Self-management Tools Research Articles

Older Veterans’ Treatment Preferences: Psychotherapy and Self-Management Treatment Modalities

ABSTRACT Objectives Self-management may help older Veterans with mental health challenges and can overcome barriers to traditional psychotherapy. However, the reasons underlying older Veterans’ treatment preferences remain unknown. The current study investigated older Veterans’ perspectives on psychotherapy and self-management. Methods Seventy-four Veterans ≥ 60 years old were included in this mixed methods study. Participants provided rationale(s) after ranking their preferences for psychotherapy and four self-management modalities. Logistic regressions examined whether depressive and anxiety symptom severity contributes to preferences. Qualitative analyses were conducted to investigate reasoning for preferences. Results Most participants preferred psychotherapy (64.9%) over self-management (35.1%). Logistic regressions showed that depressive and anxiety symptom severity was not significantly associated with preferences. Qualitative analyses revealed that past experience and access-related barriers were underlying the preferences. Themes unique to psychotherapy included the availability of emotional support and the process of information sharing. In contrast, ease of access was associated with self-management. Conclusions Older Veterans preferred psychotherapy to receive support and to develop trust in meeting their goals. Clinical Implications Older Veterans’ needs point to the importance of providers’ consideration of a person-centered approach and treatment collaboration. Notably, Veterans’ preference for psychotherapy highlights the importance and need for human support in addition to self-management tools.

Adaptation and Psychometric Evidence of the ARABIC Version of the Diabetes Self-Management Questionnaire (A-DSMQ).

(1) Background: Diabetic patients must engage in self-care practices in order to maintain optimal glycemic control, hence reducing the likelihood of developing complications, and enhance the overall quality of their lives. The Diabetes Self-care Management Questionnaire (DSMQ) is a tool for assessing self-management habits that may be used to predict glycemic control in people with diabetes. However, no Arabic language version of the instrument has been found. Therefore, we adapted an Arabic language version of the instrument in Tunisia. The purpose of the current research aimed to assess the psychometric features of the Tunisian version of the DSMQ in patients with type 2 diabetes. (2) Method: Two samples including both genders, one exploratory (n = 208, mean age 53.2 ± 8.3) and one confirmatory (n = 441, mean age 53.4 ± 7.4), completed an adapted Arabic language version of the DSMQ, a sociodemographic questionnaire and information about their HbA1C levels. (3) Results: The exploratory factor analysis revealed that the 15 items of the A-DSMQ fit well with the data. Likewise, the alpha coefficients for the A-DSMQ factors were above 0.80: for “Glucose Management” (GM), “Dietary Control” (DC), “Physical Activity” (PA), and “Heath-Care Use” (HU). The fit indices for the CFA were good, and the four-factor solution was confirmed. The Average Variance Extracted values and Fornell–Larcker criterion established the convergent and discriminant validity, respectively. The concurrent validity of the tool was established through the statistically significant negative relationships between the A-DSMQ factors and HbA1C, in addition to its positive association with the practice of physical activity measured by the IPAQ. (4) Conclusions: Given the high EFA factor loadings, the CFA fit indices, the correlation matrix, the sensitivity analysis, the convergent validity, and the excellent internal consistency of the A-DSMQ, it can be concluded that the A-DSMQ is an effective psychometric tool for diabetes self-management in Tunisia.

An In-Home Medication Dispensing System to Support Medication Adherence for Patients With Chronic Conditions in the Community Setting: Prospective Observational Pilot Study.

BackgroundInnovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients’ homes. One such smart medication dispenser, spencer, provides alerts to patients to take their medications and allows for tracking and reporting real-time medication adherence data.ObjectiveThe objectives of this study were to examine the use of a smart medication dispenser as a medication adherence and self-management support tool for community dwelling adults over a 6-month period, in addition to usability, usefulness, satisfaction, and impact on caregiver support.MethodsThis prospective, observational study invited community-dwelling adults aged 45 years and older taking at least one chronic medication and their caregivers to use this smart medication dispenser for their medication administration for 6 months. Adherence was defined as a dose intake within 2 hours post scheduled time. Real-time adherence data were collected using the smart medication dispenser and the AdhereNet platform. Usability, usefulness, and satisfaction were measured using the System Usability Scale and the Usefulness, Satisfaction, and Ease of Use questionnaire, respectively. Caregiver burden was measured on a visual analog scale at baseline and at the end of the 6-month study period.ResultsA total of 58 participants were recruited, of which 55% (32/58) were female with a mean age of 66.36 (SD 11.28; range 48-90) years. Eleven caregiver participants were recruited, of whom 91% (10/11) were female. The average monthly adherence over 6 months was 98% (SD 3.1%; range 76.5%-100%). The average System Usability score was 85.74 (n=47; SD 12.7; range 47.5-100). Of the 46 participants who provided data, 44 (96%) rated the product as easy, 43 (93%) as simple to use, and 43 (93%) were satisfied with the product. Caregiver burden prior to and following smart medication dispenser use for 6 months was found to be statistically significantly different (P<.001; CI 2.11-5.98).ConclusionsSmart medication adherence products such as spencer, when connected and clinically monitored, can be a useful solution for medication management and have the potential to improve caregiver burden.

Curricular Approaches to Supporting University Student Academic Success and Wellbeing

The goal of this work was to determine whether contextualized prompting can promote student engagement with resources designed to develop self-management skills. In a second-year social and developmental psychology unit, a special section of the learning management system (LMS) contained multiple self-management tools/resources which covered topics such as time-management, study strategies, and emotional regulation. “Just-in-time” (JIT) prompts regarding selected self-management tools were delivered through LMS reminders (e.g., time-management tools early in the term). The primary measures were the number of hits on each resource and the percentage of students who accessed each resource, which allowed comparison between those resources selected for JIT LMS prompts, and those that were not. Across two studies (whereby in the second study, the LMS section was simplified, and the frequency of JIT prompts was increased), it was found that there were more hits on the JIT-prompted resources than those resources that were not prompted, and that the percentage of students accessing the JIT resources generally dropped off across the term. In addition, Study 2 suggested that increasing the frequency of JIT prompts did not increase student engagement. Limitations, implications, and future directions for this initiative are discussed.

Brief Wellness Recovery Action Planning (WRAP®) as a mental health self-management tool for community adults in Hong Kong: A randomized controlled trial

Background Wellness Recovery Action Planning (WRAP ® ) is a recovery-oriented program designed for people with mental illness to improve well-being and self-manage symptoms. Aims This randomized controlled trial investigates the effectiveness of brief Wellness Recovery Action Planning (WRAP ® ) as a mental health self-management tool for adults without formal clinical diagnoses in Hong Kong. Methods 182 adults were randomly assigned to WRAP ® or waitlist control condition to investigate whether WRAP ® can promote mental well-being and reduce psychological distress for community adults with no known diagnosable mental disorders. Results Significant improvements were found in depressive (η p 2 = .11) and anxiety symptoms (η p 2 = .06), empowerment (η p 2 = .09), and personal recovery (η p 2 = .11) among WRAP ® participants compared with waitlist control participants. Moreover, changes in anxiety symptoms, hope, empowerment, and reliance on others were found to sustain at 3-month follow-up. Conclusions Brief WRAP® is an effective self-management tool in enhancing mental health and alleviating psychological distress for millennials living in the community.

Preparing to survive: Improving outcomes for young women with breast cancer

Introduction: Young women with breast cancer (YWBC) have unique needs compared to their older-age counterparts, due to life-stage at diagnosis; often yet to start a family, responsible for young children, and/or in the midst of career progression. Interventions to address this are limited. We aimed to understand the unmet needs of YWBC in order to develop a tailored self-management tool (SMT) to improve YWBC's experience and psychosocial-sexual wellbeing, long-term.

The role of social media in management of individuals with endometriosis: A cross-sectional study.

To better understand the potential role of social media (SM) as a self-management tool for individuals with endometriosis and to assess its current use by endometriosis patients. The primary outcome was use of SM for health in patients with endometriosis. Secondary outcomes included preferred SM platforms for health information sharing and factors that influenced use, positive and negative experiences and reported impacts on health. A single-centre, cross-sectional study performed within benign gynaecology units at a tertiary hospital in Melbourne, Australia. One hundred patients with a confirmed diagnosis of endometriosis participated. Individuals did not have to be users of SM. Data were collected through an electronic third-party survey tool (SurveyMonkey® ). Analysis methods included descriptive statistical analysis, frequency counts, as well as cross-tabulation to examine statistical association between variables. Free-text responses were qualitatively analysed using deductive-inductive semantic thematic analysis. Social media was used for health by 76% of patients with endometriosis in this study. SM users were younger, had pelvic pain for more than six months and reported higher rates of psychosocial impact and symptoms from endometriosis. Respondents reported overall positive impacts on psychological, social and cognitive health outcomes (76%) from SM use. In our cohort, a high number of people with endometriosis are using SM for health. These individuals are more likely to suffer both physical and psychosocial impacts from endometriosis. Hospitals and health organisations may consider support of the endometriosis community through SM.

Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients and Healthcare Providers.

Aim(s): The aim of the study was to explore perspectives of hospitalised patients with schizophrenia or a bipolar disorder and their healthcare providers on medication self-management. Methods: In a qualitative descriptive design, semi-structured interviews were used. Forty-nine interviews were completed (nurses n = 18; psychiatrists n = 3; hospital pharmacists n = 2; patients n = 26). Data analysis was iterative using an inductive and thematic approach. Results: From the thematic analysis of the interviews, three main themes emerged: monitoring and shared decision-making, relationship based on trust, and patient satisfaction and rehabilitation; as well as three sub-themes: available tools, patient readiness, and safety. Regular monitoring and follow-ups were considered conditions for medication self-management. All stakeholders considered that the patient, the nursing staff, and the psychiatrist should all be involved in the process of medication self-management. All healthcare providers emphasized the importance of regular re-evaluations of the patient and were worried about medication errors and misuse. Most patients considered medication self-management during hospitalisation to increase their confidence, self-reliance, and satisfaction. Many participants thought it would make a positive contribution to the recovery process. Discussion: All stakeholders were positive towards medication self-management under specific conditions. According to the participants, medication self-management offered many benefits, including the implementation of more structure for the patient, an ameliorated preparatory phase towards discharge, and an actual improvement of future adherence. All participants considered medication self-management to contribute to more profound medication knowledge and an overall improvement of their health literacy. Implications and future perspectives: These findings will be used to develop a medication self-management tool in hospitalised patients with schizophrenia or bipolar disorders.

An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial.

BackgroundRheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated.ObjectiveThis study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands.MethodsA single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups.ResultsIn total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; η2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05).ConclusionsAdults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes.Trial RegistrationClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04713-4

IDF21-0186 Real-world effectiveness of Diabefly digital therapeutics program for glycemic control during COVID-19 pandemic in India

Background: The COVID-19 pandemic led to significant changes in everyday life through lockdowns and home confinement, leading to substantial indirect risk for people with diabetes. The resulting disruptions in the management of diabetes have been attributed to factors like limitations on physical activity, changes in dietary habits, anxiety, and limited access to health care facilities. Clinically validated digital therapeutics platforms have potential towards enabling continuity-of-care during the pandemic. Aim: The study is aimed at examining the effectiveness of Diabefly digital therapeutics program for people with type 2 diabetes (T2D) during the COVID-19 pandemic in India. Method: De-identified data was analyzed for 72 participants with T2D who had completed 90 days on the Diabefly digital therapeutics program during the COVID-19 pandemic since April 2020. The Diabefly program provided personalized glycemic response-based lifestyle management support, educational and motivational content, personalized nutrition plan by nutritionist, and remote health coaching. The program offered access to mobile application-based logging of meals while providing details of calorie intake as well as macro- and micro-nutrient compositions. The program also facilitated logging of clinical and anthropometric parameters like HbA1c, body weight and body mass index (BMI). In this work, the variation in these parameters was analyzed at the beginning (first 7 days) and at the end of the program. Paired t-test was used for statistical comparison between two groups, while Kruskal-Wallis test and Dunn’s multiple comparison test was used for assessing the difference between more than two groups. P<0.05 was considered as statistically significant. Results: The participants had a mean age of 44.44 ± 14.35 years with 32 females (44.44%). The average duration of diabetes was 4.24 ± 6.59 years with the most common comorbidities being hypertension in 20 participants (27.77%) and dyslipidemia in 14 participants (19.44%). After completion of the program, a significant mean reduction in HbA1c of 1.96 ± 2.06% was observed (P<0.0001). Similarly, weight and BMI of participants showed a mean reduction of 2.62 ± 3.33 kg (P<0.0001) and 0.88 ± 1.10 kg/m2 respectively (P<0.0001). After 90 days on the program, 68 participants (94.44%) showed reduction in HbA1c while 55 (76.38%) reduced their body weight when compared to baseline. The group with lesser than median interactions, median interactions, and higher than median interactions showed a median (IQR) reduction of HbA1c by 0.50 (0.95) %, 1.70 (3.47) %, and 1.75 (2.37) %. A significant variation in the HbA1c reduction was observed with different level of interactions with the platform (P=0.03). Group with higher than median interactions showed significantly higher reduction in HbA1c as compared to the group with lower than median interactions (P<0.05). Discussion: There was a significant reduction in HbA1c, body weight, and BMI in participants who completed 90 days on the Diabefly program. Higher interaction with the platform showed higher reduction in HbA1c suggesting the potential of the program for overall improvement in glycemic control. Thus, Diabefly program was used as an effective tool for diabetes self-management, education and support during the COVID-19 pandemic while ensuring continuity-of-care in times of limited access to health care resources.

A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change.

BackgroundMusculoskeletal conditions such as joint pain are a growing problem, affecting 18.8 million people in the United Kingdom. Digital health interventions (DHIs) are a potentially effective way of delivering information and supporting self-management. It is vital that the development of such interventions is transparent and can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalized, supported self-management tools available to patients with musculoskeletal conditions by providing knowledge, skills, and confidence to navigate through a self-management journey.ObjectiveThe aim of this study was to map a logic model of behavior change for getUBetter to illustrate how the content and functionality of the DHI are aligned with recognized behavioral theory, effective behavior change techniques, and clinical guidelines.MethodsA range of behavior change models and frameworks were used, including the behavior change wheel and persuasive systems design framework, to map the logic model of behavior change underpinning getUBetter. The three main stages included understanding the behavior the intervention is attempting to change, identifying which elements of the intervention might bring about the desired change in behavior, and describing intervention content and how this can be optimally implemented.ResultsThe content was mapped to 25 behavior change techniques, including information about health consequences, instruction on how to perform a behavior, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including tailoring, personalization, simulation, and reminders.ConclusionsThis process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques used to support patients to self-manage their condition. These findings provide guidance for the ongoing evaluation of the effectiveness (including quality of engagement) of the intervention and highlight areas that might be strengthened in future iterations.

Smartphone applications for sleep tracking: rating and perceptions about behavioral change among users.

IntroductionThis study aims to assess existing sleep apps for mobile phones to determine the perceived effect of these applications on user’s attitudes, knowledge, willingness to change, and its likelihood to change behavior from a user’s perspective.Material and MethodsA systematic search was conducted through Google play store and iTunes Apple store using terms related to sleep tracking. Apps were evaluated using Mobile Application Rating Scale (MARS) tool for assessing and classifying mobile health applications quality. Additionally, a convenience sample of subjects were asked to evaluate the included apps for perceived sleep behavior changes.ResultsThe average MARS app quality score on a 5-point scale was 3.3. Between 30-50% of participants believed that sleep tracker apps are likely to increase awareness about sleep patterns and sleep hygiene, infuence sleep hygiene habits, and are likely to encourage help seeking for sleep hygiene when required.ConclusionApps available for sleep self-management and tracking may be valuable tools for self-management of sleep disorder and/or improving sleep quality, yet they require improvement in terms of quality and content, highlighting the need for further validity studies.

Using the NICE evidence standards for digital health technologies to evaluate a digital self-management tool for people with musculoskeletal conditions

Using the NICE evidence standards for digital health technologies to evaluate a digital self-management tool for people with musculoskeletal conditions

The ASTHMAXcel PRO Mobile Application's Field Testing Results: Exit Interviews

The ASTHMAXcel PRO mobile application is an asthma self-management tool that provides education and adherence support to adult patients. We field tested the ASTHMAXcel PRO mobile platform and studied its impact on patients’ asthma control, knowledge and hospitalization rates.

A Research Protocol for Implementation and Evaluation of a Patient-Focused eHealth Intervention for Chronic Kidney Disease

Self-management in chronic kidney disease (CKD) can slow disease progression; however, there are few tools available to support patients with early CKD. My Kidneys My Health is a patient-focused electronic health (eHealth) self-management tool developed by patients and caregivers. This study will investigate the implementation of My Kidneys My Health across primary care and general nephrology clinics. The study aims to: (1) identify and address barriers and facilitators that may impact implementation and sustainability of the website into routine clinical care; (2) evaluate implementation quality to inform spread and scale-up. We will conduct a multi-stage approach using qualitative methods, guided by the Quality Implementation Framework and using a qualitative content analysis approach. First, we will identify perceived barriers and facilitators to implementation and considerations for sustainability through interviews with clinicians, based on the Readiness Thinking Tool and the Long Term Success Tool. Analysis will be guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Appropriate implementation strategies will be identified using the Expert Recommendations for Implementing Change compilation, and implementation plans will be developed based on Proctor’s recommendations and the Action, Actor, Context, Target, Time framework. Finally, we will explore implementation quality guided by the RE-AIM framework. There is limited literature describing systematic approaches to implementing and sustaining patient-focused self-management tools into clinical care, in addition to employing tailored implementation strategies to promote adoption and sustainability. We aim to generate insights on how My Kidneys My Health can be integrated into clinical care and how to sustain use of patient-centric eHealth tools in clinical settings on a larger scale.

Patient perspectives of the Self-management and Educational Technology tool for Atrial Fibrillation (SETAF): A mixed-methods study in Singapore.

Atrial fibrillation (AF) is the most common arrythmia and is associated with costly morbidity such as stroke and heart failure. Mobile health (mHealth) has potential to help bridge the gaps of traditional healthcare models that may be poorly suited to the sporadic nature of AF. The Self-management and Educational technology support Tool for AF patients (SETAF) was designed based on the preferences and needs of AF patients but more study is required to assess the acceptance of this novel tool. Explore the usability and acceptance of SETAF among AF patients in Singapore. A mixed methods study was conducted with AF patients who were purposively sampled from an outpatient cardiology clinic in Singapore. After 6 weeks of using SETAF, semi-structured interviews were performed, and data were analyzed inductively following a thematic analysis approach. Results from a short 4-item survey and application usage data were also analyzed descriptively. Both qualitative and quantitative results were organized and presented following the Technology Acceptance Model (TAM) framework. A total of 37 patients participated in the study and 19 were interviewed. Participants perceived SETAF as useful for improving AF knowledge, self-management and access to healthcare providers and was easy to use due to the guided tutorial and user-friendly interface. They also identified the need for better personalization of content, psychosocial support features and reduction of language barriers. Application usage data revealed preference for AF related content and decreased interaction with the motivational message component of SETAF over time. Overall, most of the participants would continue using SETAF and were willing to pay for it. AF patients in Singapore found SETAF useful and acceptable as a tool for AF management. The insights from this study not only support the potential of mHealth but may also inform the design and implementation of future mHealth tools for AF patients.

Healthcare professional students' perceptions of supporting patient self-management: A mixed method study.

Individuals self-manage chronic illnesses daily with episodic support provided by healthcare professionals. Learning about supporting self-management should be part of healthcare professional student programme curricular and training. However, little is known about the perceptions and attitudes students hold about supporting patient self-management and whether support for self-management is implemented on clinical placement. A mixed method approach explored students' perceptions and attitudes to supporting patient self-management via e-survey and semi-structured interviews. Survey data (n = 96; 11 programmes) were analysed descriptively and interviews thematically (n = 10; F = 9; aged 19-34 years; 8 programmes). Survey data suggested participants had a positive attitude towards, and were confident in providing support for self-management, but did not implement it frequently in clinical environments. One main theme "Self-management support is puzzling" identified the uncertainty around what students thought their role was or how to enact support within the patient interaction. A smaller theme "Self-management support is valuable" showed participants were open to learning more about how to support patient self-management. We suggest more explicit and frequent learning opportunities need to be provided for healthcare professional students to learn how to support patient self-management, with particular emphasis on involving family and incorporating self-management tools within the patient encounter.

Effect of an Integrative Mobile Health Intervention in Patients With Hypertension and Diabetes: Crossover Study

BackgroundObesity, hypertension, and type 2 diabetes mellitus (T2DM) are worldwide epidemics that inflict burdens on both public health and health care costs. Self-management plays an important role in the proper management of these 3 chronic diseases, and in this context, mobile health (mHealth) can be a cost-effective self-management tool.ObjectiveThe aim of this pilot study is to evaluate the effects of an integrative mHealth approach for obesity, hypertension, and T2DM on body fat, blood pressure, and blood glucose levels and demonstrate the clinical outcomes. The participants were patients aged 40 to 70 years who were treated for T2DM (hemoglobin A1c [HbA1c] above 6.0%) without insulin or hypertension and obesity, controlled with pharmacotherapy.MethodsThis pilot study was performed using a controlled, randomized, 3-month, 2-period crossover design. A total of 37 participants were recruited from 2 university hospitals in South Korea. Integrative mHealth comprised 4 parts: self-measuring home devices for monitoring blood glucose and blood pressure; 2 smartphone apps, where one gathered lifestyle data, giving them feedback with health information, and the other provided drug information and reminders of the medication schedule; unmanned kiosks for official measurement of blood pressure and body composition; and web-based access to participants’ health information.ResultsData from the 32 participants were analyzed. Their mean HbA1c level was 7.5% (SD 0.8, ranging from 6.1% to 9.4%). Approximately 38% (12/32) of the participants had hypertension. BMIs of all participants except 1 were >23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9% and 5.3%, respectively). On the contrary, the input rate of medicine intake was high (84.0%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3% and 87.3%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (−0.519 kg vs 0 kg), BMI (−0.133 kg/m2 vs −0.167 kg/m2), body composition (body fat −0.255% vs 0.172%), blood pressure (systolic −0.226 mm Hg vs −2.839 mm Hg), and HbA1c (−0.269% vs –0.009%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group.ConclusionsAlthough smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels.

Design and Development of a Digital Counseling Program for Chronic Kidney Disease.

Background:Self-management has shown to improve the quality of life in patients with chronic kidney disease (CKD). Readily accessible self-management tools are essential in promoting adherence to self-care behaviors. In recognizing that digital health facilitates efficient access to self-management programs, we developed a digital counseling program, ODYSSEE Kidney Health, to promote self-care behaviors while supporting health-related quality of life.Objective:To present the design and development of ODYSSEE Kidney Health for digital counseling for patients with CKD.Design:The study involved an iterative design process based on user-centered design principles to develop the digital counseling program, ODYSSEE Kidney Health.Setting:A sample of 10 to 15 participants were purposively sampled from nephrology clinics at the University Health Network, Toronto, Canada.Methods:Participants underwent 2 phases in the development process. In each phase, participants were presented with a component of the program, asked to perform goal-oriented tasks, and participate in the “think-aloud” process. Semi-structured interviews followed the first phase to identify feedback about the overall program. Thematic analysis of the interviews identified themes from the usability testing. Descriptive statistics were used to summarize patient demographic data.Results:We enrolled 11 participants (n = 7 males, n = 4 females, ages 30-82). The main themes generated anchored on (1) impact on nephrology care, (2) technical features, and (3) CKD content. Overall, participants reported positive satisfaction toward the navigation, layout, and content of the program. They cited the value of the program in their daily CKD care.Limitations:Study limitations included using a single center to recruit participants, most of the participants having prior technology use, and using one module as a representative of the entire digital platform.Conclusion:The acceptability of a digital counseling program for patients with CKD relies on taking the patients’ perspective using a user-centered design process. It is vital in ensuring adoption and adherence to self-management interventions aimed at sustaining behavioral change.

СВІТОВИЙ О. М. САМОМЕНЕДЖМЕНТ ЯК ЕФЕКТИВНИЙ ІНСТРУМЕНТ КАР'ЄРНОГО ЗРОСТАННЯ УПРАВЛІНЦЯ

The purpose of the article is to summarize and substantiate the principles of self-management as a tool for career growth of managers. Methodology of research. To achieve the goal set in the article, the author uses the following general and special research methods: dialectical, analysis and synthesis, comparison, abstract-logical.Findings. The article describes the best technologies of efficient use of time and systematizes the interpretation of the concept of "self-management" by scientists. It has been proven that for professional and career growth the self-development of a manager as a specialist and as a person must be continuous and comprehensive. Emphasis is placed on the importance for the manager to constantly develop leadership skills, work to improve their intellectual and professional level, seek the best opportunities for self-realization.The need to perform as many tasks as possible per unit time is pointed out. It is substantiated that such personal and professional qualities of a manager as decency, determination, impeccable business reputation, ability and willingness to work in a team acquire special importance.It is noted that the role of self-management in the career growth of a manager in today's world is becoming increasingly important. Given this circumstance, the modern manager needs to achieve greater self-organization, self-education and self-control. The motivation of the manager in career development, which is based on the interest in promotion and professional development based on the use of internal reserves, is studied. It is important that the results achieved in this process are sufficient for appointment to a higher level of the career vertical. It is argued that for a manager at every stage of career growth, it is worth comparing the goal with their own capabilities, constantly taking care of their professional reputation.Practical value. The theoretical approaches and practical recommendations proposed by the author are aimed at finding and implementing new career opportunities for managers through the integrated use of self-management tools.