Self-monitoring Technologies Research Articles

Perspectives on wellness self-monitoring tools for older adults

PurposeOur purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults’ personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians’ tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use. MethodsWe conducted three focus groups with health care providers (n=10) and four focus groups with community-dwelling older adults (n=31). ResultsOlder adult participants’ found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes toward wellness monitoring tools for older adults and brainstormed about various stakeholders’ use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools. ConclusionsOur paper provides implications and solutions for how older adults’ wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness.

Innovations in e-health

The theme of ISOQOL’s 19th Annual Conference in Budapest, Hungary, was The Journey of Quality of Life Research: A Path Towards Personalized Medicine. Innovations in e-health was one of four plenary panels. E-health is changing the landscape of clinical practice and health care, but the best way to leverage the many promised benefits of emerging e-health technologies is still not clear. The Innovations in e-health panel presented emerging changes in technologies and applications that will facilitate clinical decision making, improve quality and efficiency of care, engage individuals in clinical decision making, and empower them to adopt healthy behaviors. The purpose of this paper was to present emerging trends in e-health and considerations for successful adoption of new technologies, and an overview of each of the presentations in the e-health plenary. The presentations included a personal perspective on the use of technology for self-monitoring in Parkinson’s disease, an overview of online social networks and emerging technologies, and the collection of patient-reported outcomes through web-based systems in clinical practice. The common thread across all the talks was the application of e-health tools to empower individuals with chronic disease to be actively engaged in the management of their health. Considerations regarding data ownership and privacy, universal access to e-health, interactivity between different types of e-health technologies, and tailoring applications to individual needs were explored.

“You've got to walk before you run”: Positive evaluations of a walking program as part of a gender-sensitized, weight-management program delivered to men through professional football clubs.

To explore men's views of a pedometer-based walking program, part of a weight-management intervention delivered through Scottish Premier League football clubs, and the congruence or challenge this poses to masculine identities. Semistructured telephone interviews with a sample of participants in a gender-sensitized, group weight-management program. Interviewing continued until data saturation was reached (n = 29). All men were positive about the context, style of delivery, and content of the broader intervention. These things encouraged men to increase their physical activity (and adopt other behavioral changes) that they may not otherwise have found appealing. The success and acceptability of the walking program resided in three interrelated factors: (a) the utility of pedometers as a technology for motivation, self-monitoring and surveillance, and target setting; (b) the speed with which fitness was regained and weight reduced (enabling men to begin to do more desired forms of physical activity, and so regain visceral, experiential, and pragmatic masculine capital); and (c) bolstering their masculine identities through the receipt of the program in a valued, masculinised context. These data suggest that men will enthusiastically embrace a graduated walking program when the presentation is gender sensitive in context, content, and delivery. Pedometers were viewed as a valuable, reliable technological aid which motivated men and empowered them in self-monitoring of progress toward self-defined goals. Many men experienced the walking program as a means of regaining fitness, thereby enabling them to also regain valued masculine identities and activities, and a step toward regaining a more acceptable masculine body.

Feasibility of the Diabetes and Technology for Increased Activity (DaTA) Study: A Pilot Intervention in High-Risk Rural Adults

Rural Canadians are at increased risk of metabolic syndrome. Physical inactivity is a primary target for preventing and reversing metabolic syndrome. Adherence to lifestyle interventions may be enhanced using cell phones and self-monitoring technologies. This study investigated the feasibility of a physical activity and self-monitoring intervention targeting high-risk adults in rural Ontario. Rural adults (n = 25, mean = 57.0 ± 8.7 years) with ≥ 2 criteria for metabolic syndrome participated in an 8-week stage-matched physical activity and self-monitoring intervention. Participants monitored blood glucose, blood pressure, weight, and physical activity using self-monitoring devices and Blackberry Smart phones. VO2max, stage of change, waist circumference, weight, blood lipids, and HbA1c were measured at weeks 1, 4, and 8. Adherence to self-monitoring was > 94%. Participants' experiences and perceptions of the technology were positive. Mean stage of change increased 1 stage, physical activity increased 26%, and predicted VO2max increased 17% (P < .05). Significant changes in weight, waist circumference, diastolic blood pressure, LDL cholesterol, and total cholesterol were found. This stage-matched technology intervention for increased physical activity was feasible and effective.

Portable Technologies for Self-Monitoring of Coagulation Time: A Review

Anti-coagulation treatments are required for medical conditions that become more and more frequent with the ageing of the population in developed countries (atrial fibrillation, deep-venous thrombosis, heart prosthetic valves, etc.). These treatments generally use coumarin derivative (vitamin-K antagonist), whose activity needs to be monitored in order to keep the patient in an appropriate therapeutic range. This measurement can be done in laboratories but can also be performed by the patient himself using portable devices. This paper presents the different technological ways to selfmonitor vitamin-K antagonist treatment by measuring coagulation time. It will focus on portable devices, well suited to be used at home and on device to be manipulated by the patient, thus not requiring an extensive training nor sample treatment. Keywords: Anti-coagulant, vitamin-K antagonist, coagulation, coagulation time measurement, coumarin, diagnostic, hand-held devices, international normalized ratio, point-of-care, portable devices, prothrombin time, Quick test, self-monitoring, thromboses prevention.

A Primary Care-Based Exercise Intervention to Improve Metabolic Risk Factors of Cardiovascular Disease

Prescribing exercise can be an efficacious and cost-effective way for primary care physicians to lower their patients' risk of cardiometabolic disease. Despite the expected benefits, program supervision and monitoring patient compliance remains a challenge, especially in rural settings. Remote monitoring technology could be a way of addressing these issues by increasing patient accountability without requiring more physician visits. PURPOSE: The purpose of the current randomized control trial was to examine the effect of a physician-supervised exercise prescription and the use of remote monitoring technology on blood sugar and lipid profiles in participants with metabolic syndrome. METHODS: Eighty-one men and women (mean age = 57) with metabolic syndrome in rural southwestern Ontario were randomized to a control group (n = 39; exercise prescription and paper-based exercise log) or intervention group (n = 44; exercise prescription and remote blood pressure, blood glucose, and exercise monitoring technology). Fasting blood was collected at baseline, 12, and 24 weeks for serum levels of total cholesterol (TCHL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), HbA1c and glucose (BG). Using SPSS Version 19.0, a one-way repeated measures ANOVA was used to assess for significant changes across time and between groups. RESULTS: A significant decrease in LDL was observed (p = 0.027) in both groups with time as the main effect. There was a trend towards decreased TCHL (p = 0.063) with time as the main effect. A trend towards increased HDL (p = 0.093) was demonstrated in the intervention group only. There were no significant changes in BG, HbA1c, or TG across time or between groups (p > 0.05). CONCLUSION: An exercise program with self-monitoring technology may help to improve HDL in patients with metabolic syndrome. In addition, an exercise prescription with either self-monitoring technology or a paper-based exercise log may help to improve LDL and TCHL. However, these are preliminary results at the 6-month mark of a one-year study and only include results from half of the study's total sample. As such, final results may differ from those presented here. Thank-you to CIHR for their generous funding.

Self-Monitoring Technologies for Type 2 Diabetes and the Prevention of Cardiovascular Complications: Perspectives from End Users

The objective of this study was to explore facilitators and barriers to the adoption of self-monitoring devices in individuals with type 2 diabetes mellitus (T2DM). Individuals with T2DM who were currently using one or more devices to monitor their disease participated in focus groups. Transcripts of focus group meetings were coded into themes by two reviewers using NVivo qualitative software. Twenty-eight adults with T2DM reported using a blood glucose meter, and almost half reported monitoring their blood pressure. Few individuals consistently monitored other aspects of their cardiovascular health. Four major themes impacting device use/disuse were identified: knowledge gaps, relationships with health care providers, environment, and personal experience. Knowledge barriers included lack of information regarding diabetes and the associated risk of complications. Perceptions of inconvenience, pain, and financial restrictions were important factors influencing the adoption, use, and abandonment of self-monitoring devices. Community-run programs, as well as dieticians and pharmacists, were identified as important resources for accessing information related to T2DM. We identified the need for development of accessible and relevant education material; improved communication of disease-specific information between patients and providers, as well as providers and community resources; and strategies to improve the convenience and cost of monitoring devices.

Multiple Forms of Appropriation in Self-Monitoring Technology: Reflections on the Role of Evaluation in Future Self-Care

This article discusses implications for the design of evaluation studies of self-care technologies and practices with respect to a current shift toward technologically mediated self-care in health care. Through the notion of appropriation of technology, this article shows that as self-care devices migrated into lay patients' lives and their domestic environment, we are confronted with a series of different instances of appropriation where patient empowerment and autonomy take different forms. With a particular focus on self-monitoring devices such as blood-pressure monitors and glucose meters, the article examines a series of illustrative vignettes from an ethnographic study and discusses multiple forms of appropriation of self-care technology and the need to understand its implications on the design of studies for their evaluation. Three conclusive reflections to rethink the role of evaluation study in the current shift toward self-care are addressed: the need to move beyond technological determinism, the need to reflect on whose interests the evaluation serve, and the need to carefully rethink the very goal of evaluation studies in self-care themselves.

Health technologies for monitoring and managing diabetes: a systematic review.

The primary objective of this review was to determine the strength of evidence for the effectiveness of self-monitoring devices and technologies for individuals with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on specific health-related outcome measures. Self-monitoring devices included those that assist patients with managing diabetes and preventing cardiovascular complications (CVCs). A secondary objective was to explore issues of feasibility, usability, and compliance among patients and providers. Study criteria included individuals >or=14 years and youth (7-14 years) with T1DM or T2DM, intervention with a self-monitoring device, assessment of clinical outcomes with the device, literature in English, and >or=10 participants. Relevant published literature was searched from 1985 to 2008. Randomized controlled trials and observational studies were included. Data were extracted for clinical outcomes, feasibility and compliance methods, and results. Selected studies were independently evaluated with a validated instrument for assessing methodological quality. Eighteen trials were selected. Predominant types of device interventions included self-monitoring of blood glucose, pedometers, and cell phone or wireless technologies. Feasibility and compliance were measured in the majority of studies. Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologies can improve diabetes self-care, and pedometers are effective lifestyle modification tools. The results of this review indicate a need for additional controlled trial research on existing and novel technologies for diabetes self-monitoring, on health outcomes associated with diabetes and CVCs, and device feasibility and compliance.

Clinical Application and Challenges of Blood Glucose Measurement Technology for Self-Monitoring

Patients and many physicians believe that modern blood glucose meters provide reliable results under all circumstances. The aim of this (mini-)review is to critically review a number of aspects that should be taken into account for successful self-monitoring of blood glucose (SMBG). Usage and practical knowledge of patients about the optimal knowledge of SMBG appear to be lower than one expects. A number of factors like coding and calibration have an impact on the reliability of the measurement. Unfortunately, we have no standard procedure to evaluate the quality of the glucose measurement by the meters. In practice, SMBG is more than simply the glucose measurement; it involves many steps that also have a critical impact on the final outcome. We will also highlight that the digital number provided at the end of this diagnostics procedure is of no help per se; it requires a translation in an adequate therapeutic action. Most of the aspects mentioned have not gained thorough scientific interest in the last years. Also, in view of the economic relevance of SMBG (billions are spend each and every year) SMBG and the factors that have an impact on the reliability of the measurement should receive more attention by academia.

Using Interactive Voice Response to Enhance Brief Alcohol Intervention in Primary Care Settings

Self-monitoring is recommended following brief alcohol intervention (BI). We have previously demonstrated that self-monitoring with an automated telephone system (interactive voice response; IVR) is associated with a steady reduction in alcohol consumption in the absence of BI. In this study we explore the feasibility and efficacy of IVR as a possible therapeutic enhancement for BI. We updated all providers (N= 112) in 15 primary care clinics about BI and encouraged them to do a BI with their patients whenever appropriate and to invite those patients to participate in the research project. Interested patients (N = 338) were randomized to one of four study conditions including no IVR and three groups who self-monitored for 6 months using an IVR: no feedback, feedback, and feedback plus a monetary calling incentive. The IVR proved to be a feasible method for self-monitoring. Of those invited to use the IVR, 90% initiated use and made 95% of the calls while they remained engaged with the system; more than half continued calling for the entire 6 months. Reported impact of the IVR and associated feedback on drinking awareness was high. Therapeutic results were mixed. Overall, the IVR groups reported higher consumption on the Timeline Followback (TLFB) at the 3- and 6-month follow-ups than did the no IVR group. However, because of a potential measurement confound, the TLFB may not have operated in an unbiased fashion across the four study conditions. A comparison of the feedback and no feedback IVR groups, which is independent of this confound, shows a significant therapeutic advantage of IVR with feedback. IVR is a feasible technology for behavioral self-monitoring in primary care clinics. IVR with regular feedback may be an effective therapeutic enhancement to BI.

Menstrual Cycle Effects on Insulin Sensitivity in Women with Type 1 Diabetes: A Pilot Study

Many women complain of difficulty maintaining euglycemia during the luteal phase of the menstrual cycle. This pilot study's objective was to evaluate possible differences in insulin sensitivity between follicular and luteal phases in women with type 1 diabetes. Women using insulin infusion pumps (n = 5, mean age 29.2 +/- 10.9 years, mean body mass index 24 +/- 1.8 kg/m(2)) underwent frequently sampled intravenous glucose tolerance tests during each cycle phase. Insulin sensitivity and glucose effectiveness were determined by Minimal Model analysis. Non-insulin-mediated glucose disposal increased during the luteal phase (0.009 +/- 0.004 min(1)) versus the follicular phase (0.005 +/- 0.003 min(1)) (P < 0.05). Although no significant differences were found in mean insulin sensitivity between follicular (0.76 +/- 0.27 x 10(4)/min(1) /microU/mL) and luteal phase (0.58 +/- 0.26 x 10(4)/min(1) /microU/ mL), three of the five subjects had a decline in insulin sensitivity. Elevated blood glucose during the luteal phase may increase insulin-independent glucose disposal. Some individuals appear more responsive to menstrual cycle effects on insulin sensitivity. Women should be encouraged to use available self-monitoring technology to identify possible cyclical variations in blood glucose that might require clinician review and insulin dosage adjustments.

Self-Monitoring Technology Still Requires the Services of an RD

To help patients and clients avoid the misconception that nutrient analysis databases have a “magical effect” on weight loss, Kim Stote, MPH, RD, says nutritionists need to be clear about what exactly the function of that database is—to monitor calorie intake.

SICK-DAY MANAGEMENT IN TYPE 1 DIABETES

Illness and stress are common occurrences. For the person with type 1 diabetes, these events can be triggers for counterregulation and [table: see text] subsequent metabolic deterioration if there is no attention to diabetes management tasks. Sick-day management requires increased monitoring of blood glucose and assessment for ketosis. Although urine testing for ketones has been the standard approach to sick-day management, new technology for self-monitoring of blood 3HB levels is now available. According to the American Diabetes Association, blood measurement of 3HB "may offer a useful alternative to urine ketone testing." This new technology may provide an opportunity to improve the management of uncontrolled diabetes and sick days in an attempt to reduce the human and economic burden of DKA.

Impact of Glucose Self-monitoring on Glycohemoglobin Values in a Veteran Population

Twenty-one diabetic patients who self-monitored their glucose levels (via either reflectance meter or visual strips) were compared with 17 closely matched patients who did not monitor their levels. Mean age, duration of diabetes, ancillary illnesses, hospitalizations, and diabetes complications (number and type) did not statistically differ between the two groups. Over the 3-year interval of the retrospective study, there were no differences in glycohemoglobin values between the groups. We conclude that self-monitoring of blood glucose levels alone did not improve the mean amount of glycemia in these patients. Alternative strategies must be developed for use in concert with self-monitoring technology to improve its effectiveness.