scholarly journals What makes digital health intrusive? Qualitative findings from an international study on diabetes

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T Oikonomidi ◽  
P Ravaud ◽  
A James ◽  
E Cosson ◽  
V Montori ◽  
...  
Keyword(s):  
Private Sector ◽  
Health Care Professionals ◽  
Online Survey ◽  
Dietary Habits ◽  
Digital Health ◽  
Treatment Burden ◽  
Convenience Sample ◽  
Digital Monitoring ◽  
Food Monitoring

Abstract Background Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why. Methods We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]). Results We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests. Conclusions Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden. Key messages Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.

A Practical Guide to Concentrated Insulin for Pharmacists

2014 ◽  
Vol 27 (5) ◽  
pp. 481-486 ◽  
Author(s):  
Jennifer Andres ◽  
Jennifer N. Clements
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Health Care Professionals ◽  
Dietary Habits ◽  
Hepatic Glucose Production ◽  
Management Strategies ◽  
Glucose Production ◽  
Practical Guide

Purpose: Insulin improves glycemic control in several ways, for example, by stimulating glucose uptake in the muscle and inhibiting hepatic glucose production. It has other mechanisms of action for correcting the abnormal metabolism of proteins, fats, and carbohydrates. The formulation of concentrated insulin (U-500) is a higher potency of insulin than the U-100 regular formulation. It is indicated for children and adults with type 1 and type 2 diabetes who have not achieved adequate glycemic control with exercise and proper dietary habits. However, the unique characteristics of concentrated insulin require that a patient be educated on its use. This article provides a practical guide for pharmacists on the use of concentrated insulin in both inpatient and outpatient settings and highlights specific concerns and management strategies. Conclusion: Concentrated insulin works in the same mechanism as U-100 insulin formulations for treating type 1 and type 2 diabetes. Pharmacists are knowledgeable about managing the disease and can identify patients who will benefit with treatment of concentrated insulin. They can provide recommendations to prevent and resolve situations, such as dosing errors, which arise in patients on concentrated insulin and can educate patients and health care professionals on dosing conversions and titration.

scholarly journals O008 Embedding digital sleep health into primary care practice: perspectives of general practitioners, nurses, and pharmacists

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A4-A4
Author(s):  
J Cheung ◽  
Z Menczel Schrire ◽  
M Aji ◽  
H Salomon ◽  
I Doggett ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Informatics ◽  
Online Survey ◽  
Service Providers ◽  
Care Service ◽  
Digital Health ◽  
Care Practice ◽  
Health Providers ◽  
Sleep Health ◽  
Convenience Sample

Abstract Introduction Digital health interventions (DHI) have the potential to address the unmet sleep health needs of patients in primary care. The current study explored primary care health providers’ attitudes and beliefs towards DHIs for sleep health and the implementation into practice. Methods A mixed-methods study was conducted in a convenience sample of primary care service providers (GPs, nurses, pharmacists). An online survey captured participants’ scope of practice and attitudes towards DHIs. Associations between practice factors and attributes of DHIs were explored. A subset of participants was interviewed to explore perceived barriers/facilitators for implementing DHIs into primary care, which was thematically analysed using the Framework Approach. Results 71 surveys were returned (GPs = 26, nurses = 21, pharmacists = 24) and 37 interviews were conducted (GPs = 13, nurses = 12, pharmacists = 12). Self-reported familiarity with DHIs was highest for GPs followed by pharmacists and nurses. Three major themes were identified: 1) Technology in Current Practice 2) Education Gaps and Training Needs and 3) Envisioning a Model of Care. Participants reported the “vague” definition of DHIs and mostly spoke in terms of personal experience and/or the health informatics systems used in practice. Despite recognising knowledge gaps, participants were confident in becoming upskilled and welcomed the idea of expanding digitalisation into sleep health. However, implementation success would depend on a supportive practice culture, patient uptake, and revising reimbursement structures. Conclusion With appropriate training and support, service providers highlighted the potential for embedding DHIs into primary care to optimise sleep health.

Examining preconception care-related knowledge and attitudes among Chinese immigrants in Canada

2017 ◽  
Vol 13 (1) ◽  
pp. 69-92
Author(s):  
Jing Teng ◽  
Rukhsana Ahmed
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Online Survey ◽  
Preconception Care ◽  
Chinese Immigrants ◽  
Preconception Health ◽  
Convenience Sample ◽  
Content Type ◽  
Prenatal Health ◽  
Knowledge And Attitudes

Purpose The purpose of this paper is to examine knowledge and attitudes about preconception health care among Chinese immigrants in Canada. Design/methodology/approach A cross-sectional internet-based survey, informed by the principles of the health belief model, was administered to a convenience sample in Ottawa, Canada. In total, 76 respondents from the Chinese community participated in the online survey. Findings Overall, participants demonstrated: low to moderate awareness of preconception related risk factors and preconception health; neutral to slightly positive attitudes toward carrying out preconception care; considerable confusion over the differences among preconception care, premarital health care (Mainland China), and prenatal health care; great sensitivity to subjective norms related to spouses, parents, and friends; and a strong desire for receiving information and communication from health care professionals. Practical implications An emphasis on reducing misperceptions and offering information about the preconception period and potential severe pregnancy-related risks may contribute to a better knowledge and intended behavior toward preconception care among Chinese immigrants, and ultimately optimize both their reproductive health and their future children’s health. Originality/value The cultural norms and population policies in the sending country may frame immigrants’ knowledge and attitudes related to preconception health care. This study fills the gap in the literature regarding Chinese immigrants’ knowledge levels and attitudes toward preconception care in Canada and thus offers insights into how to deliver culturally competent care and design effective communication strategies to reach out to ethnocultural communities.

scholarly journals Does COVID-19 change dietary habits and lifestyle behaviours in Kuwait: a community-based cross-sectional study

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Wafaa Husain ◽  
Fatemah Ashkanani
Keyword(s):  
Physical Activity ◽  
Fast Food ◽  
Dietary Habits ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Lifestyle Behaviours ◽  
Late Night ◽  
Main Meal

Abstract Background The coronavirus pandemic has transformed and continues to transform and affect the daily lives of communities worldwide, particularly due to the lockdown restrictions. Therefore, this study was designed to understand the changes in dietary and lifestyle behaviours that are major determinants of health during the COVID-19 outbreak. Methods A cross-sectional study was conducted through an online questionnaire using a convenience sample of 415 adults living in Kuwait (age range 18–73 years). Results The rate of skipping breakfast remained consistent, with a slight increase during the pandemic. Lunch remained the main reported meal before and during COVID-19. Compared to before COVID-19, people were much more likely have a late-night snack or meal during COVID-19 (OR = 3.57 (95% CI 1.79–7.26), p < 0.001). Moreover, there was a drastic decrease in the frequency of fast-food consumption during COVID-19, up to 82% reported not consuming fast food (p < 0.001). There was a significant increase in the percentage of participants who had their main meal freshly made (OR = 59.18 (95% CI 6.55–1400.76), p = 0.001). Regarding food group patterns, no significant differences were found before and during the pandemic in terms of the weekly frequency of consumption, except in the case of fish and seafood. There were no remarkable changes in beverage consumption habits among participants before and during the pandemic, except for Americano coffee and fresh juice. Furthermore, there was a great reduction in physical activity and an increase in the amount of screen time and sedentary behaviours. A notable increase was detected in day-time sleep and a decrease in night-time sleep among participants. Conclusion In general, this study indicates some changes in daily life, including changes in some eating practices, physical activity and sleeping habits during the pandemic. It is important that the government considers the need for nutrition education programmes and campaigns, particularly during this critical period of the pandemic in Kuwait.

scholarly journals Burnout Determinants among Nurses Working in Palliative Care during the Coronavirus Disease 2019 Pandemic

2021 ◽  
Vol 18 (7) ◽  
pp. 3358
Author(s):  
José Vítor Gonçalves ◽  
Luísa Castro ◽  
Guilhermina Rêgo ◽  
Rui Nunes
Keyword(s):  
Palliative Care ◽  
Health Care Professionals ◽  
Online Survey ◽  
Three Dimensions ◽  
Linear Regression Models ◽  
Perceived Health Status ◽  
Cross Sectional ◽  
National Network ◽  
Work Related ◽  
High Level

Nurses working in palliative care are at risk of burnout. The Copenhagen Burnout Inventory was used to determine burnout levels of nurses working in the Portuguese national network of palliative care. We evaluated the contribution of personal, work, and COVID-19 variables in three burnout subclasses: personal, work, and patient-related. A cross-sectional, exploratory, and quantitative design was employed and participants were sampled using convenience and snowball technique. An online survey was conducted and 153 nurses participated in our study. Socio-demographic characterization was conducted, levels of burnout and determinants were explored through multiple linear regression models for its three dimensions. High levels of personal, working, and patient burnout were present in 71 (46%), 68 (44%), and 33 nurses (22%), respectively. Most of them agreed that COVID-19 had an impact on their activities. Significant personal and work related burnout factors found were specialization in palliative care, self-perceived health status, unit type, weekly hours of work, and allocation to COVID-19 units. Gender was found to be a significant factor in patient-related burnout. There is a high level of burnout among nurses working in the Portuguese national network of palliative care. Measures for identification and mitigation of burnout are necessary to protect health care professionals.

scholarly journals Beyond the high: Mapping patterns of use and motives for use of cannabis as medicine

2021 ◽  
pp. 145507252098596
Author(s):  
Sinikka L. Kvamme ◽  
Michael M. Pedersen ◽  
Sagi Alagem-Iversen ◽  
Birgitte Thylstrup
Keyword(s):  
Mental Health ◽  
Side Effects ◽  
Sleep Disturbances ◽  
Online Survey ◽  
Cannabis Use ◽  
Health Conditions ◽  
Convenience Sample ◽  
Mental Health Conditions ◽  
Patient Organisations ◽  
Patterns Of Use

Background: In Denmark the boundaries between cannabis as an illicit drug and licit medicine have shifted rapidly in recent years, affecting also policy. However, the vast majority of Danes, who use cannabis as medicine (CaM) continue to rely on the unregulated market for supply. This study explores patterns of use and motives for use of CaM in Denmark. Methods: An anonymous online survey was made available to a convenience sample of users of CaM from July 14, 2018 to November 1, 2018. Participants were recruited through patient organisations, social and public media, and the illegal open cannabis market. Results: Of the final sample ( n = 3,021), a majority were women (62.6%) and the mean age was 49 years. Most had no prescription for CaM (90.9%), a majority had no or limited previous experience with recreational cannabis use (63.9%), and had used CaM for two years or less (65.0%). The most common form of intake was oil (56.8%) followed by smoke (24.0%). CBD oil (65.0%) was used more than hash, pot or skunk (36.2%). Most frequent conditions treated were chronic pain (32.0%), sleep disturbances (27.5%), stress (23.7%), osteoarthritis (22.7%), anxiety (19.6%), and depression (19.6%). Overall, users experienced CaM to be effective in managing somatic and mental health conditions and reported relatively few side-effects. CBD oil only users were more likely to be women, older, have limited recreational experience and have initiated use recently. Conclusions: A new user group has emerged in Denmark that, for the most part, use illegally sourced CaM to treat a broad range of somatic and mental health conditions, often with experienced effect and relatively low level of side-effects. The prevalent use of low-potency CBD oil indicates an interest in effects beyond the high normally associated with cannabis use. More clinical research into the effects and side-effects of CaM is needed to draw the boundaries of the medical utility of cannabis.

scholarly journals Exploring the use of cannabis as a substitute for prescription drugs in a convenience sample

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sinikka L. Kvamme ◽  
Michael M. Pedersen ◽  
Kristine Rømer Thomsen ◽  
Birgitte Thylstrup
Keyword(s):  
Side Effects ◽  
Drug Use ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
Online Survey ◽  
Convenience Sample ◽  
Patient Organizations ◽  
Public Media ◽  
Prescription Drug Use ◽  
The Impact

Abstract Background The use of cannabis as medicine (CaM) both prescribed and non-prescribed has increased markedly in the last decade, mirrored in a global shift in cannabis policy towards a more permissive stance. There is some evidence that cannabis functions as a substitute for prescription drugs, particularly opioids; however, more knowledge is needed on the motives of substitution users, their patterns of use, and perceived effects of substitution use. Aims To explore who substitutes prescription drugs with cannabis, the type of prescription drugs substituted and the type of cannabis used, and the impact that substitution with cannabis has on prescription drug use as well as the motives for substitution in terms of experienced effects and side effects. Methods A self-selected convenience sample was recruited through social media, public media, and patient organizations to take part in an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis (prescribed or non-prescribed) with a medical purpose. Results The final sample included 2.841 respondents of which the majority (91%) used non-prescribed cannabis, and more than half (54.6%) had used CaM with the purpose of replacing a prescribed drug. Compared to non-substitution users, substitution users were more likely to be women and to use CaM in the treatment of chronic pain and other somatic conditions. Pain medication (67.2%), antidepressants (24.5%), and arthritis medication (20.7%) were the most common types of drugs replaced with CaM. Among substitution users, 38.1% reported termination of prescription drug use, and 45.9% a substantial decrease in prescription drug use. The most frequent type of cannabis used as a substitute was CBD-oil (65.2%), followed by ‘hash, pot or skunk’ (36.6%). More than half (65.8%) found CaM much more effective compared to prescription drugs, and 85.5% that the side effects associated with prescription drug use were much worse compared to use of CaM. Conclusion CaM is frequently used as a substitute for prescription drugs, particularly opioids. More research is needed on the long-term consequences of use of CaM, including the impact from low and high THC cannabis products on specific somatic and mental health conditions.

scholarly journals A Roadmap to Inform Development, Validation and Approval of Digital Mobility Outcomes: The Mobilise-D Approach

2020 ◽  
Vol 4 (1) ◽  
pp. 13-27 ◽  
Author(s):  
Lynn Rochester ◽  
Claudia Mazzà ◽  
Arne Mueller ◽  
Brian Caulfield ◽  
Marie McCarthy ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Health Care Professionals ◽  
Digital Health ◽  
Disease Status ◽  
Proximal Femoral Fracture ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Physical Mobility ◽  
High Level

Health care has had to adapt rapidly to COVID-19, and this in turn has highlighted a pressing need for tools to facilitate remote visits and monitoring. Digital health technology, including body-worn devices, offers a solution using digital outcomes to measure and monitor disease status and provide outcomes meaningful to both patients and health care professionals. Remote monitoring of physical mobility is a prime example, because mobility is among the most advanced modalities that can be assessed digitally and remotely. Loss of mobility is also an important feature of many health conditions, providing a read-out of health as well as a target for intervention. Real-world, continuous digital measures of mobility (digital mobility outcomes or DMOs) provide an opportunity for novel insights into health care conditions complementing existing mobility measures. Accepted and approved DMOs are not yet widely available. The need for large collaborative efforts to tackle the critical steps to adoption is widely recognised. Mobilise-D is an example. It is a multidisciplinary consortium of 34 institutions from academia and industry funded through the European Innovative Medicines Initiative 2 Joint Undertaking. Members of Mobilise-D are collaborating to address the critical steps for DMOs to be adopted in clinical trials and ultimately health care. To achieve this, the consortium has developed a roadmap to inform the development, validation and approval of DMOs in Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease and recovery from proximal femoral fracture. Here we aim to describe the proposed approach and provide a high-level view of the ongoing and planned work of the Mobilise-D consortium. Ultimately, Mobilise-D aims to stimulate widespread adoption of DMOs through the provision of device agnostic software, standards and robust validation in order to bring digital outcomes from concept to use in clinical trials and health care.

scholarly journals Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey

2021 ◽  
pp. bmjsrh-2020-200975
Author(s):  
Ruth Lewis ◽  
Carolyn Blake ◽  
Michal Shimonovich ◽  
Nicky Coia ◽  
Johann Duffy ◽  
...  
Keyword(s):  
Young People ◽  
Online Survey ◽  
Unmet Need ◽  
Initial Response ◽  
Mitigation Measures ◽  
Routine Practice ◽  
Sexual Risk Taking ◽  
Transmitted Infection ◽  
Convenience Sample ◽  
Preventive Practices

BackgroundThe initial response to COVID-19 in the UK involved a rapid contraction of face-to-face sexual and reproductive health (SRH) services and widespread use of remote workarounds. This study sought to illuminate young people’s experiences of accessing and using condoms and contraception in the early months of the pandemic.MethodsWe analysed data, including open-text responses, from an online survey conducted in June–July 2020 with a convenience sample of 2005 16–24-year-olds living in Scotland.ResultsAmong those who used condoms and contraception, one quarter reported that COVID-19 mitigation measures had made a difference to their access or use. Open-text responses revealed a landscape of disrupted prevention, including changes to sexual risk-taking and preventive practices, unwanted contraceptive pathways, unmet need for sexually transmitted infection (STI) testing, and switches from freely provided to commercially sold condoms and contraception. Pandemic-related barriers to accessing free condoms and contraception included: (1) uncertainty about the legitimacy of accessing SRH care and self-censorship of need; (2) confusion about differences between SRH care and advice received from healthcare professionals during the pandemic compared with routine practice; and (3) exacerbation of existing access barriers, alongside reduced social support and resources to navigate SRH care.ConclusionsEmerging barriers to STI and pregnancy prevention within the context of COVID-19 have the potential to undermine positive SRH practices, and widen inequalities, among young people. As SRH services are restored amid evolving pandemic restrictions, messaging to support navigation of condom and contraception services should be co-created with young people.

scholarly journals Food insecurity among Finnish private sector service workers and food pantry clients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Erkkola ◽  
L Uusitalo ◽  
K Puputti ◽  
T Saari ◽  
P Jallinoja ◽  
...  
Keyword(s):  
Private Sector ◽  
Food Insecurity ◽  
Low Income ◽  
Perceived Health ◽  
Resource Scarcity ◽  
Considerable Proportion ◽  
Convenience Sample ◽  
Service Workers ◽  
Food Pantry ◽  
Sector Service

Abstract Background There is a paucity of comparable quantitative data on the prevalence and predictors of food insecurity in high-income countries. We applied the Household Food Insecurity Access Scale (HFIAS) to assess food insecurity among i) the Service Union United members; female-dominated, low-income employees of the Finnish private service sector, and ii) a convenience sample of Finnish food pantry clients. Methods The HFIAS classification was based on 9 validated questions capturing respondents' perceptions on food scarcity and behavioural responses to food insecurity due to lack of resources during the past month. The resulting indicator categorized respondents as food secure, and mildly, moderately and severely food insecure. We performed cross-tabulations and regression models to assess if education, housing, self-perceived health, income, and resource scarcity associated with levels of food insecurity. In addition, gender, age, and self-perceived disadvantage were assessed among the food pantry clients. Results Among the service workers (n = 6 573, 6% of those invited), 35% were food secure, 29% mildly or moderately food insecure, and 36% severely food insecure. The respective proportions were 28%, 26%, and 46% among the 129 food pantry clients. All assessed variables were associated to food insecurity status in the service workers (p &lt; 0.01 for all). Among the food pantry clients, men (OR 1.60; 95% CI 1.09 − 4.80) and homeless/tenants in community rental units (OR 7.12; 95% CI 2.42 − 20.95) were most likely to experience severe food insecurity. Conclusions Alongside the food pantry clients the majority of the service workers demonstrated some degree of food insecurity, with a considerable proportion being severely food-insecure. This predominantly low-income group is subject to rapid changes in the labour market and social security systems. The data demonstrated that well-known SES indicators and self-perceived health are linked to food insecurity. Key messages Severe food insecurity was common among predominantly low-income private sector service workers and food pantry clients. Food insecurity is linked to SES indicators and wellbeing.

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