July 2, 2017.

Implementation of Mobile Application for Diabetes Self-Management on Self Efficacy and Clinical Outcome in Indonesia

Implementation of Mobile Application for Diabetes Self-Management on Self Efficacy and Clinical Outcome in Indonesia

A close look at socio-technical design features of mobile applications for diabetes self-management

Many mobile apps used for chronic disease self-management suffer from low usage and retention. In this paper, we analyzed apps for self-management of diabetes to understand their strengths and shortcomings from a Socio-Technical (ST) perspective and identify areas for improvement. The ST model and ST categories (Task-Actor, Task-Structure, Task-Technology, Actor-Structure, Actor-Technology, Structure-Technology) were used to identify gaps in the current design of Diabetes Management Mobile Apps. We used a content analysis approach to analyze each app’s functionality and users’ comments against a set of ST features generated based on the ST model and the associated categories. Results showed that most mobile apps are designed to support the technical characteristics in such context as reflected in the Task-Technology and Actor-Technology categories like self-care functionality, ease of use and usefulness, managing resources, and coordinating tasks. However, limitations exist when considering the larger structure within which self-care tasks are performed such as enabling physician–patient communication and feedback. Most of the limitations we observed are in the Task-Structure and Technology-Structure categories that capture features related to the interdependency of self-care tasks with provider and payer workflows.

Exploring self-management within hospital-based stroke care: current and future opportunities

Purpose This study explored stroke self-management within a tertiary hospital setting from the perspectives of health professionals working across the continuum of stroke care. Materials and methods A qualitative descriptive design guided five focus groups in the acute stroke service (n = 2), inpatient rehabilitation (n = 2), and outpatient day hospital service (n = 1). Focus groups were transcribed verbatim and analysed using thematic analysis. Results Twenty-eight health professionals participated representing medical, nursing, and allied health services. Two themes emerged from the data: Pieces of the puzzle illustrates the inconsistent understanding about self-management with elements of the puzzle described but rarely within the full concept of self-management; Readiness for self-management highlighted that although self-management should commence in the acute setting, there were many factors influencing why this was not always happening. Conclusions A consistent conceptualisation and approach to stroke self-management in the hospital setting is required. Interprofessional education and shared intentional language can enhance understanding and practice. IMPLICATIONS FOR REHABILITATION Understanding and application of stroke self-management varies among members of hospital-based stroke teams. Health professionals working in hospital-based stroke care should use the term self-management with their patients. Education of healthcare teams is necessary to develop knowledge about self-management and develop consistent practices across the continuum of care.

Systematic Review of mHealth Applications That Interface with Inhaler Sensors in Asthma

A better understanding of outcomes associated with mobile health (mHealth) applications (apps) for asthma self-management that pair with inhaler sensor technology is needed for clinicians to practice evidence-based medicine. To evaluate the effects of mHealth apps that integrate with an inhaler-based sensor on outcomes of patients with asthma. We performed a systematic review in GooglePlay and Apple App stores for consumer-facing mHealth apps for asthma management that pair with an inhaler-based sensor. We then searched for evidence evaluating these apps via PubMed and Cochrane Central (January 2007-May 2020), bibliographies on product websites, and www.clinicaltrials.gov. We included studies in patients with asthma evaluating apps discovered in the app stores on adherence or a health outcome of interest, and qualitatively summarized evidence. We identified 6 mHealth apps and screened 2594 citations for evidence on these apps; 7 studies of 2 apps were included. Interventions modestly improved maintenance inhaler adherence and reduced rescue inhaler use but did not impact Asthma Control Test scores. Effects on exacerbations, quality of life, and pulmonary function were not evaluated in these studies. The current literature evaluating mHealth apps paired with inhaler-based sensors focuses on a small number of available products and has limitations in quality. Positive effects on rescue inhaler use, inhaler adherence, and patient satisfaction were found. However, more comprehensive evaluation of products and their impact on health outcomes is needed before clinicians and patients can weigh the benefits against resources needed to adopt these technologies.

Developing Self-Management Application of Fall Prevention Among Older Adults: A Content and Usability Evaluation.

This paper presents a research and development project for studying aging and technology in fall prevention. Falls are an important global health problem in an aging global population. Up to 50% of serious falls may be fatal. Falls result from the cumulative effects of cognitive, musculoskeletal and sensory decline on postural control and substantially affect the activities of daily living, leading to a lower quality of life and physical injury. A near-fall, misstep and a prior fall are established risk factors for a more serious fall. The fear of falling may reduce physical activity and further predispose to falling. However, limitations in the reporting and documentation of fall events create “silent events”—events that are neither documented nor acted upon. An “Age-Techcare” Application (App) was designed using open innovation methods with local older adult populations and health care professionals through a mixed-methodology approach. The App comprised a digital diary for the self-reporting of fall events and an exercise video to strengthen balance as a fall-prevention intervention. The older adults recorded four fall events: a near-fall, the fear of falling, a fall, or no-fall. Prompts to watch the video and the number of times the video was watched were also recorded on the App. Reports retrieved from the App were analyzed after a 10-week pilot study among older adults accessing the App on their smartphones (n = 28) and through their smartTV (n = 23). All participants used the App to self-report fall events. Near-falls were the most frequently reported fall event among both smartphone and smartTV groups. The scale of silent falls (including a fear of falling and near falls) is greater than anticipated (according to prevailing literature) and significant, especially among the older cohort of participants who had previously experienced falls and are living alone. The exercise video was regularly accessed within a self-report–fall-prevention feedback loop. Watching a preventive exercise video clip as a preventive intervention is positively associated with self-reporting of all events. We have shown that the utility and effectiveness of an App in the self-management of fall events to raise self-awareness, document risk and prompt preventive action. As we address the health needs of an aging global population, Apps such as this will need to be further developed and interface with health and social care services. The facility for older adults to negotiate ideas and practices of risk and safety—the hallmark of the aging-in-place and healthy aging discourse—is important to them in their acceptance of dynamic and diverse technology.

A self-management application “pain-housekeeper” to control cancer pain: a randomized controlled trial study protocol†

Abstract Objective Pain is a prevalent and distressing symptom in patients with cancer which has a significant impact on patients’ physical health, psychological well-being, and quality of life (QOL). Deficiency of pain care, inadequate pain communication, and reluctance toward pain medication contribute to the difficulties in improving the situation of patients with cancer pain. Fortunately, the integration of self-management and professional healthcare provides new opportunities for patients with cancer pain. Methods A two-arm randomized controlled trial will be conducted to assess the effectiveness of self-management application compared with routine care among patients with cancer pain. Based on Orem's self-care theory and Naylor's transitional care theory, cancer pain self-management application “Pain-housekeeper” was developed with dual client: patient client and medical client. A total of 120 patients with cancer pain are recruited from two university-affiliated tertiary public hospitals in China. They are randomly assigned to the control group and the intervention group. The patients in the control group get routine care while the patients in the intervention group get routine care and Pain-housekeeper App. The intervention is delivered by registered doctors, nurses, and postgraduate nursing students specialized in pain care. Effect measurements for both groups are carried out with questionnaires at baseline (T0), after 4 weeks (T1) and after 12 weeks (T2). The primary outcomes include pain condition, self-efficacy, and QOL. The secondary outcomes include pain medication adherence, satisfaction, anxiety, and depression. Compliance of data submission, economic evaluation, usage, and clinical data are also considered in the test. Data for the evaluation are gathered continuously during the study period. Discussion This article provides insight into the effectiveness of a theory-based self-management mobile application intervention delivered to patients with uncontrolled cancer pain. The results are used to help patients to improve cancer pain control, self-efficacy, and QOL. Conclusions The findings of this article provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes. Trial registration ChiCTR: ChiCTR1800020295, Registered 22 December, 2018.

Usability testing of a tablet-based self-management application for older adults with T2DM: The ASSISTwell application

Usability testing of a tablet-based self-management application for older adults with T2DM: The ASSISTwell application

Usability testing of a tablet-based self-management application for older adults with T2DM: The ASSISTwell application

Usability testing of a tablet-based self-management application for older adults with T2DM: The ASSISTwell application