scholarly journals FEASIBILITY OF MOBILE HEALTH FOR LOW-INCOME MINORITY HISPANIC PATIENTS WITH A STROKE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S334-S334
Author(s):  
Stuti Dang ◽  
Kasra Sarhadi ◽  
Sonjia Kenya ◽  
Chuanhui Dong ◽  
Natalie Ferras ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Patient Education ◽  
Mobile Health ◽  
Low Income ◽  
Health Knowledge ◽  
Randomized Study ◽  
Response Rates ◽  
Text Messages ◽  
Stroke Patients ◽  
The Impact

Abstract Stroke is a leading cause of death and functional impairment that disproportionately impacts Hispanics. Several studies have supported the feasibility of mobile health interventions (mHealth) to provide health monitoring and patient education for improving chronic disease management, but none have focused on Latino stroke patients. The Hispanic Secondary Stroke Prevention Initiative is a randomized study of 200 stroke patients designed to evaluate the impact of a 12-month multi-modal Community Health Worker (CHW) and mHealth intervention on blood pressure control. Eligible participants were Latinos who experienced a mild-moderate stroke within the last five years. The CHW component included home visits, telephone calls, and daily text messages to obtain home blood pressure readings and provide patient navigation and health education. Feasibility was defined as the proportion of patients that responded to at least half the messages. Pre-post paired t-tests assessed improvements in question accuracy while correlation coefficients highlighted improvements in response rates. Among the 65 participants randomized to the intervention, the response rate was as follows: 37% - >50% response, 21% - 25-50%, 19% - 10-25%, and 23% - <10%, This finding suggests that mHealth interventions may be challenging in this population. However, the proportion of questions answered correctly increased from 63% to 84% in the intervention period’s last two months (p<0.05). There was a positive correlation between increased response rates and response accuracy to patient education assessments (r=0.82, p<0.05). These improvements in health knowledge suggest that a subset of patients may benefit from mHealth interventions, and the benefit correlates with use.

scholarly journals Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes

10.2196/15927 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e15927
Author(s):  
Scott Sittig ◽  
Jing Wang ◽  
Sriram Iyengar ◽  
Sahiti Myneni ◽  
Amy Franklin
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Mobile Health ◽  
Self Efficacy ◽  
Chronic Disease Management ◽  
Text Messages ◽  
Feasibility Trial ◽  
Significant Difference ◽  
Within Subjects ◽  
The Impact

Background Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. Objective The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. Methods The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants’ classified usage of capABILITY. Results Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. Conclusions Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. Trial Registration ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089

Comparative Analysis of Mobile Pain Management Applications in Developed versus Developing Countries (Preprint)

2021 ◽  
Author(s):  
Wilson Mupfururirwa ◽  
Victoria Nembaware ◽  
Jack Morrice ◽  
Khuthala Mnika ◽  
Gaston Kuzamunu Mazandu ◽  
...  
Keyword(s):  
Pain Management ◽  
Uniform Distribution ◽  
Mobile Health ◽  
Low Income ◽  
Cochrane Review ◽  
High Income ◽  
Low Income Countries ◽  
App Store ◽  
Significant Difference ◽  
The Impact

BACKGROUND The impact of mobile phones and their applications in healthcare (mobile health) is well established for a range of diseases and cross-cutting complications, such as pain. While numerous mobile health (mHealth) pain interventions have been established, an evaluation of their prevalence, adequacy and distribution remains limited. OBJECTIVE This study aims at reviewing and comparing current pain management mHealth tools in high- versus low-income countries. METHODS A literature and application (app) store search was conducted in May 2021 using combinations of the following keywords: “pain management”, “pain”, “mobile health”, “telemedicine”, and “app”. Literature searches were conducted in PubMed, Scopus, Cochrane Review Library, and Google scholar. App store searches were conducted in Google Play and Apple App Store. Data characteristics descriptive analysis was performed using R software to summarize different datasets and compute p-values (P) for testing the significance of different hypotheses with the significance level set to 0.05. RESULTS The search identified 40 publications (literature search) and 230 mHealth applications (app store search), revealing a non uniform distribution of search categories (χ2= 133.7, P < 0.004) with a ratio approximating 1:6 (OR = 5.730, 95%CI:3.745-8.909, P < 0.004). About 86.7% of these 270 applications (apps) are from high-income countries, showing a statistically significant non uniform distribution of country categories: high- and low-income (χ2= 145.2, P < 0.004) approximating the theoretical distribution of a 7:1 ratio (OR = 6.476, 95%CI:4.180-10.222, P < 0.004). Moreover, there is no significant difference in the proportion of search categories between country categories ( χ2= 0.113, P = 0.737) and the difference in pain app prevalence in high- versus low-income countries is not statistically significant. Finally, we have observed that pain-tracking apps are significantly more prevalent in developed countries in comparison to low-income countries. CONCLUSIONS As expected, pain management app prevalence is higher in high-income countries. However, more research is required to readily comprehend the effectiveness of these apps.

Abstract 242: Evaluating the Impact and Barriers to a Collaborative Physician-pharmacist Care Model to Control Hypertension in a Low-income Population

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Kerrilynn C Hennessey ◽  
Carolyn Hickman ◽  
Brianne Krawczyk ◽  
Michelle Opare ◽  
Leslie Churchwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Blood Pressure Control ◽  
Low Income ◽  
Health Workers ◽  
Pressure Control ◽  
Low Income Population ◽  
Early Results ◽  
Patient Reported ◽  
The Impact

Objectives: Physician-pharmacist collaborative practice models have emerged as an effective model for managing hypertension (HTN). We implemented this model in a low-income, hospital-based cardiology clinic and sought to identify programmatic features necessary to control HTN in this vulnerable population. Methods: Patients with persistently elevated blood pressure (>130/80) were referred by their primary cardiologist. Patients were excluded if they were pregnant, had acute kidney injury, or acute cardiovascular complaints including anginal chest pain, decompensated heart failure, or unstable arrhythmia. The initial pharmacist appointment occurred within 2 weeks of referral, with the goal of bi-weekly visits for 6 weeks or until blood pressure was controlled. Patients were prescribed home blood pressure cuffs and given specific instructions for home-based monitoring. Telehealth visits were made available to interested patients. During each encounter, pharmacists assessed response and side effects to medication, adherence, lifestyle behaviors, stressors, and social barriers to blood pressure control. Clinical management and barriers to HTN control were reviewed at standing weekly staff meetings that included cardiologists and pharmacists. Early results: Among 35 people referred, 22 patients attended at least one pharmacist visit. A total of 139 reminder or follow-up calls were made for these 22 patients. Among the first 35 referrals (mean age 58; 57% male; 65% African American or Latinx), 26% have documented substance use disorders, 34% have a mental health comorbidity, 20% were not taking their medications as prescribed on intake, and 17% had side effects from 2 or more prior antihypertensive medications. Medications adjustments were made in 21/43 patient visits (49% of visits). In 8/43 visits more than 1 medication change was made. The most common patient reported barriers to care include transportation (20%) and language barriers (11%). Discussion and Future Direction: Managing HTN in a low-income population requires attention to the social and contextual factors impacting blood pressure control. We plan to: 1) support the uptake of telehealth to address issues of transportation and access; 2) pilot blue-tooth connected blood pressure cuffs to facilitate home monitoring and management; and 3) partner with community health workers to assess best practices for capturing and addressing social determinants of health in the clinical setting.

scholarly journals Does a Different Household Registration Affect Migrants’ Access to Basic Public Health Services in China?

2019 ◽  
Vol 16 (23) ◽  
pp. 4615 ◽  
Author(s):  
Meng
Keyword(s):  
Public Health ◽  
Health Services ◽  
Low Income ◽  
Health Knowledge ◽  
Medical Knowledge ◽  
Public Health Services ◽  
Household Registration ◽  
Career Training ◽  
Permanent Settlement ◽  
The Impact

On the basis of the China Migrants Dynamic Survey Data of 2015, the author provides an analysis of how a different household registration impacts migrants’ access to preventive care provided by public health services, such as health records and medical knowledge, in areas of immigration. This study shows that eliminating the distinction between agricultural and non-agricultural permanent residence registration could raise the rate of establishing health files, but it has no significant effect on migrants’ health knowledge. In fact, encouraging those with non-agricultural registration to move to different counties that belong to the same city or to different cities that belong to the same province can notably eliminate the impact of a different household registration status. Improving the income level of low-income migrants can have the same impact. Recommendations to enable migrants to obtain basic public health services include abolishing the separation of agricultural and non-agricultural household registration, increasing the permanent settlement rate of resident migrants, promoting basic medical security systems across the whole country, strengthening career training, and enhancing the education level of migrants.

scholarly journals The Southside Simple Suppers Scale-Up (S4): Effects of a Family Meals Program on Head Start Caregivers

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 279-279
Author(s):  
Amy Sharn ◽  
Leah May ◽  
Miranda Westrick ◽  
Ashley Walther ◽  
Carolyn Gunther
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Data Collection ◽  
Head Start ◽  
Perceived Stress ◽  
Low Income ◽  
Family Meals ◽  
Post Test ◽  
The Impact

Abstract Objectives Assess the impact of an 8-week Head Start family meals intervention (Simple Suppers) on participating caregiver's weight status and health outcomes. Methods This is a single arm pre- to post-test study. The intervention is occurring during the 2019–20 school year (fall, winter, and spring sessions) at 3 Head Start sites. Caregiver outcomes include: BMI (kg/m2), waist circumference (cm), blood pressure (mm Hg), and mental health measures (depression (Patient Health Questionnaire-9 (PHQ-9)), perceived stress (Perceived Stress Scale (PSS)), and anxiety (Generalized Anxiety Disorder-7 (GAD-7))). Regression models factoring in attendance will be used to examine pre- to post-test changes. Results Nineteen caregivers completed data collection for the fall session. 55.6% of families were low-income and 21.1% had low/very low food security. Mean (SD) caregiver age was 37.6 (12.1) yr, 94.7% were female, and 84.2% were non-Hispanic Black. There were no significant changes in BMI, blood pressure, waist circumference, depression, or perceived stress from pre- to post-test according to attendance level, however anxiety significantly decreased with increasing attendance (P &lt; 0.05). Data collection for the remaining sessions will be completed in spring 2020. Conclusions This study can be expected to have a positive impact by understanding the role of healthy family mealtime routines in caregiver's physical and mental health among racial minorities residing in low-income households. Funding Sources USDA NIFA.

Personalized SMS, Survey Participation and Data quality – The Italian Case

2017 ◽  
Vol 136 (1) ◽  
pp. 21-39 ◽  
Author(s):  
Chiara Respi ◽  
Emanuela Sala
Keyword(s):  
Online Survey ◽  
Positive Impact ◽  
Response Rates ◽  
Text Messages ◽  
Short Text ◽  
Italian Case ◽  
Data Limitations ◽  
Survey Participation ◽  
The Impact ◽  
E Mail

A number of papers have found that personalization of salutations in e-mail communications may lead to higher response rates. Given their widespread use, Short Text Messages (SMS) may also be useful contact modes in surveys. Using experimental data from an online survey on Italian graduates, this work intends to evaluate the impact of personalized SMS salutations on response and measurement error. We find evidence that personalization has a positive impact on response rates and some indication that it may lead to better survey data. Limitations and implications of the study are also discussed.

scholarly journals Managing hypertension in 2018: which guideline to follow?

Heart Asia ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. e011127 ◽  
Author(s):  
Fabio Angeli ◽  
Gianpaolo Reboldi ◽  
Monica Trapasso ◽  
Adolfo Aita ◽  
Paolo Verdecchia
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Low Income ◽  
Asian Population ◽  
Public Health Issue ◽  
Global Public Health ◽  
Asian Countries ◽  
Western Countries ◽  
Asian Populations ◽  
The Impact

Hypertension is a global public health issue and a major cause of morbidity and mortality. Its prevalence is increasing in many Asian countries, with a number of countries with blood pressure above the global average. Although the average systolic blood pressure is decreasing worldwide since the 1980s at the rate of about 1 mm Hg systolic blood pressure per decade, it is increasing in low-income and middle-income countries, especially in the East and South Asian population. Of note, the much larger base Asian population results in a considerably larger absolute number of individuals affected. When compared with Western countries, hypertension among Asian populations has unique features in terms of its onset, clustering of associated cardiovascular risk factors, complications and outcomes. Moreover, only a minority of hypertensive individuals are receiving treatment and achieving control. Projected number of deaths related to hypertension dramatically increased in the last 25 years in some Asian regions with a disproportionately high mortality and morbidity from stroke compared with Western countries. The relation between blood pressure and the risk of stroke is stronger in Asia than in Western regions. Although new Guidelines for hypertension diagnosis and management have been recently released from Europe and North America, the unique features of Asian hypertensive patients raise concerns on the clinical applicability of Western Guidelines to Asian populations. To this purpose, we critically reviewed key elements from the most updated Guidelines. We also discussed their core concepts to verify the impact on hypertension prevention and management in Asian countries.

Abstract 2462: Obstructive Sleep Apnea Treatment Improves the Blood Pressure Behavior in Normotensive Patients: A Randomized Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Luciano F Drager ◽  
Patrícia M Diniz ◽  
Luzia Diegues-Silva ◽  
Roberta B Couto ◽  
Rodrigo P Pedrosa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Study ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
The Impact ◽  
Current Guidelines ◽  
Concomitant Hypertension

Introduction: Obstructive sleep apnea (OSA) promotes significant alterations on blood pressure during sleep. In patients with concomitant hypertension, the treatment with continuous positive airway pressure (CPAP) promotes significant reductions on blood pressure. However, the impact of CPAP on 24 hour blood pressure in normotensive patients is poorly understood. Methods: We included 22 apparently healthy patients with severe OSA defined by polysomnography (apnea/hypopnea index (AHI) >30 events/hour). We excluded hypertension according current guidelines by office measurements. They were randomized to no treatment (control) or CPAP for 3 months. At baseline and at the end of the protocol, we performed 24 hour blood pressure (BP) monitoring evaluating daytime and nighttime BP as well as the morning surge (average of systolic BP during the 2 hours after awakening minus the average of systolic BP during the 1 hour that included the lowest nighttime BP) and highest systolic nighttime BP (mean of 3 BP measurements, centered on the highest nighttime reading). Results: After 3 months, patients randomized to CPAP (mean CPAP usage: 6 hours) presented a significant reduction on daytime (80.3±6.3 to 75.3±6.9 mmHg; P=0.02) and nighttime diastolic BP (67.8±9.5 to 61.4±7.5 mmHg; P=0.03). In addition, we observed a significant reduction on highest nighttime systolic BP (120.0±13.6 to 112.0±.9 mmHg; P=0.02) with a trend for a reduction on morning surge (22.3±9.2 to 17.3±.4 mmHg; P=0.08). No significant alterations occurred in the control group. Conclusion: Even in the absence of established hypertension, CPAP therapy improved the behavior of 24 hour BP in patients with severe OSA.

Effect of upper airway obstruction on blood pressure variability after stroke

2004 ◽  
Vol 107 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Peter M. TURKINGTON ◽  
John BAMFORD ◽  
Peter WANKLYN ◽  
Mark W. ELLIOTT
Keyword(s):  
Blood Pressure ◽  
Airway Obstruction ◽  
Acute Stroke ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Stroke Patients ◽  
Sleep Study ◽  
Ischaemic Brain ◽  
Respiratory Disturbance ◽  
The Impact

Approx. 60% of acute stroke patients have periods of significant UAO (upper airway obstruction) and this is associated with a worse outcome. UAO is associated with repeated fluctuation in BP (blood pressure) and increased BP variability is also associated with a poor outcome in patients with acute stroke. UAO-induced changes in BP, at a time when regional cerebral perfusion is pressure-dependent in areas of critically ischaemic brain, could explain the detrimental effect of UAO on outcome in these patients. The aim of the present study was to examine the relationship between UAO and BP variability in patients with acute stroke. Twelve acute stroke patients and 12 age-, sex- and BMI (body mass index)-matched controls underwent a sleep study with non-invasive continuous monitoring of BP to assess the impact of UAO on BP control after stroke. Stroke patients had significantly more 15 mmHg dips in BP/h than the controls (51 compared with 6.7 respectively; P<0.004). Stroke patients also demonstrated significantly higher BP variability than the controls (26.8 compared with 14.4 mmHg; P<0.001). There were significantly more 15 mmHg dips in BP/h in stroke patients who had significant UAO than those who did not (85.7 compared with 29.5 respectively; P<0.032). Furthermore, stroke patients without UAO (RDI <10, where RDI is respiratory disturbance index) had significantly more 15 mmHg dips in BP/h than the controls (29.5 compared with 6.7 respectively; P<0.037). There was a positive correlation between the severity of UAO (RDI) and 15 mmHg dips in BP/h (r=0.574, P<0.005) in stroke patients. Our results suggest that UAO alone does not explain BP variation post-stroke, but it does play an important role, particularly in determining the severity of the BP fluctuation.

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