eHealth and the use of individually tailored information:a systematic review

Tailored messages are those that specifically target individuals following an assessment of their unique characteristics. This systematic review assesses the evidence regarding the effectiveness of tailoring within eHealth interventions aimed at chronic disease management. OVID Medline/Embase databases were searched for randomised control trials, controlled clinical, trials, before -after studies, and time series analyses from inception - May 2014. Objectively measured clinical processes/outcomes were considered. Twenty-two papers were eligible for inclusion: 6/22 used fully tailored messaging and 16/22 used partially tailored messages. Two studies isolated tailoring as the active component. The remainder compared intervention with standard care. In all, 12/16 studies measuring clinical processes and 2/6 studies reporting clinical outcomes showed improvements, regardless of target group. Study quality was low and design did not allow for identification of interventions’ active component. Heterogeneity precluded meta-analysis. This review has demonstrated that there is a lack of evidence to suggest that tailoring within an eHealth context confers benefit over non-tailored eHealth interventions. </jats:p

User Experiences of an Electronic Personal Health Record for Diabetes

Background: My Diabetes My Way (MDMW) is an electronic personal health record (ePHR) that provides access to educational resources and clinical data to people with diabetes in Scotland. This questionnaire study aims to assess user experience, barriers to access, and inform future development.Methods: All active MDMW users (n = 3797) were invited to complete an online questionnaire in May 2015, surveying usage patterns and system utility. A “utility score” was calculated, based on responses to Likert-scale questions and used as the dependent variable within regression analysis, with demographic features as independent predictors. Free-text responses were analyzed thematically and presented using descriptive statistics.Results: A total of 1095/3797 (27.5%) active users completed the survey. Of them, 690/1095 (63%) were male. There was representation of all age and socioeconomic groups. Respondents were positive regarding the system utility, which met expectations. The majority of respondents believed that online access to diabetes information has the potential to improve diabetes self-care within the population. The most valued features were personal clinical data associated visualizations. The main problems cited were data accuracy and system access (ie, log-in procedure). Perceived usefulness of the system was inversely associated with duration of diabetes, which was the only significant predictor of utility score.Conclusions: This study has demonstrated that MDMW users find the system useful in supporting diabetes self-management. The system was found to have greatest utility among those most recently diagnosed with diabetes. This study has informed further development of the service, including enhancing data visualization and the need to improve access to the system

My Diabetes My Way:supporting online diabetes self-management: progress and analysis from 2016

Abstract Background My Diabetes My Way (MDMW) is the National Health Service (NHS) Scotland website for people with diabetes and their carers. It consists of an interactive information website and an electronic personal health record (ePHR) available to the 291,981 people with diabetes in Scotland. We aimed to analyse the demographic characteristics of current registrants and system usage and activity during 2016. Methods We analysed system audit trails to monitor user activity and page accesses on the information website, and logins and activity within the ePHR. The ePHR contains data from SCI-Diabetes, NHS Scotland’s flagship diabetes record, sourcing data from primary and secondary care, specialist screening services and laboratory systems. We reviewed patient registration characteristics to collate demographic data for the MWDH cohort, then compared this to aggregate data published in the 2016 Scottish Diabetes Survey. The Scottish Diabetes Survey is an annual population-based report detailing diabetes statistics for the whole diabetes population in NHS Scotland. Results The MDMW information website received an average of 101,382 page accesses per month during 2016 (56.9% increase from 2015; n = 64,607). ePHR registrants were more likely to be younger (p < 0.001) and have an ethnicity of “white” (p < 0.001) than the background diabetes population. At the end of 2016, 11,840 people with diabetes had accessed their personal clinical information (58.6% increase since end 2015; n = 7464). During 2016, an average of 1907 people accessed their records each month (48.3% increase from 2015; n = 1286). Conclusion My Diabetes My Way is a useful tool aid to diabetes self-management. The service is unique in offering records access to a national population, providing information from all relevant diabetes-related sources, rather than a single silo. MDMW supports the diabetes improvement, self-management, healthcare quality and eHealth strategies of the Scottish Government. The service also has potential to be adapted to work with other clinical systems and conditions

The Role of Internal Resources in Academic Achievement: Exploring the Meaning of Self-Compassion in teh Adaptive Functioning of Low-Income College Students

Although there are many statistics on low-income students, most focus on deficits. This study is designed to concentrate on strengths, by exploring the role of self-compassion in the academic achievement of low-income community college students. This research, based broadly on resiliency theory, specifically encompasses the Buddhist psychology perspective on the meaning of suffering and self-reflection, in explaining how self-compassion may develop over a period of difficulty, and contributes positively to academic success. Further, this framework is placed within the context of Bronfenbrenner's ecological theory, to differentiate the influence of internal versus external resources, as well as to highlight the role of the chronosystem and its relevance to persistent poverty. Participants were 410 low-income community college students in southwestern Pennsylvania who responded to multiple objective measures to gain insight into academic success despite adversity. An exploratory factor analysis on the Self-Compassion Scale (SCS) was completed with regard to the use of this measure with a low-income population, as well as correlational studies, and a series of multiple regression analyses, to predict academic achievement in low-income community college students. Findings indicate that older students, African American students, students who are parents, and students who have fewer social supports reported more self-compassion. Further, self-compassion acted as a moderating mediator between income and academic success in students who report a pattern of persistent poverty. This subset of students reported more self-compassion and greater academic success in college

Decision Support for Diabetes in Scotland:Implementation and Evaluation of a Clinical Decision Support System

Background: Automated clinical decision support systems (CDSS) are associated with improvements in health care delivery to those with long-term conditions, including diabetes. A CDSS was introduced to two Scottish regions (combined diabetes population ~30 000) via a national diabetes electronic health record. This study aims to describe users’ reactions to the CDSS and to quantify impact on clinical processes and outcomes over two improvement cycles: December 2013 to February 2014 and August 2014 to November 2014. Methods: Feedback was sought via patient questionnaires, health care professional (HCP) focus groups, and questionnaires. Multivariable regression was used to analyze HCP SCI-Diabetes usage (with respect to CDSS message presence/absence) and case-control comparison of clinical processes/outcomes. Cases were patients whose HCP received a CDSS messages during the study period. Closely matched controls were selected from regions outside the study, following similar clinical practice (without CDSS). Clinical process measures were screening rates for diabetes-related complications. Clinical outcomes included HbA1c at 1 year. Results: The CDSS had no adverse impact on consultations. HCPs were generally positive toward CDSS and used it within normal clinical workflow. CDSS messages were generated for 5692 cases, matched to 10 667 controls. Following clinic, the probability of patients being appropriately screened for complications more than doubled for most measures. Mean HbA1c improved in cases and controls but more so in cases (–2.3 mmol/mol [–0.2%] versus –1.1 [–0.1%], P = .003). Discussion and Conclusions: The CDSS was well received; associated with improved efficiencies in working practices; and large improvements in guideline adherence. These evidence-based, early interventions can significantly reduce costly and devastating complications. </jats:sec

The Free State Housing Campaign: supporting people-led demands for social justice and accountable governance

In South Africa, community advice offices (CAOs) have historically played an important role as intermediaries for community issues and in efforts to increase accountability. CAOs are non-profit organisations that offer free legal and human rights information, advice and services to local communities, particularly poor and marginalised groups. Since the end of apartheid, their role has changed and their funding has been cut, with some turning to state service provision, potentially compromising their social justice role. Yet CAOs remain a well-known and trusted body for local people to raise issues through. This practice paper focuses on the experience of the Free State Housing Campaign, run by a group of 22 CAOs across the province, which aimed to improve people’s access to housing. The campaign came about through a Making All Voices Count scouting process, which convened the 22 CAOs. The CAOs received an innovation grant to design and launch a housing campaign to tackle their most pressing problems. The campaign adopted a participatory action research approach as a fundamental way of working and achieving its goals. The campaign also received an embedded practitioner research and learning grant from Making All Voices Count, to enable a process of evaluation, reflection and learning, rather than simply focusing on achieving the stated campaign objectives. The key themes in this paper include: participatory action research as a way to strengthen voice and build activism; the challenge and potential of community-led activism in the current neoliberal context; building women’s leadership in a patriarchal context; lessons for donor agencies about supporting grass-roots campaigns towards accountability and good governance.DFIDUSAIDSidaOmidyar Networ

Does an Adolescent’s accuracy of recall improve with a second 24-h dietary recall?

The multiple-pass 24-h dietary recall is used in most national dietary surveys. Our purpose was to assess if adolescents’ accuracy of recall improved when a 5-step multiple-pass 24-h recall was repeated. Participants (n = 24), were Chinese-American youths aged between 11 and 15 years and lived in a supervised environment as part of a metabolic feeding study. The 24-h recalls were conducted on two occasions during the first five days of the study. The four steps (quick list; forgotten foods; time and eating occasion; detailed description of the food/beverage) of the 24-h recall were assessed for matches by category. Differences were observed in the matching for the time and occasion step (p < 0.01), detailed description (p < 0.05) and portion size matching (p < 0.05). Omission rates were higher for the second recall (p < 0.05 quick list; p < 0.01 forgotten foods). The adolescents over-estimated energy intake on the first (11.3% ± 22.5%; p < 0.05) and second recall (10.1% ± 20.8%) compared with the known food and beverage items. These results suggest that the adolescents’ accuracy to recall food items declined with a second 24-h recall when repeated over two non-consecutive days