Rationalizing personal health management (PHM) policy: Identifying health IT use patterns via observations of daily living (ODLs) data

ObjectivesManaging personal health information is mainly dependent upon individual users’ adoption and use of new health technology. Despite the increasing popularity of mobile health apps, recent endeavors of self-health management have been somewhat limited to fitness management whose apps have selective features and capabilities. Under this context, it raises a question as to whether health consumers are capable of adopting and utilizing mobile health apps with varying features and capabilities in order to manage both medical and fitness health information.MethodsBorrowing from a theoretical lens of observations of daily living (ODLs), the authors posit that if individual health consumers can record their daily activities with both health and non-health related mobile IT, such self-tracking information can then serve as an evaluation tool for measuring their future capabilities of new health IT adoption. To explore the phenomenon, we administered an online survey to collect technology-related ODL data from 226 international health consumers with known ODL survey items.ResultsBy applying confirmatory factor analysis and K-means cluster analysis, we found health consumers’ use of social and finance-related technology are closely linked to the use of mobile health technology in their daily living. Moreover, health consumers who actively use all three technologies (i.e., social, financial and health technologies) tend to have affinitive perceptions toward health management outcomes.ConclusionThe findings of this study can inform health policymakers to vie for more effective mobile health technology in rationalizing personal health management (PHM) policy.     

Making sense with numbers. Unravelling ethico‐psychological subjects in practices of self‐quantification

Prevention enthusiasts show great optimism about the potential of health apps to modify peoples’ lifestyles through the tracking and quantification of behaviours and bodily signs. Critical sociologists warn for the disciplining effects of self‐tracking. In this paper we use an empirical ethics approach to study the characteristics and strivings of the various types of ‘ethico‐psychological subjects’ that emerge in practices of self‐quantification by analysing how people and numbers relate in three cases of self‐quantification: in prevention discourse, in testimonies from the quantified self (QS) movement and in empirical work we did with people with Diabetes type I and with ‘every day self‐trackers’. We show that a free subject that needs support to enact its will is crucial to understand the optimism about prevention. In the QS‐movement the concern is with a lack of objective and personalised knowledge about imperceptible processes in the body. These subjects are decentered and multiplied when we trace how numbers in their turn act to make sense of people in our empirical study. We conclude that there are many different types of ethico‐psychological subjects in practices of self‐tracking that need to be explored in order to establish what good these practices of self‐quantification might do.     

Do Fitness Apps Need Text Reminders? An Experiment Testing Goal-Setting Text Message Reminders to Promote Self-Monitoring

Fitness tracking apps have the potential to change unhealthy lifestyles, but users’ lack of compliance is an issue. The current intervention examined the effectiveness of using goal-setting theory-based text message reminders to promote tracking activities on fitness apps. We conducted a 2-week experiment with pre- and post-tests with young adults (n = 50). Participants were randomly assigned to two groups—a goal-setting text message reminder group and a generic text message reminder group. Participants were asked to use a fitness tracking app to log physical activity and diet for the duration of the study. Participants who received goal-setting reminders logged significantly more physical activities than those who only received generic reminders. Further, participants who received goal-setting reminders liked the messages and showed significantly increased self-efficacy, awareness of personal goals, motivation, and intention to use the app. The study shows that incorporating goal-setting theory-based text message reminders can be useful to boost user compliance with self-monitoring fitness apps by reinforcing users’ personal goals and enhancing cognitive factors associated with health behavior change.     

Digital disruption of dietetics: are we ready?

Digital health is transforming the delivery of health care around the world to meet the growing challenges presented by ageing populations with multiple chronic conditions. Digital health technologies can support the delivery of personalised nutrition care through the standardised Nutrition Care Process (NCP) by using personal data and technology‐supported delivery modalities. The digital disruption of traditional dietetic services is occurring worldwide, supporting responsive and high‐quality nutrition care. These disruptive technologies include integrated electronic and personal health records, mobile apps, wearables, artificial intelligence and machine learning, conversation agents, chatbots, and social robots. Here, we outline how digital health is disrupting the traditional model of nutrition care delivery and outline the potential for dietitians to not only embrace digital disruption, but also take ownership in shaping it, aiming to enhance patient care. An overview is provided of digital health concepts and disruptive technologies according to the four steps in the NCP: nutrition assessment, diagnosis, intervention, and monitoring and evaluation. It is imperative that dietitians stay abreast of these technological developments and be the leaders of the disruption, not simply subject to it. By doing so, dietitians now, as well as in the future, will maximise their impact and continue to champion evidence‐based nutrition practice.     

Multidisciplinary perspectives: Application of the Consolidated Framework for Implementation Research to evaluate a health coaching initiative

Long‐term conditions are a leading cause of mortality and morbidity. Their management is founded on a combination of approaches involving government policy, better integration between health and care systems, and individual responsibility for self‐care. Health coaching has emerged as an approach to encouraging individual responsibility and enhancing the self‐management of long‐term conditions. This paper focuses on the evaluation of a workforce initiative in a diverse and socially deprived community. The initiative sought both to improve integration between health and care services for people with long‐term conditions, and equip practitioners with health coaching skills. The aim of the study was to contribute an empirical understanding of what practitioners perceive to be the contextual factors that impact on the adoption of health coaching in community settings. These factors were conceptualised using the Consolidated Framework for Implementation Research (CFIR). A stratified purposive sample of 22 health and care practitioners took part in semi‐structured telephone interviews. Data were analysed using the CFIR as an analytical framework. The perceptions of trainees mapped onto the major domains of the CFIR: characteristics of the intervention, outer setting, inner setting, characteristics of individuals involved and process of implementation. Individual patient expectations, comorbidities and social context were central to the extent to which practitioners and patients engaged with health coaching. Structural constraints within provider services and the wider NHS were also reported as discouraging initiatives that focused on long‐term rewards rather than short‐term wins. The authors recommend further research is undertaken both to understand the role of health coaching in disadvantaged communities and ensure the service user voice is heard.     

Positive effects of art therapy on depression and self-esteem of older adults in nursing homes

Depression and self‐esteem affects the health and quality of life of older adults who live in nursing homes. This study tested the effectiveness of art therapy activities on reducing the depression and improving the self-esteem of elderly living in long‐term care institutes. This was a quasi‐experimental study. A purposive sampling strategy was used to select 55 subjects who were aged 65 and above with intact mental functions and depression tendencies and currently residing in nursing homes in Kaohsiung, Taiwan. 29 subjects who participated in a selection of 12 artistic activities were assigned to the experimental group and 26 subjects who adhered to their ordinary activities were allocated to the control group. Structured questionnaires of the artistic group were used for data collection. The art therapy programs showed promising effects in improving the depression and self‐esteem of older adults living in nursing homes. Art therapy activities benefit the mental health of older adults. Incorporating artistic activities into social work care may help develop long‐term care into a more diverse, unique, and innovative direction.     

The role of health‐related claims and health‐related symbols in consumer behaviour: Design and conceptual framework of the CLYMBOL project and initial results

Health claims and symbols are potential aids to help consumers identify foods that are healthier options. However, little is known as to how health claims and symbols are used by consumers in real‐world shopping situations, thus making the science‐based formulation of new labelling policies and the evaluation of existing ones difficult. The objective of the European Union‐funded project Role of health‐related CLaims and sYMBOLs in consumer behaviour (CLYMBOL) is to determine how health‐related information provided through claims and symbols, in their context, can affect consumer understanding, purchase and consumption. To do this, a wide range of qualitative and quantitative consumer research methods are being used, including product sampling, sorting studies (i.e. how consumers categorise claims and symbols according to concepts such as familiarity and relevance), cross‐country surveys, eye‐tracking (i.e. what consumers look at and for how long), laboratory and in‐store experiments, structured interviews, as well as analysis of population panel data. EU Member States differ with regard to their history of use and regulation of health claims and symbols prior to the harmonisation of 2006. Findings to date indicate the need for more structured and harmonised research on the effects of health claims and symbols on consumer behaviour, particularly taking into account country‐wide differences and individual characteristics such as motivation and ability to process health‐related information. Based on the studies within CLYMBOL, implications and recommendations for stakeholders such as policymakers will be provided.     

Fertility and digital technology: narratives of using smartphone app ‘Natural Cycles’ while trying to conceive

Fertility awareness apps, which help to identify the ‘fertile window’ when conception is most likely, have been hailed as ‘revolutionising’ women’s reproductive health. Despite rapidly growing popularity, little research has explored how people use these apps when trying to conceive and what these apps mean to them. We draw on in‐depth, qualitative interviews, adopting a critical digital health studies lens (a sub‐field of science and technology studies), to explore the experiences of cisgender women and partners with one such app, Natural Cycles, in the context of their daily lives. We found that many women valued the technology as a ‘natural’, inobtrusive alternative to biomedical intervention, and a means of controlling and knowing their bodies, amid a dearth of fertility‐related education and care. Yet this technology also intervened materially and affectively into the spaces of their lives and relationships and privileged disembodied metrics (temperature) over embodied knowledge. Meanwhile, app language, advertising and cost have contributed to characterising ‘typical’ users as white, heterosexual, affluent, cisgender women without disabilities. In the context of neoliberal shifts towards bodily self‐tracking, technologies appealing as novel, liberating and ‘natural’ to individuals who can access them may nevertheless reproduce highly gendered reproductive responsibilities, anxieties and broader health and social inequalities.     

The role of collective efficacy in long‐term condition management: A metasynthesis

Social networks have been found to have a valuable role in supporting the management of long‐term conditions. However, the focus on the quality and how well self‐management interventions work focus on individualised behavioural outcomes such as self‐efficacy and there is a need for understanding that focuses on the role of wider collective processes in self‐management support. Collective efficacy presents a potentially useful candidate concept in the development and understanding of self‐management support interventions. To date it has mainly been utilised in the context of organisations and neighbourhoods related to social phenomena such as community cohesion. Drawing on Bandura's original theorisation this meta‐synthesis explores how studies of collective efficacy might illuminate collective elements operating within the personal communities of people with long‐term conditions. A qualitative meta‐synthesis was undertaken. Studies published between 1998 and 2018 that examined collective efficacy in relation to health and well‐being using qualitative and mixed methods was eligible for inclusion. Timing of engagement with others, building trust in the group, and legitimising ongoing engagement with the group arised as central elements of collective efficacy. The two themes forming third order constructs were related to the presence of continuous interaction and ongoing relational work between members of the group. Collective efficacy can develop and be sustained over time in a range of situations where individuals may not have intense relationships with one another and have limited commitment and contact with one another. Extending this to the personal communities of people with long‐term conditions it may be the case that collective efficacy enables a number of engagement opportunities which can be oriented towards assisting with support from networks over a sustained length of time. This may include negotiating acceptable connections to resources and activities which in turn may help change existing practice in ways that improve long‐term condition management.     

Limited self‐control and longevity

This paper proposes a new framework to discuss self‐control problems in the context of life‐cycle health and longevity. Individual decisions are conceptualized as the partial control of impulsive desires of a short‐run self by a rationally forward‐looking long‐run self. The short‐run self strives for immediate gratification through consumption of health‐neutral and unhealthy goods. The long‐run self reflects the long‐term consequences of unhealthy behavior on health outcomes and longevity and invests time and money to improve current and future health. The model is calibrated with data from the United States and used to provide an assessment of the impact of imperfect self‐control on unhealthy consumption, health investments, lifetime health, and the age at death.     

Long-term effects of poor health on employment: the significance of life stage and educational level

Previous research has found the employment consequences of poor health to be of increased magnitude in low qualified groups. The purpose of this study is to investigate if this relationship varies within different stages of the life course when focusing on long term associations with non‐employment. An expectation of the article is that stronger effects of poor health may be found in young adults compared to middle aged people. The article considers two possible explanations: normative change and life stage resources. Using three‐wave panel data from the Norwegian county of Nord‐Trøndelag, the HUNT study allows the study of respondents over two decades. Two narrow cohorts have been selected for comparison, and health was measured by self‐reported longstanding limiting illness. For the analyses, cross tabulations, logistic regression, and fixed effects logistic regression techniques are used. The article concludes in favour of the resource explanation; young adulthood is a critical period in relation to long term employment consequences of poor health, and especially so among people with fewer educational resources. Cohort differences in the employment consequences of poor health are not likely to be caused by poorer work ethics among younger cohorts.     

Nutrition labels and claims in New Zealand and Australia: a review of use and understanding

Objective: To determine how well consumers use and understand nutrition labels and claims in New Zealand and Australia. Method: A review was undertaken of the literature on nutrition labelling in New Zealand and Australia published up to the end of July 2005. Major electronic databases were searched for appropriate literature and research, as were the bibliographies of relevant publications and pertinent websites. Studies that focused on health claims were excluded. Results: Sixteen papers were suitable for inclusion in the review. All but one study evaluated self‐reported use and understanding of nutrition labels. The single study that evaluated actual (observed) use of labels while shopping found frequency to be much lower than would be expected based on self‐reported data. While self‐reported understanding of nutrition labels was common, actual (evaluated) understanding appeared moderate at best. Conclusions: Self‐reported use of nutrition labels and claims is common in New Zealand and Australia, but actual use and understanding appears limited. Nutrition labels present an opportunity to improve consumer food choice at point of purchase, but their potential value is limited by apparent lack of consumer understanding. Implications: Nutrition labels are an important part of a supportive environment that empowers people to make healthy food choices. Improving their ease of use and understanding has the potential to promote healthier food choices.     

Fathers’ contributions to the management of their child’s long‐term medical condition: a narrative review of the literature

Context Fathers’ contributions to the management of long‐term childhood medical conditions are under‐represented in the literature; therefore, the full extent of their involvement is poorly understood by practitioners and researchers, so strategies for promoting their involvement have not yet been fully considered. Objective To review studies of fathers’ actual contributions in a wide range of conditions, the potential to optimize their contribution through additional interventions by health professionals and a direction for future research. Design Narrative review of the literature. Methods CINAHL, Medline, PsychInfo and ERIC databases were searched electronically between the years 1995–2008. The terms adherence, adjustment, child, chronic, compliance, concordance, condition, coping, disease, father, illness, information, long‐term, management/intervention, mother, role, self‐care and treatment were searched for separately and in combination. English language papers reporting primary research were selected and supplemented by hand‐searching reference lists. Thirty‐five papers (arising from 29 studies) met criteria and were selected for narrative review. Results Five themes were identified: (i) the impact of long‐term conditions on fathers’ ability to promote their child’s well‐being, (ii) factors influencing fathers’ involvement in health care, (iii) personal growth/beneficial effects for fathers, (iv) the impact of father’s involvement on family functioning and (v) strategies that increase fathers’ participation in their child’s health care and in research investigating fathers’ participation. Conclusions The review suggests that fathers’ involvement in children’s health care can positively impact on fathers’, mothers’ and children’s well‐being and family functioning. A range of strategies are identified to inform the promotion of fathers’ contributions and future research investigating their input.     

Provider-sponsored virtual communities for chronic patients: improving health outcomes through organizational patient-centred knowledge management

Patients with long‐term chronic disease experience numerous illness patterns and disease trends over time, resulting in different sets of knowledge needs than patients who intermittently seek medical care for acute or short‐term problems. Health‐care organizations can promote knowledge creation and utilization by chronic patients through the introduction of a virtual, private, disease‐specific patient community. This virtual socialization alters the role of chronic disease patients from external consumers of health‐care services to a ‘community of practice’ of internal customers so that, with the tacit support of their health‐care organization, they have a forum supporting the integration of knowledge gained from the experiences of living with chronic disease in their self‐management. Patient‐centred health‐care organizations can employ the virtual community to direct and support the empowerment of chronic patients in their care.     

What Motivates Users to Continue Using Diet and Fitness Apps? Application of the Uses and Gratifications Approach

This study explored how the gratifications obtained from the use of diet and fitness apps may motivate users to continue their use of these apps. The effects of seven gratifications obtained were analyzed through hierarchical regression analyses. Results showed that the five gratifications of recordability, networkability, credibility, comprehensibility, and trendiness significantly predicted user intention to continue using diet/fitness apps; the hypothesized gratifications of accuracy and entertainment were not significant predictors. These findings contribute to broadening our theoretical and practical knowledge of new digital, mobile media phenomena by identifying use motivations specific to diet/fitness apps. Based on the findings, recommendations for researchers, practitioners, and developers are provided.     

Changing emotional engagement with running through communal self-tracking: the implications of ‘teleoaffective shaping’ for public health

Emerging research explores the role of self-tracking in supporting healthy behaviour. Self-tracking comprises a number of interrelated practices; some individual some communal. In this article, we focus on practices that enable interaction between self-trackers through data sharing and communication around personal data. For public health, communal self-tracking has been explored for the additional benefits it provides in addition to self-knowledge. However, under-explored is the emotional entanglement of self-tracking and tracked activities, or the role of practitioners in the dynamic evolution of tracked practices. Qualitative, mixed methods data were collected from leisure-time runners in the SW England who self-track using social fitness app ‘Strava’, and were interpreted through the lens of practice theory. We find that communal self-tracking affords the active shaping of the emotion and purpose of running. This ‘teleoaffective shaping’ allows practitioners to negotiate and reconstitute appealing meanings associated with running to protect their practice loyalty. We identify three mechanisms for teleoaffective shaping afforded by Strava: labelling, reward and materialising effort. Findings advance our understanding of how social fitness apps work to retain practitioners of physically active leisure practices. Future research should further explore the multiple ways that associations with tracked physical activity evolve through entanglement with self-tracking practices.     

Consumer input into health care: Time for a new active and comprehensive model of consumer involvement

Background

To ensure the provision of patient‐centred health care, it is essential that consumers are actively involved in the process of determining and implementing health‐care quality improvements. However, common strategies used to involve consumers in quality improvements, such as consumer membership on committees and collection of patient feedback via surveys, are ineffective and have a number of limitations, including: limited representativeness; tokenism; a lack of reliable and valid patient feedback data; infrequent assessment of patient feedback; delays in acquiring feedback; and how collected feedback is used to drive health‐care improvements.

Objectives

We propose a new active model of consumer engagement that aims to overcome these limitations. This model involves the following: (i) the development of a new measure of consumer perceptions; (ii) low cost and frequent electronic data collection of patient views of quality improvements; (iii) efficient feedback to the health‐care decision makers; and (iv) active involvement of consumers that fosters power to influence health system changes.     

Experiences and implications of smartphone apps for depression and anxiety

Apps on smartphones are increasingly used for self-care for depression and anxiety, yet how and why they are accessed, and their social effects, remain under-investigated. Sociologists have begun to theorise how these technologies affect and relate; crucial questions for a contemporary sociology of health. This study seeks to contribute to our conceptualisation of how digital health technologies are implicated in health by investigating the motivations, experiences and relations of people using mobile apps for depression or anxiety. We interviewed 14 individuals living in England with a diagnosis of depression or an anxiety disorder, who used smartphone apps as part of self-care. Analysis followed a thematic approach. Three themes were identified. Apps exist within relational contexts – alongside smartphones, beliefs about mental health and other support – which shape app use and lead to an imprecise, casual approach. People engage with apps in a straightforward and uncomplicated manner, leading to immediate symptomatic alleviation, but to limited longer term benefit. The contradiction between the apps’ promise as tools of individual empowerment, with their ability to promote responsibilising frameworks that restrain users’ reflexivity, is central to their implications. Apps can thus contribute to isolation from interpersonal support and promote reductionist biomedical conceptualisations of mental ill health.