Transitions in Technology Mediated Cardiac Rehabilitation and Self-management: A Qualitative Study using the Theoretical Domains Framework (Preprint)

2021 ◽  
Author(s):  
Shreya Tadas ◽  
Claudette Pretorius ◽  
Emma J. Foster ◽  
Trish Gorely ◽  
Stephen J. Leslie ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Self Management ◽  
Normal Life ◽  
Use Of Technology ◽  
Holistic Understanding ◽  
The Impact ◽  
Over Time

BACKGROUND An acute cardiac incident is a life changing event, often necessitating surgery. While surgery has high success rates, rehabilitation, behaviour change, and self-care are critical to long-term health. Recent systematic reviews highlight the potential of technology in this area, but significant shortcomings are also identified, particularly in regard to patient experience. OBJECTIVE To improve future systems this paper explores the experiences of cardiac patients during key phases post-hospitalisation: recuperation, initial rehabilitation and long term self-management. The key objective is to provide a holistic understanding of behavioural factors that impact people across these phases, understand how experiences evolve over time, and provide user-centred recommendations to improve the design of cardiac rehabilitation and self-management technologies. METHODS Semi-structured interviews were conducted with people who attended rehabilitation programs following hospitalisation for an acute cardiac event. Interviews were developed and data is analysed via the Theoretical Domains Framework (TDF), a pragmatic framework that synthesizes prior theories of behaviour change. RESULTS Three phases that arise post-hospitalisation are examined: recuperation, rehabilitation, and long-term self-management. Through these phases we describe the impact of key factors and important changes that occur in patients’ experiences over time, including: a desire for and redefinition of normal life; the need for different types of formal and informal knowledge; the benefits of safe-zoning and connectedness; and the need to recognise capability. The use of the TDF allows us to show how factors that influence behaviour evolve over time and identify potential sources of tension. CONCLUSIONS The paper provides empirically grounded recommendations for the design of technology-mediated cardiac rehabilitation and self-management systems. Key recommendations include the use of technology to support a normal life; leveraging social influences to extend participants’ sense of normality; the use of technology to provide a safe zone; the need to support both emotional and physical wellbeing; and a focus on recognizing capability and providing recommendations that are positive and reinforce this capability.

scholarly journals Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Obesity Facts ◽  
2021 ◽  
pp. 1-14
Author(s):  
R. James Stubbs ◽  
Cristiana Duarte ◽  
António L. Palmeira ◽  
Falko F. Sniehotta ◽  
Graham Horgan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Behaviour Change ◽  
Digital Health ◽  
Self Regulation ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behavioural Science ◽  
Digital Architecture

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

scholarly journals Locking down the Impact of New Zealand’s COVID-19 Alert Level Changes on Pets

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 758
Author(s):  
Fiona Esam ◽  
Rachel Forrest ◽  
Natalie Waran
Keyword(s):  
New Zealand ◽  
Separation Anxiety ◽  
National Surveys ◽  
Normal Life ◽  
Pet Owners ◽  
Level 1 ◽  
The Impact ◽  
Better Than

The influence of the COVID-19 pandemic on human-pet interactions within New Zealand, particularly during lockdown, was investigated via two national surveys. In Survey 1, pet owners (n = 686) responded during the final week of the five-week Alert Level 4 lockdown (highest level of restrictions—April 2020), and survey 2 involved 498 respondents during July 2020 whilst at Alert Level 1 (lowest level of restrictions). During the lockdown, 54.7% of owners felt that their pets’ wellbeing was better than usual, while only 7.4% felt that it was worse. Most respondents (84.0%) could list at least one benefit of lockdown for their pets, and they noted pets were engaged with more play (61.7%) and exercise (49.7%) than pre-lockdown. Many respondents (40.3%) expressed that they were concerned about their pet’s wellbeing after lockdown, with pets missing company/attention and separation anxiety being major themes. In Survey 2, 27.9% of respondents reported that they continued to engage in increased rates of play with their pets after lockdown, however, the higher levels of pet exercise were not maintained. Just over one-third (35.9%) of owners took steps to prepare their pets to transition out of lockdown. The results indicate that pets may have enjoyed improved welfare during lockdown due to the possibility of increased human-pet interaction. The steps taken by owners to prepare animals for a return to normal life may enhance pet wellbeing long-term if maintained.

Gender, mobility and contact

2021 ◽  
Vol 7 (2) ◽  
pp. 142-167
Author(s):  
Catherine E. Travis ◽  
Inas Ghina
Keyword(s):  
Older Women ◽  
High Mobility ◽  
Spontaneous Speech ◽  
Social Changes ◽  
Change Over Time ◽  
Aceh Province ◽  
Rural Variety ◽  
The Impact ◽  
Over Time

Abstract We examine variation in a rural variety of Acehnese spoken in Aceh Province, to better understand the impact of long-term contact with Indonesian and increasing urbanization. The Great Aceh variety is characterized by variable realization of word-final (t) as a dental vs. glottal stop. Analyses of over 2,000 tokens of this variable from a corpus of spontaneous speech from 35 speakers indicate that the variability is relatively stable among men, and among women of high mobility, measured in terms of education, occupation, and time spent outside Great Aceh. Women with low mobility produce the lowest rates of [t̪], and in this group we observe a higher rate of [t̪] by younger than older women, suggesting change over time. We thus find both stability – among those who have long enjoyed high levels of mobility – and change – among those most affected by recent social changes, namely low-mobility women.

scholarly journals THE IMPACT OF REGIONAL INEQUALITY ON MIGRATION TRENDS IN LATVIA

2021 ◽  
Vol 6 ◽  
pp. 79-91
Author(s):  
Anastasija Jeršova ◽  
Iveta Mietule
Keyword(s):  
Research Methods ◽  
Synthesis Method ◽  
Constructive Method ◽  
Territorial Development ◽  
Integral Index ◽  
Index Method ◽  
Regional Inequalities ◽  
The Impact ◽  
Over Time

The topic of current research and key findings are topical, taking into the consideration the territorial development tendencies of Latvia, which is characterized by the long-term regional inequalities and the tendencies of the migration of the population. The aim of the research is to analyse the impact of the regional inequalities on the migration tendencies of population in Latvia. The following research methods have been used in the research- logically constructive method, content analysis, monographic method, synthesis method, statistical analysis of interrelations, integral index method. Within the research, by using the selected research methods, authors have evaluated the influence of migration indicators-stimulators and indicators-de-stimulators on the migration trends in Latvia over time.

scholarly journals Home-Based Cardiac Rehabilitation During COVID-19: A Qualitative Study

2021 ◽  
Author(s):  
Smitha Ganeshan ◽  
Crystal Tse ◽  
Alexis Beatty
Keyword(s):  
Cardiac Rehabilitation ◽  
Organizational Factors ◽  
Structured Interviews ◽  
Ongoing Research ◽  
Staff Members ◽  
Use Of Technology ◽  
Home Based ◽  
Mobile Phone Applications ◽  
Delivery Models

Abstract Background: Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity, and hospitalizations. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research.Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

scholarly journals Long Term Implications in Surgical Re-assisting (L.I.S.A. study) During Covid-19 Outbreak: A Retrospective Observational Study on a Rural Population.

2021 ◽  
Author(s):  
Nicolò Fabbri ◽  
Antonio Pesce ◽  
Lisa Uccellatori ◽  
Salvatore Greco ◽  
Francesco D'Urbano ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Operative Management ◽  
Surgical Interventions ◽  
Male Sex ◽  
Non Operative Management ◽  
The Impact ◽  
Colorectal Resections ◽  
Surgical Operations ◽  
Over Time

Abstract BackgroundThe spread of the COVID-19 is having a worldwide impact on surgicaltreatment. Our aim was to investigate the impact of the pandemic in a rural hospital in a lowdensely populated area.MethodsWe investigated the volume and type of surgical operations during the pandemic(March 2020 - February 2021) versus pre-pandemic period (March 2019 - February 2020) aswell as during the first and second pandemic waves compared to the pre-pandemic period.We compared the volume and timing of emergency appendectomy and cholecystectomyduring the pandemic versus pre-pandemic period, the volume, timing and stages of electivegastric and colorectal resections for cancer during the pandemic versus the pre-pandemicperiod.ResultsIn the prepandemic versus pandemic period, 42 versus 24 appendectomies and 174versus 126 cholecystectomies (urgent and elective) were performed. Patients operated onbefore as opposed to during the pandemic were older (58 vs. 52 years old, p=0.006),including for cholecystectomy (73 vs. 66 years old, p=0.01) and appendectomy (43 vs. 30years old, p = 0.04).The logistic regression analysis with regard to cholecystectomy and appendectomy performedin emergency showed that male sex and age were both associated to gangrenous typehistology, both in pandemic and prepandemic period. Finally, we found a reduction in cancerstage I and IIA in pandemic versus prepandemic period, with no increase in the moreadvanced stages.Conclusionsthe reduction in services imposed by governments during the first months oftotal lock down did not justify the whole decrease in surgical interventions in the year of thepandemic. Data suggest that greater "non-operative management" for cases of appendicitisand acute cholecystitis does not lead to an increase in cases operated over time, nor to anincrease in the "gangrenous" pattern, which seems to depend on age advanced and malepopulation.

scholarly journals The Price Impact of Lending Relationships

2015 ◽  
Vol 16 (3) ◽  
pp. 367-389 ◽  
Author(s):  
Ingrid Stein
Keyword(s):  
Strong Relationship ◽  
Price Impact ◽  
Bank Debt ◽  
Relationship Strength ◽  
Borrowing Costs ◽  
Lending Relationships ◽  
Relationship Length ◽  
The Impact ◽  
Over Time

Abstract This study analyzes the impact of bank relationships on a firm’s borrowing costs. We find that a firm’s borrowing costs decrease with relationship strength, proxied by the share of bank debt provided by the lender. Borrowing costs, however, rise with relationship length. While the increase over time is weak on average, bank-dependent borrowers face a substantial premium after several relationship years. Switching the lender initially leads to only a small price discount on average. However, the discount is considerable for borrowers that switch and had a strong relationship with their previous lender. Our results suggest that close lending relationships lead to benefits for the firm, but may also imply hold-up costs in the long term.

scholarly journals Quantifying the impact of delayed delivery of cardiac rehabilitation on patients’ health

2020 ◽  
Vol 27 (16) ◽  
pp. 1775-1781
Author(s):  
Sebastian Hinde ◽  
Alexander Harrison ◽  
Laura Bojke ◽  
Patrick Doherty
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Life Expectancy ◽  
Cardiac Rehabilitation ◽  
National Health ◽  
Average Lifetime ◽  
National Guidelines ◽  
Patient Health ◽  
The Impact

Background Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article. Methods Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure. Results We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay. Conclusions The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.

scholarly journals PREDICTING THE RISK OF LONG-TERM NURSING HOME ADMISSION OVER TIME: THE IMPACT OF NETWORK SIZE AND COMPOSITION

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 84-84
Author(s):  
A Restorick Roberts ◽  
A L Curl ◽  
K M Abbott
Keyword(s):  
Nursing Home ◽  
Network Size ◽  
Nursing Home Admission ◽  
The Impact ◽  
Over Time

scholarly journals Medical Ethnography over Time

2019 ◽  
Vol 26 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Murray Last
Keyword(s):  
Local Culture ◽  
Important Data ◽  
The Past ◽  
Women And Children ◽  
Medical Ethnography ◽  
The Impact ◽  
Over Time

Too often, research into the health of a particular community is brief and superficial, focusing only on what is public and leaving the private health of women and children ‘foggy’. By contrast, long-term anthropology can offer access to processes taking place within a local culture of illness. Here, an account of a community’s experience of health over the past 50 years not only outlines the key changes as seen anthropologically but also shows how even close ethnography can initially miss important data. Furthermore, the impact of a researcher – both as a guest and as a source of interference – underlines how complex fieldwork can be in reality, especially if seen through the eyes of the researcher’s hosts.

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