scholarly journals User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study (Preprint)

2018 ◽  
Author(s):  
Victoria Haldane ◽  
Joel Jun Kai Koh ◽  
Aastha Srivastava ◽  
Krichelle Wei Qi Teo ◽  
Yao Guo Tan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Technology Use ◽  
Text Messaging ◽  
Design Thinking ◽  
User Preferences ◽  
Future Research ◽  
Atherosclerotic Cardiovascular Disease ◽  
User Centered Design ◽  
Mhealth Intervention ◽  
Key Characteristics

BACKGROUND The use of mobile health (mHealth) has gained popularity globally, including for its use in a variety of health interventions, particularly through short message service (SMS) text messaging. However, there are challenges to the use of mHealth, particularly among older users who have a large heterogeneity in usability and accessibility barriers when using technology. OBJECTIVE In order to better understand and conceptualize the diversity of users and give insight into their particular needs, we turned to persona creation. Personas are user archetypes created through data generated from multi-method inquiry with actual target users. Personas are an appropriate yet largely underutilized component of current mHealth research. METHODS Leveraging data from a multi-method study conducted in Singapore with an ethnically diverse population including Chinese, Malay, and Indian participants, we used a proforma to analyze data from the qualitative component (ie, 20 in-depth interviews) and quantitative component (ie, 100 interviewer-guided surveys). We then identified key characteristics, including technology use and preferences as well as adherence factors, to synthesize five personas reflective of persons over the age of 40 years in Singapore with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, such as hypertension. RESULTS We present five personas typologized as (1) The Quiet Analog, (2) The Busy Grandparent, (3) The Socializer, (4) The Newly Diagnosed, and (5) The Hard-to-Reach. We report on four key characteristics: health care access, medication adherence, mobile phone technology usage (ie, ownership, access, and utilization), and interest in mHealth. Finally, we provide insights into how these personas may be used in the design and implementation of an mHealth intervention. Our work demonstrates how multi-method data can create biopsychosocial personas that can be used to explore and address the diversity in behaviors, preferences, and needs in user groups. CONCLUSIONS With wider adoption of mHealth, it is important that we consider user-centered design techniques and design thinking in order to create meaningful, patient-centered interventions for adherence to medications. Future research in this area should include greater exploration of how these five personas can be used to better understand how and when is best to deliver mHealth interventions in Singapore and beyond.

scholarly journals Perspectives on Acceptance and Use of a Mobile Health Intervention for the Prevention of Atherosclerotic Cardiovascular Disease in Singapore: Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
Victoria Haldane ◽  
Yao Guo Tan ◽  
Krichelle Wei Qi Teo ◽  
Joel Jun Kai Koh ◽  
Aastha Srivastava ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Mixed Methods ◽  
Technology Acceptance ◽  
Mobile Health ◽  
Technology Use ◽  
Mixed Methods Study ◽  
Intention To Use ◽  
Atherosclerotic Cardiovascular Disease ◽  
Mhealth Intervention

BACKGROUND Cardiovascular disease, including atherosclerotic cardiovascular disease (ASCVD), is a growing public health threat globally and many individuals remain undiagnosed, untreated, and uncontrolled. Simultaneously, mobile health (mHealth) interventions using short messaging service (SMS) have gained popularity globally. There is an opportunity for innovative approaches such as mHealth to encourage and enable adherence to medications for ASCVD and its risk factors. OBJECTIVE This study aimed to understand mobile technology acceptance, use, and facilitating conditions among the study population ahead of the design of an mHealth intervention. METHODS Using data from a mixed-methods study conducted in Singapore, we conducted a cross-sectional survey with 100 participants and in-depth, semistructured interviews with 20 patients. All participants were over the age of 40 years with ASCVD or its risk factors. Interviews were conducted in English and Mandarin and if needed translated to English. Nvivo 11 (QSR International) was used for analyses. RESULTS Participants reported their perspectives on technology use and preferences, including low or sporadic mobile phone use and usability concerns including small screen and text size, among others; the benefit of previous mHealth use in creating a favorable opinion of SMS for health information; trust in both the source of mHealth SMS, as well as in treatment; the formation of habits; and fear of sequelae or death for facilitating intention to use an mHealth intervention and adhere to medication. We also highlighted a case that underscored the importance of the period after diagnosis in habit forming as an opportunity for an mHealth intervention. CONCLUSIONS We explored both technology- and adherence-related factors that influence a patient’s intention to use an mHealth intervention for adherence to ASCVD medication in Singapore. We highlighted the importance of identifying the right opportunity to engage with patients and promote an mHealth intervention for adherence, such as immediately following diagnosis when patients are establishing medication-taking habits.

The application of human-centered design approaches in health research and innovation: a systematic review of current practices. (Preprint)

2021 ◽  
Author(s):  
Irene Göttgens ◽  
Sabine Oertelt-Prigione
Keyword(s):  
Health Research ◽  
Design Thinking ◽  
Data Extraction ◽  
Innovation Process ◽  
Research Process ◽  
Cochrane Library ◽  
Future Research ◽  
User Centered Design ◽  
Human Centered Design ◽  
Health Innovations

BACKGROUND Design-based approaches to healthcare strive to support the development of innovative, effective and person-centered solutions for healthcare. Although their use is increasing, there is no systematic overview describing the details of human centered design (HCD) methods in health innovations. OBJECTIVE This study aims to provide an overview of human centered design approaches applied for the development of health innovations, with the aim of assisting healthcare workers and design researchers in selecting suitable methods for participatory and human centered design processes. METHODS We performed electronic searches in Pubmed, CINHAL, Embase, Cochrane Library, Web of Science, PsycInfo and Sociological Abstracts (2000 – 2020) using search terms related to “human-centered design”, “design thinking”(DT) and “user-centered design”(UCD). Abstracts and full-text articles were screened by two reviewers independently based on predefined inclusion criteria. Data extraction focussed on (a) the methodology employed throughout the research process, (b) the choice of methods in different phases of the innovation cycle and (c) the level of engagement of end-users. RESULTS A wide variation of design-based practices are increasingly applied in health research. Design-based approaches are applied in health research in combination with traditional qualitative and quantitative approaches. All included studies structured the innovation process using a variation of the following phases: understand – define – generate ideas – test. HCD/DT-based research primarily targeted understanding the context and defining the problem whereas UCD-based work focused mainly on the direct generation of solutions. CONCLUSIONS Design-based researchers should tailor their choice of design methods according to their primary focus; problem identification or solution development. Design techniques are challenging to evaluate with traditional biomedical research methods, limiting the opportunity for standardized assessment. Future research on HCD practices should focus on the development of specific standards, transdisciplinary evaluation methods, and guidelines for stakeholder engagement.

scholarly journals Health Information Technology Use among Patients with Self-Reported Atherosclerotic Cardiovascular Disease: Evidence from the 2011-2018 National Health Interview Survey (Preprint)

2020 ◽  
Author(s):  
Uchenna Nwokeji ◽  
Erin M. Spaulding ◽  
Rongzi Shan ◽  
Ruth-Alma Turkson-Ocran ◽  
Diana Baptiste ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health Information ◽  
National Health ◽  
Social Determinants ◽  
Technology Use ◽  
National Health Interview Survey ◽  
The Internet ◽  
Atherosclerotic Cardiovascular Disease ◽  
Interview Survey ◽  
General Technology

BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide. Health-Information Technologies (HIT) have recently emerged as a viable intervention to mitigate the burden of ASCVD. At least 60% of United States (US) adults report searching the internet for health information; however, previous research has not examined the prevalence of general technology or HIT use between adults with and without ASCVD. In addition, social determinants in HIT use among adults with ASCVD are not well understood. OBJECTIVE To evaluate the prevalence and social determinants of HIT use among U.S. adults with vs without self-reported ASCVD. METHODS We pooled cross-sectional data from the 2011-2018 National Health Interview Survey (NHIS) to examine general technology and HIT use between adults aged ≥18 years with and without self-reported ASCVD (coronary heart disease and/or stroke). General technology use was defined as mobile phone ownership, Internet use, and computer use. HIT use was defined as looking up health information on the Internet, filling a prescription online, scheduling a medical appointment on the Internet, communicating with a healthcare provider by email, or using online group chats to learn about health topics. We evaluated sociodemographic differences in HIT use among respondents using Poisson regression. Analyses were weighted according to NHIS standards. RESULTS A total sample of N=256,534 individuals were included, 2,194 (0.9%) reported prior ASCVD. Among adults with prior ASCVD, the mean (±SD) age was 70.6 (11.5) years, and 47% were female. General technology use differed between participants with and without prior ASCVD, with 36% (657/1,826) and 76% (162,500/213,816) indicating internet usage and 25% (394/1,575) and 61% (112,580/184,557) indicating using a computer every day, respectively. Similarly, adults with ASCVD were less likely to use HIT use than those without ASCVD (25% vs. 51%, p<0.001). Among adults with prior ASCVD, social determinants that were associated with HIT use included younger age, higher education, higher income, being employed, and being married. CONCLUSIONS HIT use was low among adults with a history of ASCVD, which may represent a barrier to delivering care via emerging HIT. Given the associations with social determinants such as income, education and employment, targeted strategies and policies are needed to eliminate barriers to impact HIT usage. CLINICALTRIAL N/A

Capturing feedback from user sub-groups in user-centered design: A protocol integrating key user characteristics in the development of digital support for seniors’ fall preventive physical activity (Preprint)

2020 ◽  
Author(s):  
Åsa Revenäs ◽  
Ann-Christin Johansson ◽  
Maria Ehn
Keyword(s):  
Physical Activity ◽  
Technology Use ◽  
User Involvement ◽  
Activity Level ◽  
User Centered Design ◽  
Iterative Development ◽  
Key Characteristics ◽  
Per Se ◽  
Systematic Collection ◽  
User Centered

BACKGROUND User-centered design (UCD) aims at understanding the users’ perspective and shape new solutions thereafter. UCD gives access to users’ needs and requirements and thereby improves solutions design. However, involving users in the development process does not per se guarantee that feedback from different sub-groups of users are equally shaping the development, and therefore resulting in solutions that are useful for the whole intended population. OBJECTIVE The aim of this study is to describe a protocol to integrate key characteristics of user sub-groups in collection and analysis of feedback in User-centered design (UCD) of a digital motivation support for fall preventive physical activity (PA) in seniors (older adults, 65 years of age or older). METHODS This study follows a UCD model, with early user involvement as one key principle. The protocol describes a method for systematic collection and prioritization of user feedback during the iterative development of two digital applications. For each of the four cycles in the iterative development, the aim is to recruit a group of at least 8 seniors (65 years or older, independent living) with equal distribution of men and women and a variation in both PA level and technology use. Procedures for collecting data during and after the user tests are mainly qualitative. RESULTS This paper describes a novel approach for integrating key characteristics of users sub-groups in UCD. We have developed a protocol for ensuring that feedback from both genders, persons with varied activity level and technology use are considered in the iterative development of a digital motivation support for seniors’ PA. The method has been applied in a study that has been approved by the regional ethics committee in Uppsala (Dnr 2018/044). Data collection and iterative development of the digital support has been conducted during Spring-Summer 2018 and the result is expected to be published during 2020/2021. CONCLUSIONS User involvement is the golden standard in systems design. However, it does not per se guarantee that feedback from different user sub-groups are equally shaping the development, and hence resulting in a solution that is useful for the whole intended population. Methods for systematic collection, analysis and prioritization of feedback from sub-groups might be particularly important in heterogenous groups, such as seniors. This protocol can contribute to identify and improve our understanding of potential differences in use and experiences of technical support systems for fall preventive PA among user-subgroups of seniors. This knowledge can be relevant for developing technology support that is appropriate, useful and attractive to the users and for enabling design of technology targeting specific user sub-groups, i.e. tailoring of the support. The protocol needs to be further used and investigated to understand its potential value.

scholarly journals User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study

10.2196/10465 ◽  
2019 ◽  
Vol 7 (5) ◽  
pp. e10465 ◽  
Author(s):  
Victoria Haldane ◽  
Joel Jun Kai Koh ◽  
Aastha Srivastava ◽  
Krichelle Wei Qi Teo ◽  
Yao Guo Tan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
User Preferences ◽  
Mhealth Intervention

scholarly journals Revisiting the Role of Aspirin for the Primary Prevention of Cardiovascular Disease

Circulation ◽  
2019 ◽  
Vol 140 (13) ◽  
pp. 1115-1124 ◽  
Author(s):  
Guillaume Marquis-Gravel ◽  
Matthew T. Roe ◽  
Robert A. Harrington ◽  
Daniel Muñoz ◽  
Adrian F. Hernandez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Community Dwelling ◽  
Drug Formulation ◽  
Future Research ◽  
Atherosclerotic Cardiovascular Disease ◽  
Dose Selection ◽  
Optimal Drug

Aspirin is the cornerstone of the antithrombotic management of patients with established atherosclerotic cardiovascular disease, but major guidelines provide conflicting recommendations for its use in primary prevention. Findings from recent randomized trials totaling >47 000 patients called into question the net clinical benefits of aspirin in primary prevention for 3 key populations: patients with diabetes mellitus, community-dwelling elderly individuals, and patients without diabetes mellitus who are at intermediate risk for atherosclerotic events. In the context of increasing emphasis on the use of other treatments for primary prevention in patients with moderate-high future risk of developing atherosclerotic cardiovascular disease, the efficacy and safety of aspirin for primary prevention has become uncertain. Key unresolved questions regarding the role of aspirin in primary prevention include the optimal drug formulation, dosing schedule, weight-based dose selection, and interplay between sex and treatment response. In the current era, most patients without established atherosclerotic cardiovascular disease should not be prescribed aspirin. Rather, aggressive management of comorbidities tailored to the expected cardiovascular risk needs to be emphasized. In this context, informed shared decision making between clinicians and patients regarding the use of aspirin for primary prevention of cardiovascular events is a suitable and laudable approach. In this article, we revisit the role of aspirin for the primary prevention of cardiovascular diseases by critically reviewing the key scientific literature, highlight key areas of uncertainties for future research, and propose a decisional framework for clinicians to support prescription of aspirin in primary prevention.

scholarly journals Connecting the Lines between Hypogonadism and Atherosclerosis

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Akl C. Fahed ◽  
Joanna M. Gholmieh ◽  
Sami T. Azar
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Gender Differences ◽  
Androgen Deprivation Therapy ◽  
Laboratory Experiments ◽  
Epidemiological Studies ◽  
Future Research ◽  
Atherosclerotic Cardiovascular Disease ◽  
Undiagnosed Disease ◽  
Complex Process

Epidemiological studies show that atherosclerotic cardiovascular disease is a leading cause of morbidity and mortality worldwide and point to gender differences with ageing males being at highest risk. Atherosclerosis is a complex process that has several risk factors and mediators. Hypogonadism is a commonly undiagnosed disease that has been associated with many of the events, and risk factors leading to atherosclerosis. The mechanistic relations between testosterone levels, atherosclerotic events, and risk factors are poorly understood in many instances, but the links are clear. In this paper, we summarize the research journey that explains the link between hypogonadism, each of the atherosclerotic events, and risk factors. We look into the different areas from which lessons could be learned, including epidemiological studies, animal and laboratory experiments, studies on androgen deprivation therapy patients, and studies on testosterone-treated patients. We finish by providing recommendations for the clinician and needs for future research.

scholarly journals Non-HDL cholesterol is better than LDL-c at predicting atherosclerotic cardiovascular disease risk factors clustering, even in subjects with near-to-normal triglycerides: A report from a Venezuelan population

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 504 ◽  
Author(s):  
Valmore Bermúdez ◽  
Wheeler Torres ◽  
Juan Salazar ◽  
María Sofía Martínez ◽  
Edward Rojas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Multivariate Logistic Regression Model ◽  
Future Research ◽  
Atherosclerotic Cardiovascular Disease ◽  
Multiple Risk Factors ◽  
Multiple Risk

Background:Non-high density lipoprotein cholesterol (non-HDL-c) has emerged as an important tool in primary prevention of atherosclerotic cardiovascular disease (ASCVD), especially among those at high risk. The main objective of this study was to evaluate the predictive value of non-HDL-c for the coexistence aggregation of multiple ASCVD risk factors and compare this with LDL-c in general subjects with normal or near normal triglycerides from Maracaibo city in Venezuela.Methods:This is a descriptive, cross-sectional study with a randomized multistage sampling. 2026 subjects were selected for this study, all were adults ≥18 years old of both genders and inhabitants of Maracaibo city, Venezuela. A complete history and physical medical assessment was performed. A multivariate logistic regression model was used to determine the odds ratio (CI95%) for the coexistence of multiple risk factors for ASCVD.Results:The median (p25-p75) of non-HDL-c was 143 mg/dL (114-174 mg/dL). 52.1% (n=1056) of the sample were women, with a median of 144 mg/dL (115-174 mg/dL) among women and 143 mg/dL (114-17 4mg/dL) among men; p=0.740. Individuals ≥50 years old, smokers, those with hypertension, obesity, diabetes, high waist circumference and elevated hs-C Reactive Protein, all had higher levels of non-HDL-c. A lower median was observed among those <30 years of age with elevated physical activity levels in their leisure time. Non-HDL-c between 130-159 mg/dL (OR=2.44; CI 95%=1.48-4.02; p<0.001) and ≥160 mg/dL (OR=3.28; CI 95%=1.72-6.23; p<0.001) was associated with greater risk of coexistent multiple risk factors for ASCVD, albeit LDL-c was not significant in the multivariate model.Conclusions:Elevated non-HDL-c was associated with conglomeration of multiple risk factors for ASCVD. This suggests evaluation of non-HDL-c may be of better utility in primary care for early identification of subjects for high risk of ASCVD. Future research might focus on the influence of non-HDL-c in cardiovascular mortality.

Risk Models and Scores of Cardiovascular Disease in Patients with Diabetes Mellitus.

2020 ◽  
Vol 26 ◽  
Author(s):  
Georgios Kostopoulos ◽  
Christina Antza ◽  
Ioannis Doundoulakis ◽  
Konstantinos A. Toulis
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Clinical Practice ◽  
External Validation ◽  
Risk Scores ◽  
Future Research ◽  
Atherosclerotic Cardiovascular Disease ◽  
Risk Models ◽  
Minimum Requirement ◽  
Myocardial Infraction

: Diabetes mellitus (DM) is an established risk factor for atherosclerotic cardiovascular disease (CVD) and patients with DM are at a two to four-fold higher cardiovascular risk, including myocardial infraction, unstable angina, stroke, and heart failure. All of the above have arisen interest in CVD preventive strategies by the use of non-invasive methods, such as risk scores. The most common approach is to consider DM as a CVD equivalent and, therefore, to treat patients with DM in a similar way to those who required secondary CVD prevention. However, this approach has been disputed as all patients with DM do not have the same risk for CVD and since other potentially important factors within the context of DM, such as DM duration, presence of albuminuria, and comorbidities, should be taken into consideration. Thus, the second and third approach is the application of risk models that were either developed initially for the general population or designed specifically for patients with DM, respectively. This review summarizes the evidence and implications for clinical practice regarding these scores. Up to date, several models that can be applied to the diabetic population have been proposed. However, only a few meet the minimum requirement of adequate external validation. In addition, moderate discrimination and poor calibration, which might lead to inaccurate risk estimations in populations with different characteristics, have been reported. Therefore, future research is needed before recommending a specific risk model for universal clinical practice in the management of diabetes.

scholarly journals Non-HDL cholesterol is better than LDL-c at predicting atherosclerotic cardiovascular disease risk factors clustering, even in subjects with near-to-normal triglycerides: A report from a Venezuelan population

F1000Research ◽  
2019 ◽  
Vol 7 ◽  
pp. 504
Author(s):  
Valmore Bermúdez ◽  
Wheeler Torres ◽  
Juan Salazar ◽  
María Sofía Martínez ◽  
Edward Rojas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Multivariate Logistic Regression Model ◽  
Future Research ◽  
Atherosclerotic Cardiovascular Disease ◽  
Multiple Risk Factors ◽  
Multiple Risk

Background: Non-high density lipoprotein cholesterol (non-HDL-c) has emerged as an important tool in primary prevention of atherosclerotic cardiovascular disease (ASCVD), especially among those at high risk. The main objective of this study was to evaluate the predictive value of non-HDL-c for the coexistence aggregation of multiple ASCVD risk factors and compare this with LDL-c in general subjects with normal or near normal triglycerides from Maracaibo city in Venezuela. Methods: This is a descriptive, cross-sectional study with a randomized multistage sampling. 2026 subjects were selected for this study, all were adults ≥18 years old of both genders and inhabitants of Maracaibo city, Venezuela. A complete history and physical medical assessment was performed. A multivariate logistic regression model was used to determine the odds ratio (CI95%) for the coexistence of multiple risk factors for ASCVD. Results: The median (p25-p75) of non-HDL-c was 143 mg/dL (114-174 mg/dL). 52.1% (n=1056) of the sample were women, with a median of 144 mg/dL (115-174 mg/dL) among women and 143 mg/dL (114-17 4mg/dL) among men; p=0.740. Individuals ≥50 years old, smokers, those with hypertension, obesity, diabetes, high waist circumference and elevated hs-C Reactive Protein, all had higher levels of non-HDL-c. A lower median was observed among those <30 years of age with elevated physical activity levels in their leisure time. Non-HDL-c between 130-159 mg/dL (OR=2.44; CI 95%=1.48-4.02; p<0.001) and ≥160 mg/dL (OR=3.28; CI 95%=1.72-6.23; p<0.001) was associated with greater risk of coexistent multiple risk factors for ASCVD, albeit LDL-c was not significant in the multivariate model. Conclusions: Elevated non-HDL-c was associated with conglomeration of multiple risk factors for ASCVD. This suggests evaluation of non-HDL-c may be of better utility in primary care for early identification of subjects for high risk of ASCVD. Future research might focus on the influence of non-HDL-c in cardiovascular mortality.

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