scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia J. Lucas ◽  
Alastair D. Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract Background Type 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aims To gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups. Methods A purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically. Results A diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender. Conclusion This research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

scholarly journals The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

2020 ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia Lucas ◽  
Alastair D Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Social Resources ◽  
Health Interventions ◽  
Structured Interviews ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract BackgroundType 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aimsTo gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups.MethodsA purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.ResultsA diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender.ConclusionThis research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

scholarly journals How people with type two diabetes in England learn about digital health technologies, and what are the barriers to access and motivators for use? A qualitative study

2020 ◽  
Author(s):  
Sophie Turnbull ◽  
Patricia Lucas ◽  
Alastair D Hay ◽  
Christie Cabral
Keyword(s):  
Social Networks ◽  
Social Status ◽  
Digital Health ◽  
Self Care ◽  
Health Interventions ◽  
Structured Interviews ◽  
Web Based ◽  
Health Technologies ◽  
Digital Skills ◽  
Care Support

Abstract BackgroundType 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, digital health interventions might make no difference, or worse, exacerbate health inequity. Study aimsTo gain insights into how and why people with T2D access and use web-based self-care technology and how experiences vary between individuals and social groups.MethodsA purposive sample of people with experience of using a web-based intervention to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically.ResultsA diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about Digital Health Technology (DHT) that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHT are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHT from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHT because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to technology and self-care support, and these in turn were influenced by age and gender.ConclusionThis research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHT to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when interventions are developed and implemented.

scholarly journals Effectiveness of digital health interventions for diabetes: systematic review of systematic reviews

2021 ◽  
Author(s):  
Bonkana Maiga ◽  
Cheick O Bagayoko ◽  
Mohamed Ali Ag Ahmed ◽  
Abdrahamane Anne ◽  
Marie-Pierre Gagnon ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Digital Health ◽  
Scientific Evidence ◽  
Relevant Information ◽  
Health Interventions ◽  
Care Utilization ◽  
Clinical Indicators ◽  
Health Technologies ◽  
Digital Interventions ◽  
Effective Interventions

Abstract Background The use of digital health technologies to tackle diabetes has been particularly flourishing in recent years. Previous studies have shown to varying degrees that these technologies can have an impact on diabetes prevention and management. Objective The aim of this review is to summarize the best evidence regarding the effectiveness of digital health interventions to improve one or more diabetes indicators. Methods We included all types of interventions aimed at evaluating the effect of digital health on diabetes. We considered at all types of digital interventions (mobile health, teleconsultations, tele-expertise, electronic health records, decision support systems, e-learning, etc.). We included systematic reviews published in English or French over the last 29 years, from January 1991 to December 2019, that met the inclusion criteria. Two reviewers independently reviewed the titles and abstracts of the studies to assess their eligibility, and extracted relevant information according to a predetermined grid. Any disagreement was resolved by discussion and consensus between the two reviewers, or involved a third author as referee. Results In total in our review of journals, we included 10 reviews. The outcomes of interest were clinical indicators of diabetes that could be influenced by digital interventions. These outcomes had to be objectively measurable indicators related to diabetes surveillance and management that are generally accepted by diabetes experts. Six of the ten reviews showed moderate to large significant reductions in glycated hemoglobin (HBA1c) levels compared to controls. Most reviews reported overall positive results and found that digital health interventions improved health care utilization, behaviours, attitudes, knowledge and skills. Conclusion Based on a large corpus of scientific evidence on digital health interventions, this overview could help identify the most effective interventions to improve diabetes indicators.

scholarly journals ProACT - A Digital Platform to Support Self-Management of Multiple Chronic Conditions: Findings in Relation to Engagement during a one-year Proof-of-Concept Trial (Preprint)

2020 ◽  
Author(s):  
Julie Doyle ◽  
Emma Murphy ◽  
Shane Gavin ◽  
Alessandra Pascale ◽  
Stephane Deparis ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Digital Health ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
User Engagement ◽  
Proof Of Concept ◽  
Structured Interviews ◽  
Health Technologies ◽  
Care Approach

BACKGROUND Self-management, a core activity for older adults living with multiple chronic conditions (multimorbidity), is challenging, requiring the person to engage in multiple tasks such as symptom monitoring, recognition of exacerbations, medication adherence and inter-stakeholder communication. A digital, integrated care approach is a critical part of the solution, however, there is a dearth of literature on this topic. Furthermore, there is little research on older adults’ acceptability, usage and experiences of engaging with digital health technologies, particularly over long periods of time. OBJECTIVE The objectives were to (1) co-design and develop a digital health platform, called ProACT, to facilitate older adults self-managing multimorbidity, with support from their care network (CN); (2) evaluate end user engagement and experiences with the platform through a 12-month trial. METHODS The ProACT digital health platfrom is presented. The platform was evaluated in a year-long proof-of-concept (PoC) action research trial with 120 older persons with multimorbidity (PwMs) in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts, and a technical helpdesk. Interactions with the platform during the PoC trial were logged to determine engagement, semi-structured interviews were conducted with participants and analysed using inductive thematic analysis methods, while usability and user burden were examined using validated questionnaires. RESULTS This article presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who took part, 24 withdrew before the end of the study while three passed away. The remaining 93 participants actively used the platform until the end of the trial, on average taking two or three health readings daily over the course of the trial, in Ireland and Belgium respectively. Participants reported ProACT to be usable and of low burden. Findings from interviews outline that participants experienced multiple benefits as a result of using ProACT, including improved self-management, improved health and wellbeing and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology didn’t work as expected. CONCLUSIONS This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multiple chronic conditions. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for this include a strong focus on user-centred design and engagement throughout the project lifecycle, resulting in a platform that met user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.22125

Identifying Enablers of Participant Engagement in Clinical Trials of Consumer Health Technologies: A Qualitative Study of flu@home (Preprint)

2020 ◽  
Author(s):  
Spurthy Dharanikota ◽  
Cynthia M LeRouge ◽  
Victoria Lyon ◽  
Polina Durneva ◽  
Matthew Thompson
Keyword(s):  
Clinical Trials ◽  
Technology Acceptance ◽  
Attribution Theory ◽  
Financial Incentives ◽  
Large Scale ◽  
Digital Health ◽  
Drop Out ◽  
Evidence Based ◽  
Structured Interviews ◽  
Health Technologies

BACKGROUND Clinical trials are fraught with challenges such as inadequate enrollment, lack of fidelity to interventions, and high drop-out rates. However, such trials are essential to support large-scale implementation of crucial consumer healthcare technologies (CHTs) such as smartphone supported home diagnostic tests (Smart-HT). A rise in the recent trend of self-managing health using CHTs highlights the importance of efficient and successful CHT trials. Understanding the reasons underlying individuals’ participation in trials could inform the design and execution of future trials of CHTs. OBJECTIVE We aimed to identify the enablers of participation in clinical trials of CHTs and summarize our findings in an evidence-based framework. We used an instantiation of a specific CHT currently in trial, Smart-HT, which is an app accompanied by home-based diagnostic testing of influenza called flu@home. METHODS Based on the digital health engagement model (DIEGO) and technology acceptance model (TAM), we proposed a preliminary research framework of enablers for participants’ engagement in trials of CHTs. Further, based on the attribution theory, we categorized the enablers into dispositional and situational factors. The framework guided the confidential and semi-structured interviews and resultant transcript coding. 31 individuals who previously participated in the diagnostic accuracy pilot study of flu@home were recruited to complete the semi-structured interviews via email and received a 25$ gift card once completing the interview. RESULTS In addition to finding support and a detailed understanding of the proposed preliminary framework, we identified new themes in our analysis that extend our evidence-based framework. Situationally, we found that financial incentives and insurance status influenced trial engagement for flu@home. Motivation to advance medical research, personal innovativeness, altruism, curiosity, positive attitude, and potential to minimize doctor’s visits emerged as new dispositional enablers for trial engagement in our study. CONCLUSIONS Our findings and proposed framework provide insights into the context of trial engagement for CHTs that require testing, particularly an instantiation of Smart-HT involving testing for influenza. We suggest several trial design and trial engagement strategies to enhance these trials' financial and scientific viability, paving the way for advancements in patient care. Furthermore, our study also offers practical strategies to trial organizers to enhance participants’ enrollment and engagement in clinical trials of CHTs.

scholarly journals Self-care support for the management of type 1 diabetes during the transition from childhood to adolescence

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Neusa Collet ◽  
Annanda Fernandes de Moura Bezerra Batista ◽  
Vanessa Medeiros da Nóbrega ◽  
Maria Helena do Nascimento Souza ◽  
Leiliane Teixeira Bento Fernandes
Keyword(s):  
Type 1 Diabetes ◽  
Health Care Professionals ◽  
Diabetes Management ◽  
Self Care ◽  
Family Health ◽  
Lifestyle Changes ◽  
Self Awareness ◽  
Structured Interviews ◽  
Care Support

ABSTRACT Objective: To analyze the needs of pre-adolescents with type 1 diabetes regarding self-care support for disease management. Method: Qualitative study conducted between October and December 2016 with pre-adolescents seen at a hospital outpatient clinic and at Family Health Units; semi-structured interviews were used. Data were analyzed using a thematic analysis based on the theoretical basis of self-care support. Results: Nine pre-adolescents participated in the study. It was identified that in order to build self-efficacy, pre-adolescents need to overcome the disease denial phase, know how to handle feelings triggered by the need for lifestyle changes, receive support from their families and social networks, and have the self-awareness and self-perception needed to feel secure in managing their diabetes. Conclusion: The intrinsic challenges of adolescence and the way pre-adolescents with diabetes handle the disease have an influence on diabetes management and create needs that must be appreciated by health care professionals in order to provide self-care support.

scholarly journals “Sometimes I don’t have a pulse, and I’m still alive!” Healthcare providers on digital health techs

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Tomasella ◽  
H M Morgan
Keyword(s):  
Digital Health ◽  
Healthcare Providers ◽  
Future Research ◽  
Structured Interviews ◽  
Clinical Value ◽  
Health Technologies ◽  
Advantages And Disadvantages ◽  
Health Related ◽  
Potential Benefits ◽  
Change Promotion

Abstract Background Digital health technologies (DHTs) are increasingly becoming an integral part of our lives, healthcare field included. The WHO recently has even released the first digital health guidelines for worldwide intervention. Commercially available DHTs (e.g. smartphones, smartwatches, apps) may hold significant potential in healthcare, upon successful and constructive integration. Literature on the topic is split between enthusiasm for the potential benefits, and concerns about reliability and effectiveness. Little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they believe the main issues for implementation may be. This study aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public. Methods Nine HCPs volunteered to take part in semi-structured interviews. Data were thematically analysed adopting a pre-constructed framework (deductive approach) based on current (April 2019) literature and the findings from the first two interviews. Results The following main themes were identified and explored in detail: HCPs' experience, perceived knowledge and views on DHTs; advantages and disadvantages; barriers towards healthcare implementation and solutions; future perspectives. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this included factors such as time/resources availability; colleagues' mindset; lack of evidence of effectiveness for practice; privacy/data security concerns. Conclusions The potential advantages of DHTs' adoption in healthcare are substantial - e.g. patient autonomy, time/resources saving, health and behaviour change promotion. However, future research is warranted focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs. Key messages We explored healthcare providers’ views on the role of commercial digital health techs in clinical practice. Despite some privacy and reliability concerns, commercial digital health techs show promise.

scholarly journals A research tool for measuring non-participation of older people in research on digital health

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Arianna Poli ◽  
Susanne Kelfve ◽  
Andreas Motel-Klingebiel
Keyword(s):  
Social Participation ◽  
Digital Health ◽  
Relevant Literature ◽  
Healthcare Services ◽  
Survey Questionnaire ◽  
Health Technologies ◽  
Underrepresented Groups ◽  
Self Selection ◽  
Use Of Technology ◽  
Digital Skills

Abstract Background Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research – deriving from the processes of non-recruitment of targeted individuals and self-selection – can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection. Methods Based on a review of the relevant literature, we designed an instrument – the NPART survey questionnaire – for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study. Results Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature. Conclusions The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.

scholarly journals “Sometimes I don’t have a pulse … and I’m still alive!” Interviews with healthcare professionals to explore their experiences of and views on population-based digital health technologies

2021 ◽  
Vol 7 ◽  
pp. 205520762110183
Author(s):  
Flavio Tomasella ◽  
Heather May Morgan
Keyword(s):  
Healthcare Professionals ◽  
Digital Health ◽  
Relevant Literature ◽  
Population Based ◽  
Future Research ◽  
Daily Routine ◽  
Structured Interviews ◽  
Clinical Value ◽  
Health Technologies ◽  
Advantages And Disadvantages

Background Digital technologies are increasingly becoming an integral part of our daily routine and professional lives, and the healthcare field is no exception. Commercially available digital health technologies (DHTs – e.g. smartphones, smartwatches and apps) may hold significant potential in healthcare upon successful and constructive implementation. Literature on the topic is split between enthusiasm associated with potential benefits and concerns around privacy, reliability and overall effectiveness. However, little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they perceive as the main advantages and disadvantages of adoption. This study therefore aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public. Methods Nine HCPs volunteered to take part in semi-structured interviews. Related data were thematically analysed, following a deductive approach with the construction of a framework based on expected themes from the relevant literature, and themes identified from the first two interviews. Findings The following main themes in relation to DHTs were identified and explored in detail: HCPs’ experience, knowledge and views; advantages and disadvantages; barriers towards healthcare implementation and potential solutions; future directions. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this were explored, including factors such as time/resources; colleagues’ mindset; lack of evidence of effectiveness for practice; data security concerns. Conclusions The potential advantages of DHTs’ adoption in healthcare are substantial, e.g. patient autonomy, time/resources saving, health and behaviour change promotion, but are presently premature. Therefore, future research is warranted, focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs.

scholarly journals A qualitative study exploring patient suggestions for the design, functionality and implementation of digital health technologies before and after bariatric surgery

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i6-i7
Author(s):  
A Robinson ◽  
A K Husband ◽  
R D Slight ◽  
S P Slight
Keyword(s):  
Bariatric Surgery ◽  
Health Behaviour ◽  
Participatory Design ◽  
Digital Health ◽  
Digital Technologies ◽  
Structured Interviews ◽  
Health Technologies ◽  
Patient Cohort ◽  
Gastric Bypass Procedure ◽  
Behaviour Changes

Abstract Introduction Health behaviour changes made during the pre-operative period can positively impact on post-operative outcomes and the success of bariatric surgery.(1) Digital technologies present an opportunity to support patients with this. Currently, little is known about the optimal design or delivery of digital technologies for this patient cohort. In order to develop useful and effective digital strategies for this unique patient cohort, it is important to first understand how bariatric surgery patients want to be supported.(2) Aim To understand how digital technologies could be designed and delivered to better support patients with surgical health behaviour changes, specifically: 1) what do patients want from technologies, 2) how do they want to use them, and 3) when should they be implemented? Methods According to the EQUATOR guidelines, the consolidated criteria for reporting qualitative research (COREQ) checklist was followed. Pre- and post-operative patients attending bariatric surgery clinics within one large teaching hospital in the North of England were invited to take part. Purposive sampling was employed to recruit a representative sample of patients. Participants received an information sheet detailing the study purpose and aims. Written informed consent was obtained before conducting semi-structured interviews. Semi-structured interviews took place between February-March 2020 and were audio-recorded and transcribed verbatim. Interviews included questions on participant surgical experience, health behaviour change and perspectives on digital technologies. A reflexive thematic analysis approach enabled the development of themes from the data. NVivo 12 software assisted data organisation. Results Eighteen patients were recruited and interviewed. The average age of participants was 46-years. 55% (n=10) of participants had or were undergoing a gastric bypass procedure. The data analysis enabled the development of four themes which highlighted specific participant desires relating to the design, functionality and implementation of optimal digital technologies to best support them during the pre- and post-operative periods. Specifically, the themes related to an intervention’s ability to: 1) provide structured content and support, 2) facilitate self-monitoring and goal-setting, 3) deliver information in an accessible, trusted and usable manner, and 4) meet patient information-seeking and engagement needs (Figure 1). “In the first couple of weeks (following surgery), we need to be told what to do by the technology” Participant 9. Conclusion This patient-informed research highlighted how interventions could be designed, what functionality would be most useful and when they should be implemented within the NHS pathway for bariatric surgical patients. This study is one of the first in this patient cohort to involve pre- and post-operative participants and provides key insights to fill knowledge gaps relating to the design and optimisation of person-centred digital interventions. We acknowledge some limitations with our work. Whilst we did not sample participants by socioeconomic status, it is possible that different socioeconomic classes may have varied experiences with technologies. Our focus was solely bariatric surgery and thus findings may not be generalisable to other elective surgical procedures. These findings have the potential to shape and influence future work on the co-design and optimisation of person-centred digital health technologies in modern healthcare settings. References 1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology. 2009;28(6):690. 2. Donetto S, Pierri P, Tsianakas V, Robert G. Experience-based Co-design and Healthcare Improvement: Realizing Participatory Design in the Public Sector. The Design Journal. 2015;18(2):227–48.

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