Participatory design of a digital platform for cardiovascular disease self-management: mutual learning through an iterative development process (Preprint)

BACKGROUND People living with cardiovascular disease (CVD) require flexible self-management support for health behaviour change for CVD secondary prevention. Digital health interventions can assist with these complex self-management activities. Many stakeholder groups can be involved in digital health design, including people living with CVD (users), researchers, healthcare professionals and technology developers. However, decision-making and aligning views can be difficult to negotiate within interdisciplinary teams, so the use of appropriate methodological strategies is vital. OBJECTIVE The aim of this paper was to design and develop Salvio, and to reflect on the methodological considerations that were the driving forces of this participatory design process. METHODS A triangulation of research methods was used for this iterative development process. Participatory design approaches used included guided group discussions, activity-based workshops, and think-aloud tasks. Data collection was supported by self-efficacy theory to encourage user contributions. Over a 12-month period, participants met at various time points to collectively design and develop Salvio. Workshops were 2-3 hours in length and were facilitated in small groups of 4-6 participants per session. All sessions were audio-recorded, central parts of workshop conversations were transcribed, and qualitative content analysis of data was undertaken. RESULTS Users (n=8) worked collaboratively with researchers (n=6) and technology developers (n=7). Findings indicated that it was critical to include an interdisciplinary team with a wide range of expertise, to build a meaningful and flexible digital platform. Effective methodological strategies were essential for genuine participation and continuous conflict resolution. Our research highlighted key elements that added to the success of this co-design process including i) the creation of a collaborative space where all voices were acknowledged and considered and ii) the effective translation of information during decision-making stages. CONCLUSIONS Future research is needed to expand and evaluate participatory design tools and techniques which challenge the power relations between users and other stakeholders. By exploring methods that create space for mutual learning and resolving conflict through systematic decision-making, complex digital platforms for health behaviour change can be successfully developed with diverse groups. It is clear that flexible digital platforms may be valuable to users, but further research will also be required for the successful implementation and knowledge translation of these contemporary developments.

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The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: A systematic review

European Journal of Preventive Cardiology ◽

10.1177/2047487315613462 ◽

2015 ◽

Vol 23 (8) ◽

pp. 801-817 ◽

Cited By ~ 55

Author(s):

Leila Pfaeffli Dale ◽

Rosie Dobson ◽

Robyn Whittaker ◽

Ralph Maddison

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Behaviour Change ◽

Health Behaviour ◽

Mobile Health ◽

Self Management ◽

Behaviour Change Interventions ◽

Health Behaviour Change

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Using Intervention Mapping to Develop a Digital Self-Management Program for People With Type 2 Diabetes: Tutorial on MyDESMOND (Preprint)

10.2196/preprints.17316 ◽

2019 ◽

Author(s):

Michelle Hadjiconstantinou ◽

Sally Schreder ◽

Christopher Brough ◽

Alison Northern ◽

Bernie Stribling ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Conditions ◽

Development Process ◽

Public Involvement ◽

Digital Health ◽

Intervention Mapping ◽

Management Program ◽

Self Management ◽

Theoretical Frameworks

UNSTRUCTURED Digital health interventions (DHIs) are increasingly becoming integrated into diabetes self-management to improve behavior. Despite DHIs becoming available to people with chronic conditions, the development strategies and processes undertaken are often not well described. With theoretical frameworks available in current literature, it is vital that DHIs follow a shared language and communicate a robust development process in a comprehensive way. This paper aims to bring a unique perspective to digital development, as it describes the systematic process of developing a digital self-management program for people with type 2 diabetes, MyDESMOND. We provide a step-by-step guide, based on the intervention mapping (IM) framework to illustrate the process of adapting an existing face-to-face self-management program (diabetes education and self- management for ongoing and newly diagnosed, DESMOND) and translating it to a digital platform (MyDESMOND). Overall, this paper describes the 4 IM steps that were followed to develop MyDESMOND—step 1 to establish a planning group and a patient and public involvement group to describe the context of the intervention and program goals, step 2 to identify objectives and determinants at early design stages to maintain a focus on the strategies adopted, step 3 to generate the program components underpinned by appropriate psychological theories and models, and step 4 to develop the program content and describe the iterative process of refining the content and format of the digital program for implementation. This paper concludes with a number of key learnings collated throughout our development process, which we hope other researchers may find useful when developing DHIs for chronic conditions.

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P110 Developing a digital interface for outpatient rheumatology

Rheumatology ◽

10.1093/rheumatology/keaa111.108 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Benjamin D Clarke ◽

Lija James ◽

Heather Lapham ◽

Carron Congreve ◽

Sophia Steer ◽

...

Keyword(s):

Digital Health ◽

User Feedback ◽

Self Management ◽

College Hospital ◽

Daily News ◽

Clinical Communication ◽

Digital Platforms ◽

General Data Protection Regulation ◽

Explicit Consent ◽

Patient Reported

Abstract Background We live in an age where digital interactions are the norm. These may take the form of communication with friends and family, social media, contacting your bank or reading the daily news. Most of our rheumatology patients have smartphones or other digital platforms to access these. Healthcare, however, lags in adopting technology. Digital health solutions such as 'GP at hand' (Babylon) are still seen as disruptive market innovations. NHS improvement would like to reduce face-to-face activity by 10% through forms of digital enablement. We set out to develop our own platform, using a smartphone-enabled app. The aim is to remotely support a patient’s self-management, collect patient reported outcomes (PROMs) and facilitate patient-department communication. We describe the development of the app and early experience of use. Methods We conducted stakeholder meetings with expert patients, clinicians and app developers. In 2015 we launched a pilot app. Following user feedback, a full version of the app was launched in September 2018. In compliance with EU General Data Protection Regulation (GDPR) laws, it currently works as a standalone tool separate to hospital Electronic Health Record (EHR) systems at King's College Hospital. App awareness took place through clinic appointments and a patient educational event. Patients download and register through Android or iOS operated devices. Basic information and explicit consent for data use are gathered. Data are stored on a cloud-based platform accessible to the clinical team and extracts anonymised for analysis. Results 301 patients registered with the app in the first year since launch. Mean age was 44 years (Median 42.5 (IQR 35-53), Range 16-76) slightly younger than that of our local cohort. Clinical enquiries recorded via email have steadily increased since the app’s inception, rising from 2 throughout September 2018 to 209 in September 2019. Almost 25% of patients entered PROMs. These were performed on 115 occasions by 70 different patients (Median 1, Range 1-12). 52 (17.3%) patients used the app to store medication reminders. User feedback has identified positive aspects: links to patient education resources, medication reminders and rapid direct clinical communication. Negative aspects include: no link to the EHR system, inability to change or view appointments, inability to request blood tests. Conclusion We have demonstrated in this project that an app is feasible to use in a rheumatology clinical practice setting, providing a mechanism for collecting patient information and enabling self-management. Use of healthcare apps is clearly not for everyone, with only a minority of our patients using our platform. For apps to be sustainable they need to be of targeted benefit with proportionate investment. A key future strategy is to strengthen our self-management interface and integrate with our EHR systems. Disclosures B.D. Clarke None. L. James None. H. Lapham None. C. Congreve None. S. Steer None. N. Alaghband None. J.B. Galloway Grants/research support; J.G. receives a grant from Pfizer to support the development of this app.

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Using Intervention Mapping to Develop a Digital Self-Management Program for People With Type 2 Diabetes: Tutorial on MyDESMOND

Journal of Medical Internet Research ◽

10.2196/17316 ◽

2020 ◽

Vol 22 (5) ◽

pp. e17316 ◽

Cited By ~ 1

Author(s):

Michelle Hadjiconstantinou ◽

Sally Schreder ◽

Christopher Brough ◽

Alison Northern ◽

Bernie Stribling ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Conditions ◽

Development Process ◽

Public Involvement ◽

Digital Health ◽

Intervention Mapping ◽

Management Program ◽

Self Management ◽

Theoretical Frameworks

Digital health interventions (DHIs) are increasingly becoming integrated into diabetes self-management to improve behavior. Despite DHIs becoming available to people with chronic conditions, the development strategies and processes undertaken are often not well described. With theoretical frameworks available in current literature, it is vital that DHIs follow a shared language and communicate a robust development process in a comprehensive way. This paper aims to bring a unique perspective to digital development, as it describes the systematic process of developing a digital self-management program for people with type 2 diabetes, MyDESMOND. We provide a step-by-step guide, based on the intervention mapping (IM) framework to illustrate the process of adapting an existing face-to-face self-management program (diabetes education and self- management for ongoing and newly diagnosed, DESMOND) and translating it to a digital platform (MyDESMOND). Overall, this paper describes the 4 IM steps that were followed to develop MyDESMOND—step 1 to establish a planning group and a patient and public involvement group to describe the context of the intervention and program goals, step 2 to identify objectives and determinants at early design stages to maintain a focus on the strategies adopted, step 3 to generate the program components underpinned by appropriate psychological theories and models, and step 4 to develop the program content and describe the iterative process of refining the content and format of the digital program for implementation. This paper concludes with a number of key learnings collated throughout our development process, which we hope other researchers may find useful when developing DHIs for chronic conditions.

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The Relationship Between Hearing Loss Self-Management and Hearing Aid Benefit and Satisfaction

American Journal of Audiology ◽

10.1044/2018_aja-18-0130 ◽

2019 ◽

Vol 28 (2) ◽

pp. 274-284 ◽

Cited By ~ 6

Author(s):

Elizabeth Convery ◽

Gitte Keidser ◽

Louise Hickson ◽

Carly Meyer

Keyword(s):

Decision Making ◽

Hearing Loss ◽

Hearing Aids ◽

Clinical Decision Making ◽

Hearing Aid ◽

Well Being ◽

Self Report ◽

Self Management ◽

Hearing Aid Benefit ◽

The Relationship

Purpose Hearing loss self-management refers to the knowledge and skills people use to manage the effects of hearing loss on all aspects of their daily lives. The purpose of this study was to investigate the relationship between self-reported hearing loss self-management and hearing aid benefit and satisfaction. Method Thirty-seven adults with hearing loss, all of whom were current users of bilateral hearing aids, participated in this observational study. The participants completed self-report inventories probing their hearing loss self-management and hearing aid benefit and satisfaction. Correlation analysis was used to investigate the relationship between individual domains of hearing loss self-management and hearing aid benefit and satisfaction. Results Participants who reported better self-management of the effects of their hearing loss on their emotional well-being and social participation were more likely to report less aided listening difficulty in noisy and reverberant environments and greater satisfaction with the effect of their hearing aids on their self-image. Participants who reported better self-management in the areas of adhering to treatment, participating in shared decision making, accessing services and resources, attending appointments, and monitoring for changes in their hearing and functional status were more likely to report greater satisfaction with the sound quality and performance of their hearing aids. Conclusion Study findings highlight the potential for using information about a patient's hearing loss self-management in different domains as part of clinical decision making and management planning.

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Effects of Leadership Development Program on Decision Making, Self - management Behavior and Interpersonal Relationship

Contemporary Research Trend of Convergence Works III ◽

10.21742/asehl.2016.10.20 ◽

2016 ◽

Author(s):

Hyejin Kim ◽

Keyword(s):

Decision Making ◽

Leadership Development ◽

Interpersonal Relationship ◽

Development Program ◽

Self Management ◽

Management Behavior ◽

Leadership Development Program

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Self-management education in patients with cardiovascular disease: a best practice implementation project

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2014-1367 ◽

2014 ◽

Vol 12 (9) ◽

pp. 454-466 ◽

Cited By ~ 2

Author(s):

Khin Sanda Tun

Keyword(s):

Cardiovascular Disease ◽

Best Practice ◽

Management Education ◽

Self Management ◽

Implementation Project ◽

Practice Implementation

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Digital Diabetes Management: A Literature Review of Smart Insulin Pens

Journal of Diabetes Science and Technology ◽

10.1177/1932296820983863 ◽

2021 ◽

pp. 193229682098386 ◽

Cited By ~ 1

Author(s):

Lutz Heinemann ◽

Oliver Schnell ◽

Bernhard Gehr ◽

Nanette C. Schloot ◽

Sven W. Görgens ◽

...

Keyword(s):

Patient Preference ◽

Diabetes Management ◽

Electronic Device ◽

Digital Health ◽

Memory Function ◽

Near Field ◽

Self Management ◽

Published Data ◽

Technical Accuracy ◽

Insulin Pens

Digital health management is increasingly pivotal in the care of patients with diabetes. The aim of this review was to evaluate the clinical benefits of using smart insulin pens with connectivity for diabetes management. The search was performed using PubMed and PubMed Central on May 15, 2019, to identify publications investigating the use of insulin pens. Studies evaluating insulin pens with connectivity via Bluetooth/Near Field Communication, with an associated electronic device enabling connectivity, or with a memory function were included in the review. Nine studies were identified in the search. Overall, these studies lacked data on smart insulin pens with a connectivity function, with eight of the available studies investigating only pens with a memory function. The studies focused primarily on assessing patient preference, usability, and technical accuracy. The number of studies assessing clinical outcomes was small ( n = 3). However, the majority of studies ( n = 8) reported that patients preferred smart insulin pens because they increased confidence with regard to diabetes self-management. These results suggest a lack of published data regarding smart insulin pens with connectivity for the management of diabetes. However, the available published data on usability and patient preference suggest that the use of smart insulin pens holds promise for improving and simplifying diabetes self-management.

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

Obesity Facts ◽

10.1159/000515663 ◽

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

Background: 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. The Project: 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. Impact: 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.

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