Impact of stress on diabetes self-management in cancer survivors.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 11-11 ◽  
Author(s):  
Janey James ◽  
Natalie Coppa ◽  
Alexandra Rosenberg ◽  
Juan P. Wisnivesky ◽  
Jenny J Lin
Keyword(s):  
Medication Adherence ◽  
Cancer Survivors ◽  
Early Stage ◽  
Healthy Diet ◽  
Self Management ◽  
Diabetic Patients ◽  
Event Scale ◽  
Factors Associated ◽  
Falling Asleep ◽  
The Impact

11 Background: Few studies have evaluated the impact of stress on diabetes self- management among cancer survivors. We undertook this study to assess factors associated medication adherence and diabetes self-management in a cohort of diabetic patients with recently-diagnosed early-stage cancer. Methods: We recruited diabetes patients recently diagnosed with early-stage breast, prostate, lung or colorectal cancer on at least one oral hypoglycemic agent and used the Impact of Event Scale (IES) to assess the subjective distress caused by cancer. The 15-item IES consists of 2 subscales assessing avoidant and intrusive feelings about cancer. We measured medication adherence using the 8-item Morisky Medication Adherence Scale, and diabetes self-management behaviors were evaluated using the Summary of Diabetes Self-Care Activities. Participants were surveyed at baseline and after 3 months. Descriptive and univariate analyses were used to assess baseline factors associated with diabetes self-management at 3 months. Results: Of the 36 participants recruited to date, 20 (56%) were male. At baseline, 70% reported adherence to their diabetes medications which dropped to 63% at 3 months. There were no gender differences between IES scores at baseline; however, at 3 months women were more stressed (p = 0.02) and had more intrusive thoughts (p = 0.005) about cancer. Higher baseline total IES scores were associated with lack of a general healthy diet (p = 0.01). Patients who had trouble falling asleep from thoughts about cancer felt more hassled sticking to their diabetes medication treatment at 3 months (p = 0.02). Those who had dreams about cancer (p = 0.007) and those who tried to stay away from reminders about cancer (p = 0.04) were more likely to forget their diabetes medications when travelling. Lastly, patients who felt that the cancer wasn’t real were more likely to have difficulty remembering to take medications (p = 0.03). Conclusions: Cancer survivors with comorbid diabetes who have higher stress are less likely to follow a healthy diet and more likely to report trouble with taking their diabetes medications. Providers should be aware of the impact of stress caused by cancer to better support diabetes self-management among early cancer survivors.

Impact of cancer related stress on illness beliefs and glycemic control in breast cancer survivors with comorbid diabetes.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24053-e24053
Author(s):  
Jenny J. Lin ◽  
Janey James ◽  
Mita Goel ◽  
Yael T Harris
Keyword(s):  
Breast Cancer ◽  
Medication Adherence ◽  
Glycemic Control ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Illness Beliefs ◽  
Event Scale ◽  
Related Stress ◽  
The Impact ◽  
The Relationship

e24053 Background: Cancer and diabetes mellitus (DM) are leading causes of death in the US and survivors with comorbid DM have a significantly higher mortality. Furthermore, posttraumatic stress disorder (PTSD) can be triggered by life-threatening illnesses such as cancer; however, little is known about the impact of cancer-related PTSD (Ca-PTSD) on illness beliefs and glycemic control. We undertook this study to assess factors associated with DM management in breast cancer survivors with DM. Methods: We recruited women with Stage 0-IIIA breast cancer diagnosed in the past 10 years, who had completed chemotherapy and/or hormonal therapy and had pre-existing DM on ≥1 oral DM medication. The Impact of Event Scale-Revised (IES-R) was used to assess distress caused by cancer. A total IES-R score of ≥33 identified those with probable Ca-PTSD. Cancer and DM related beliefs were assessed using the Illness Perception Questionnaire. Objective adherence to DM medication was assessed using electronic caps that record bottle openings. Wilcoxon rank-sum tests were used to examine the relationship between Ca-PTSD and illness beliefs. Pearson correlation tests were used to assess the relationship between cancer related stress, DM medication adherence, and glycemic control. Results: Of 111 women recruited to date, mean age was 65.4 years and 37% were black, 31% white, 14% Hispanic, 6% Asian, and 8% other. Of these, 15% had probable Ca-PTSD. Survivors with Ca-PTSD were more likely to believe the consequences of cancer and DM were more severe (median score 23.5 vs. 19.0 [p < 0.001] and 24.0 vs. 16.0 [p < 0.001], respectively), that cancer and DM were more cyclical or recurrent (15.0 vs. 9.0 [p = 0.002] and 13.0 vs. 8.5 [p = 0.002], respectively), and there was greater emotional impact due to cancer and DM (24.0 vs. 16.5 [p < 0.001] and 23.0 vs. 14.0 [p < 0.001], respectively). Additionally, those with Ca-PTSD were less likely to understand their cancer (14.0 vs. 20.0, p = 0.004). Furthermore, as cancer-related stress scores increased, glycemic control worsened (r = 0.23, p = 0.03) and DM medication adherence decreased (r = -0.23, p = 0.04). Conclusions: Breast cancer survivors with comorbid DM who have Ca-PTSD are more likely to have negative beliefs about both cancer and DM. Cancer-related stress is also associated with poorer glycemic control and DM medication adherence. Providers should be aware of the impact of cancer related stress on beliefs about comorbid illnesses and increase interventions that support cancer survivors to better manage their comorbidities.

Cancer-related side effects and diabetes self-management.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 152-152
Author(s):  
Keerti Murari ◽  
Jordonna Brown ◽  
Juan P. Wisnivesky ◽  
Jenny J Lin
Keyword(s):  
Prostate Cancer ◽  
Health Status ◽  
Medication Adherence ◽  
Side Effects ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Diabetes Management ◽  
Self Management ◽  
The Impact ◽  
Overall Health Status

152 Background: Cancer survivors often experience cancer and treatment-related side effects and may also have comorbidities that may further impact their quality of life. Little is known about how cancer-related side effects and health status impact survivors’ beliefs and management of comorbidities. We undertook this study to assess the relationship between cancer-related side effects and diabetes (DM) self-management behaviors (SMB) and beliefs in cancer survivors with comorbid diabetes. Methods: We recruited diabetes patients recently diagnosed with early-stage breast or prostate cancer who were taking at least one oral hypoglycemic agent. Side effects for prostate cancer survivors were assessed using the Expanded Prostate Cancer Index Composite; side effects for breast cancer survivors were assessed using a standardized questionnaire for hormonal therapy-related side effects. Patients were asked to rate their overall health status and about the perceived impact of cancer treatment on DM. We measured DM medication adherence using the 8-item Morisky Medication Adherence Scale, and DM SMB were evaluated using the Summary of Diabetes Self-Care Activities. Descriptive and univariate analyses were used to assess factors associated with DM SMB. Results: Of the 52 patients recruited, 32 (62%) were male. Twenty-four (46%) patients reported cancer or treatment related side effects, with most (21, 88%) being moderately or severely bothered by these symptoms. Of these patients, 20 (83%) reported non-adherence to their DM medications and 18 (71%) reported checking their fingersticks < 5 times a week. Yet most patients (20, 84%) felt that their diabetes care was at least equally as important as their cancer care. Neither the presence nor severity of side effects was associated with DM SMB. However, patients who reported poorer overall health status were more likely to be worried about the impact of cancer treatment on diabetes management (75% vs. 25%, p < 0.01). Conclusions: Many cancer survivors report moderate to severe treatment-related side effects, although severity of side effects was not found to be associated with DM SMB. Further effort should focus on addressing survivors’ concerns about the impact of cancer treatment on comorbid disease management.

The impact of physician communication on diabetes management in cancer survivors.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 77-77
Author(s):  
Yvonne Okaka ◽  
Kimberly A. Muellers ◽  
Juan P. Wisnivesky ◽  
Jenny J. Lin
Keyword(s):  
Cancer Survivors ◽  
Diabetes Management ◽  
Early Stage ◽  
Healthcare Providers ◽  
Self Care ◽  
Self Management ◽  
Physician Communication ◽  
Diet And Exercise ◽  
The Impact ◽  
Management Behaviors

77 Background: As cancer survivors live longer and many die from other comorbidities, it becomes increasingly important to understand factors associated with self-management behaviors for common comorbidities such as diabetes (DM). Provider guidance and inclusive communication have been found to promote self- management behaviors (SMB) in patients with DM. This study aims to explore the impact of provider communication on DM SMB in cancer survivors with DM. Methods: Patients with pre-existing DM who were newly diagnosed with early-stage breast, prostate, colorectal or lung cancer were enrolled. The Summary of Diabetes Self-Care Activities instrument was used to assess patients’ SMBs. The Patient Reaction Assessment scale was used to assess physician communication. Additional survey questions elicited the range of DM self-care recommendations made by patients’ healthcare providers. Mann-Whitney U test was used to assess the association between provider recommendations and communication and SMBs. Results: Of the 74 patients enrolled, the average age was 62 years and 64% were female. Patients who reported their healthcare providers recommended exercise reported more days of specific physical activity (median 5 vs. 0, p = 0.029). Patients who reported that their providers recommended checking their sugar checked their blood sugar more days out of the last 7 days (median 4 vs. 0, p < 0.001). Patients who reported that is hard to talk to their provider about how their treatment is going reported eating more sweets per week (median 2 vs. 1, p = 0.015) and fewer vegetables (median 0 vs. 1, p = 0.043). Conversely, patients who felt that their providers were interested in them as a person reported following a healthful eating plan for more days in a week (median 5.5 vs. 2, p = 0.016) and checked their feet more often (median 6.5 vs. 0, p = 0.008). Conclusions: Cancer survivors with DM whose healthcare providers recommend specific DM SMBs and who report better provider relationships perform DM SMBs more often. Healthcare providers should recognize that supportive recommendations for diet and exercise may improve survivors’ self-management of comorbidities.

scholarly journals THE IMPACT OF MEDICATION ADHERENCE ON HEALTH-RELATED QUALITY OF LIFE OF DIABETIC PATIENTS IN THE KINGDOM OF SAUDI ARABIA: FINDINGS FROM A CROSS-SECTIONAL STUDY

2020 ◽  
Vol 17 (34) ◽  
pp. 867-873
Author(s):  
Dhfer ALSHAYBAN ◽  
Royes JOSEPH
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Cross Sectional Study ◽  
P Value ◽  
Diabetic Patients ◽  
Health State ◽  
Cross Sectional ◽  
Related Quality ◽  
The Impact

Diabetes is a common chronic disease that is considered as one of the fastest-growing health problems in the world. Adherence to medications could be an important factor in reducing these complications and improving the quality of life. The purpose of this research was to assess the impact of treatment adherence on health-related quality of life in patients with type 2 diabetes. A multicenter cross-sectional study was carried out among 368 diabetes patients. General Medication Adherence Scale was used to assess the adherence level and EuroQol-5D to assess the quality of life. The results show that 19%, 21%, and 23% of patients had maintained low medication adherence due to patient’s intentional or unintentional behavior due to additional diseases or pills burden and due to financial constraints, respectively. Overall, 43% (n=162) participants had maintained high medication adherence, and 37% (n=138) had maintained low medication adherence to antidiabetic drugs. Nearly one-third (31%) of patients with high overall adherence had perfect health state in comparison with 4% among patients with low adherence. Further, the lower proportion (21%) of patients with high overall adherence had perfect health state in comparison with that among patients with low adherence (34%). In addition to the overall adherence, the association was statistically significant for the domains related to non-adherence due to the patient’s intentional or unintentional behavior (p-value 0.001) and non-adherence due to additional diseases or pills burden (p-value 0.001) after taking into account of socio-demographic and clinical characteristics. In conclusion, the findings suggest that the policymakers should establish an intervention to improve adherence to diabetic treatment, and thus improve the quality of life for the type 2 diabetic patients.

Divorce after breast cancer diagnosis and its impact on quality of life

2021 ◽  
pp. 1-6
Author(s):  
Danbee Kang ◽  
Nayeon Kim ◽  
Gayeon Han ◽  
Sooyeon Kim ◽  
Hoyoung Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Breast Cancer Survivors ◽  
Breast Cancer Diagnosis ◽  
Factors Associated ◽  
After Cancer ◽  
The Impact

Abstract Objective This study aims to identify factors associated with divorce following breast cancer diagnosis and measures the impact of divorce on the quality of life (QoL) of patients. Methods We used cross-sectional survey data collected at breast cancer outpatient clinics in South Korea from November 2018 to April 2019. Adult breast cancer survivors who completed active treatment without any cancer recurrence at the time of the survey (N = 4,366) were included. The participants were classified into two groups: “maintaining marriage” and “being divorced,” between at the survey and at the cancer diagnosis. We performed logistic regression and linear regression to identify the factors associated with divorce after cancer diagnosis and to compare the QoL of divorced and nondivorced survivors. Results Approximately 11.1/1,000 of married breast cancer survivors experienced divorce after cancer diagnosis. Younger age, lower education, and being employed at diagnosis were associated with divorce. Being divorced survivors had significantly lower QoL (Coefficient [Coef] = −7.50; 95% CI = −13.63, −1.36), social functioning (Coef = −9.47; 95% CI = −16.36, −2.57), and body image (Coef = −8.34; 95% CI = −6.29, −0.39) than survivors who remained married. They also experienced more symptoms including pain, insomnia, financial difficulties, and distress due to hair loss. Conclusion Identifying risk factors of divorce will ultimately help ascertain the resources necessary for early intervention.

scholarly journals Assessment of diabetes self-management among diabetic patients attending Jeddah Care Center for Diabetes, Saudi Arabia.

2021 ◽  
Author(s):  
Reem Alqahtani ◽  
Sami Alzahrani ◽  
Moneerah Alhemedi ◽  
Asya Hawsa ◽  
Sarah Idris ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Saudi Arabia ◽  
Glycemic Control ◽  
Healthy Eating ◽  
Care Center ◽  
Self Management ◽  
Diabetic Patients ◽  
Normal Body Mass Index ◽  
The Impact

Abstract Objectives:To assess the levels and the associated demographic factors with diabetic self- management (DSM) among diabetic patients in Saudi Arabia. The impact of implementing DSM practices on glycemic control was additionally investigated.Results:The responses of 349 patients were analyzed (51.0% males and 37.2% obese). The median (IQR) raw DSMS score was 187 (165-205). Higher DSMS scores were reported for young adults (aged 20-29 years), insulin users, employed patients, as well as those with normal body mass index values and normal HbA1c results compared to their counterparts. Low HbA1c values were linearly associated with high scores of the healthy eating (β = -0.014, p=0.018) and physical activity subscales (β = 90-0.009, p=0.042).Keywords : Self-management; diabetes; glycemic control; Saudi Arabia.

scholarly journals Social factors associated with practice of self-monitoring of blood glucose among type-2 diabetic patients

2020 ◽  
Vol 7 (8) ◽  
pp. 3020
Author(s):  
Sindhu B. M. ◽  
Rashmi B. M. ◽  
Prashanth G. ◽  
Abhinandan S. Kumbar
Keyword(s):  
Blood Glucose ◽  
Social Factors ◽  
Self Management ◽  
Diabetic Patients ◽  
Age Group ◽  
Self Monitoring ◽  
Factors Associated ◽  
Higher Educational ◽  
Hba1c Levels

Background: Self-monitoring of blood glucose (SMBG) is an effective self-management tool to achieve desirable haemoglobin A1c (HbA1c) targets and minimizing glucose variability, when the data is timely reviewed and acted upon by healthcare providers and diabetic patients to actively modify behaviour and/or adjust treatment. SMBG improves patient’s disease awareness and participation in disease management.Methods: This cross-sectional study was conducted at Basaveshwara Hospital, Chitradurga, to estimate percentage of type-2 diabetics practicing SMBG and to assess social factors associated with SMBG practice. Diabetic patients in age-group of 18-75 years were included in the study. Information was collected by interview technique, clinical examination and review of laboratory reports.Results: A 21.5% patients were practicing SMBG. SMBG practice was significantly higher among patients who were urban-area residents (25.0%), with higher educational qualifications (42.2% of patients who studied up-to 12th standard and/or above), with better awareness of diabetes self-management (28.9%) and with better socio-economic status (35.3%). Majority of patients with longer duration of diabetes (4.9±1.5 years), relatively older age group (57.3±2.5 years), with associated co-morbid conditions (26.8%) were found to be practicing SMBG. HbA1c levels were significantly lower among SMBG practicing group (6.6±0.7%).Conclusions: Better health literacy, higher educational qualifications, financial stability, easier access to specialized anti-diabetic health-care are favourable factors for SMBG practice. Study also highlighted favourable effect of SMBG practice on effective achievement of target HbA1c levels.

scholarly journals Early Insights From a Digitally Enhanced Diabetes Self-Management Education and Support Program: Single-Arm Nonrandomized Trial

JMIR Diabetes ◽  
10.2196/25295 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e25295
Author(s):  
Folasade Wilson-Anumudu ◽  
Ryan Quan ◽  
Cynthia Castro Sweet ◽  
Christian Cerrada ◽  
Jessie Juusola ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Management Education ◽  
Diabetes Education ◽  
Self Management ◽  
Diabetes Distress ◽  
Digital Format ◽  
Nonrandomized Trial ◽  
Digitally Enhanced ◽  
The Impact

Background Translation of diabetes self-management education and support (DSMES) into a digital format can improve access, but few digital programs have demonstrated outcomes using rigorous evaluation metrics. Objective The aim of this study was to evaluate the impact of a digital DSMES program on hemoglobin A1c (HbA1c) for people with type 2 diabetes. Methods A single-arm, nonrandomized trial was performed to evaluate a digital DSMES program that includes remote monitoring and lifestyle change, in addition to comprehensive diabetes education staffed by a diabetes specialist. A sample of 195 participants were recruited using an online research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in laboratory-tested HbA1c from baseline to 4 months, and secondary outcomes included change in lipids, diabetes distress, and medication adherence. Results At baseline, participants had a mean HbA1c of 8.9% (SD 1.9) and mean BMI of 37.5 kg/m2 (SD 8.3). The average age was 45.1 years (SD 8.9), 70% were women, and 67% were White. At 4-month follow up, the HbA1c decreased by 0.8% (P<.001, 95% CI –1.1 to –0.5) for the total population and decreased by 1.4% (P<.001, 95% CI –1.8 to –0.9) for those with an HbA1c of >9.0% at baseline. Diabetes distress and medication adherence were also significantly improved between baseline and follow up. Conclusions This study provides early evidence that a digitally enhanced DSMES program improves HbA1c and disease self-management outcomes.

scholarly journals Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial

10.2196/23414 ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. e23414
Author(s):  
Akshat Kapoor ◽  
Priya Nambisan
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Self Management ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Breast Cancer Survivorship ◽  
Care Plans ◽  
The Impact

Background Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID) PRR1-10.2196/23414

scholarly journals A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study

10.2196/15957 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e15957 ◽  
Author(s):  
Mar Gomis-Pastor ◽  
Eulalia Roig ◽  
Sonia Mirabet ◽  
Jan T De Pourcq ◽  
Irene Conejo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medication Adherence ◽  
Psychometric Properties ◽  
Heart Transplant ◽  
Intervention Program ◽  
Early Stage ◽  
Mobile App ◽  
Medication Nonadherence ◽  
Patient Reported ◽  
The Impact

Background Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. Objective The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. Methods A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. Results We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. Conclusions ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.

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