Social and Self-Reflective Use of a Web-Based Personally Controlled Health Management System

Background

Personally controlled health management systems (PCHMSs) contain a bundle of features to help patients and consumers manage their health. However, it is unclear how consumers actually use a PCHMS in their everyday settings.

Objective

To conduct an empirical analysis of how consumers used the social (forum and poll) and self-reflective (diary and personal health record [PHR]) features of a Web-based PCHMS designed to support their physical and emotional well-being.

Methods

A single-group pre/post-test online prospective study was conducted to measure use of a Web-based PCHMS for physical and emotional well-being needs during a university academic semester. The PCHMS integrated an untethered PHR with social forums, polls, a diary, and online messaging links with a health service provider. Well-being journeys additionally provided information to encourage engagement with clinicians and health services. A total of 1985 students and staff aged 18 and above with access to the Internet were recruited online, of which 709 were eligible for analysis. Participants’ self-reported well-being, health status, health service utilization, and help-seeking behaviors were compared using chi-square, McNemar’s test, and Student’s t test. Social networks were constructed to examine the online forum communication patterns among consumers and clinicians.

Results

The two PCHMS features that were used most frequently and considered most useful and engaging were the social features (ie, the poll and forum). More than 30% (213/709) of participants who sought well-being assistance during the study indicated that other people had influenced their decision to seek help (54.4%, 386/709 sought assistance for physical well-being; 31.7%, 225/709 for emotional well-being). Although the prevalence of using a self-reflective feature (diary or PHR) was not as high (diary: 8.6%, 61/709; PHR: 15.0%, 106/709), the proportion of participants who visited a health care professional during the study was more than 20% greater in the group that did use a self-reflective feature (diary: P=.03; PHR: P<.001).

Conclusions

There was variation in the degree to which consumers used social and self-reflective PCHMS features but both were significantly associated with increased help-seeking behaviors and health service utilization. A PCHMS should combine both self-reflective as well as socially driven components to most effectively influence consumers’ help-seeking behaviors.     

Predefined vs data-guided training prescription based on autonomic nervous system variation: A systematic review

Monitoring variations in the functioning of the autonomic nervous system may help personalize training of runners and provide more pronounced physiological adaptations and performance improvements. We systematically reviewed the scientific literature comparing physiological adaptations and/or improvements in performance following training based on responses of the autonomic nervous system (ie, changes in heart rate variability) and predefined training. PubMed, SPORTDiscus, and Web of Science were searched systematically in July 2019. Keywords related to endurance, running, autonomic nervous system, and training. Studies were included if they (a) involved interventions consisting predominantly of running training; (b) lasted at least 3 weeks; (c) reported pre- and post-intervention assessment of running performance and/or physiological parameters; (d) included an experimental group performing training adjusted continuously on the basis of alterations in HRV and a control group; and (e) involved healthy runners. Five studies involving six interventions and 166 participants fulfilled our inclusion criteria. Four HRV-based interventions reduced the amount of moderate- and/or high-intensity training significantly. In five interventions, improvements in performance parameters (3000 m, 5000 m, Loadmax, Tlim) were more pronounced following HRV-based training. Peak oxygen uptake () and submaximal running parameters (eg, LT1, LT2) improved following both HRV-based and predefined training, with no clear difference in the extent of improvement in . Submaximal running parameters tended to improve more following HRV-based training. Research findings to date have been limited and inconsistent. Both HRV-based and predefined training improve running performance and certain submaximal physiological adaptations, with effects of the former training tending to be greater.     

Integration of online and offline health services: The role of doctor-patient online interaction

ObjectiveThis study aims to investigate how doctor-patient online interaction affects the integration of online and offline health services. Drawing on justice theory and the stimulus-organism-response (S-O-R) framework, justice perceptions are conceptualized as online health communication in influencing patient experiences and subsequent responses.MethodsData were collected from 241 online consultation patients. Partial least squares structural equation modeling (PLS-SEM) approach was used to test the research model and 12 hypothesized relationships.ResultsDistributive justice, procedural justice, and interpersonal justice significantly affect trust, which in turn affects satisfaction and the continued intention to consult. Distributive justice and informational justice significantly affect satisfaction, which in turn affects the continued intention to consult. Finally, the continued intention to consult significantly affects the behavioral intention to visit.ConclusionDoctors can attract patients to visit them in physical hospitals by providing good online health services. Before physically visiting doctors, patients can also search for a suitable doctor that meets their needs through online consultations. To the best of our knowledge, this study is the first to integrate online and offline health services.Practice implicationsFrom the perspective of health communication, the understanding of doctor-patient online interaction offers doctors and hospitals guidance to improve doctor-patient relationships.     

An assessment of the quality of vaccination data produced through smart paper technology in The Gambia

IntroductionMyChild Solution is an innovative Electronic Immunisation Register (EIR) reliant on Smart Paper Technology, thereby eliminating the need for electronic devices and internet connectivity at the point-of-care. The goal of this study is to characterise the quality of routine immunisation data generated using MyChild Solution compared to data obtained through the conventional health management information system (HMIS) used in The Gambia.MethodWe used the World Health Organization’s (WHO) Data Quality Review (DQR) Toolkit to evaluate MyChild Solution’s data quality in the 19 health facilities across two regions implementing MyChild Solution in The Gambia at the time of the evaluation. We evaluated all applicable data quality metrics as well as additional metrics of interest, including the incidence of recording errors, the incidence of incomplete indicator level data, and implausible dates. Where possible, we compared results to those of the conventional HMIS.ResultsBoth MyChild Solution and the conventional HMIS produced 100% complete and timely data in their reference years. Both systems had no moderate or extreme outliers and showed the expected Penta 1 to Penta 3 dropout direction. However, the proportion of verification factors that are not acceptable was higher in the conventional HMIS. MyChild Solution was found to near perfectly (99.98%) digitise scanned documents. These and other data quality indicators evaluated demonstrate that MyChild Solution produces high quality data with high completeness, timeliness, and consistency compared to the conventional HMIS system.ConclusionMyChild Solution produces high quality data as per the DQR Toolkit metrics and other metrics of interest of interest. The more internally consitent data produced through MyChild Solution compared to the conventional HMIS demonstrates its potential for supporting data-driven decision-making in immunisation.     

The use of eHealth with immunizations: An overview of systematic reviews

BackgroundeHealth interventions may help increase vaccination uptake and health literacy related to immunization and improve immunization program efficiency.ObjectivesTo see where and how eHealth technologies have had a positive impact on immunization practices—using eHealth strategies to increase vaccination uptake, improve immunization program efficiency and advance heath literacy related to immunizations.MethodsAn overview of systematic reviews was conducted, searching PubMed, Scopus, Embase, and Web of Science for systematic reviews published through August 2017 for eHealth and immunizations (using pre-determined concepts for each). Two independent reviewers selected studies based on a priori criteria; disagreement was resolved by consensus. The quality of the included studies was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR).ResultsThe primary search identified 198 results. After eliminating duplicates 158 remained. Upon applying the a priori set criteria to these, six articles were left to analyze. Four articles showed a positive relationship (a demonstrated benefit, improvement, increase in vaccination uptake, etc. when using eHealth technologies for immunization), one showed a promising relation / with potential, and one showed unknown effects as it focused on the difficulty of analyzing cost-benefits of immunization information systems (IIS).ConclusionThe review leads to a recommendation of using eHealth technologies to encourage immunizations and increase vaccination adherence and uptake and to continue assessing and documenting the use of eHealth for immunization.     

PREDIRCAM eHealth Platform for Individualized Telemedical Assistance for Lifestyle Modification in the treatment of Obesity,Diabetes, and Cardiometabolic Risk Prevention: A Pilot Study (PREDIRCAM 1)

Background

Healthy diet and regular physical activity are powerful tools in reducing diabetes and cardiometabolic risk. Various international scientific and health organizations have advocated the use of new technologies to solve these problems. The PREDIRCAM project explores the contribution that a technological system could offer for the continuous monitoring of lifestyle habits and individualized treatment of obesity as well as cardiometabolic risk prevention.

Methods

PREDIRCAM is a technological platform for patients and professionals designed to improve the effectiveness of lifestyle behavior modifications through the intensive use of the latest information and communication technologies. The platform consists of a web-based application providing communication interface with monitoring devices of physiological variables, application for monitoring dietary intake, ad hoc electronic medical records, different communication channels, and an intelligent notification system. A 2-week feasibility study was conducted in 15 volunteers to assess the viability of the platform.

Results

The website received 244 visits (average time/session: 17 min 45 s). A total of 435 dietary intakes were recorded (average time for each intake registration, 4 min 42 s ± 2 min 30 s), 59 exercises were recorded in 20 heart rate monitor downloads, 43 topics were discussed through a forum, and 11 of the 15 volunteers expressed a favorable opinion toward the platform. Food intake recording was reported as the most laborious task. Ten of the volunteers considered long-term use of the platform to be feasible.

Conclusions

The PREDIRCAM platform is technically ready for clinical evaluation. Training is required to use the platform and, in particular, for registration of dietary food intake.