The Use of Behavior Change Theory in Internet-Based Asthma Self-Management Interventions: A Systematic Review

Background

The high prevalence rate of asthma represents a major societal burden. Advancements in information technology continue to affect the delivery of patient care in all areas of medicine. Internet-based solutions, social media, and mobile technology could address some of the problems associated with increasing asthma prevalence.

Objective

This review evaluates Internet-based asthma interventions that were published between 2004 and October 2014 with respect to the use of behavioral change theoretical frameworks, applied clinical guidelines, and assessment tools.

Methods

The search term (Asthma AND [Online or Internet or Mobile or Application or eHealth or App]) was applied to six bibliographic databases (Ovid MEDLINE, PubMed, BioMed Central, ProQuest Computing, Web of Knowledge, and ACM Digital Library) including only English-language articles published between 2004 and October 2014. In total, 3932 articles matched the priori search terms and were reviewed by the primary reviewer based on their titles, index terms, and abstracts. The matching articles were then screened by the primary reviewer for inclusion or exclusion based on their abstract, study type, and intervention objectives with respect to the full set of priori inclusion and exclusion criteria; 331 duplicates were identified and removed. A total of 85 articles were included for in-depth review and the remaining 3516 articles were excluded. The primary and secondary reviewer independently reviewed the complete content of the 85 included articles to identify the applied behavioral change theories, clinical guidelines, and assessment tools. Findings and any disagreement between reviewers were resolved by in-depth discussion and through a consolidation process for each of the included articles.

Results

The reviewers identified 17 out of 85 interventions (20%) where at least one model, framework, and/or construct of a behavioral change theory were applied. The review identified six clinical guidelines that were applied across 30 of the 85 interventions (35%) as well as a total of 21 assessment tools that were applied across 32 of the 85 interventions (38%).

Conclusions

The findings of this literature review indicate that the majority of published Internet-based interventions do not use any documented behavioral change theory, clinical guidelines, and/or assessment tools to inform their design. Further, it was found that the application of clinical guidelines and assessment tools were more salient across the reviewed interventions. A consequence, as such, is that many Internet-based asthma interventions are designed in an ad hoc manner, without the use of any notable evidence-based theoretical frameworks, clinical guidelines, and/or assessment tools.     

Characterizing the Discussion of Antibiotics in the Twittersphere: What is the Bigger Picture?

Background

User content posted through Twitter has been used for biosurveillance, to characterize public perception of health-related topics, and as a means of distributing information to the general public. Most of the existing work surrounding Twitter and health care has shown Twitter to be an effective medium for these problems but more could be done to provide finer and more efficient access to all pertinent data. Given the diversity of user-generated content, small samples or summary presentations of the data arguably omit a large part of the virtual discussion taking place in the Twittersphere. Still, managing, processing, and querying large amounts of Twitter data is not a trivial task. This work describes tools and techniques capable of handling larger sets of Twitter data and demonstrates their use with the issue of antibiotics.

Objective

This work has two principle objectives: (1) to provide an open-source means to efficiently explore all collected tweets and query health-related topics on Twitter, specifically, questions such as what users are saying and how messages are spread, and (2) to characterize the larger discourse taking place on Twitter with respect to antibiotics.

Methods

Open-source software suites Hadoop, Flume, and Hive were used to collect and query a large number of Twitter posts. To classify tweets by topic, a deep network classifier was trained using a limited number of manually classified tweets. The particular machine learning approach used also allowed the use of a large number of unclassified tweets to increase performance.

Results

Query-based analysis of the collected tweets revealed that a large number of users contributed to the online discussion and that a frequent topic mentioned was resistance. A number of prominent events related to antibiotics led to a number of spikes in activity but these were short in duration. The category-based classifier developed was able to correctly classify 70% of manually labeled tweets (using a 10-fold cross validation procedure and 9 classes). The classifier also performed well when evaluated on a per category basis.

Conclusions

Using existing tools such as Hive, Flume, Hadoop, and machine learning techniques, it is possible to construct tools and workflows to collect and query large amounts of Twitter data to characterize the larger discussion taking place on Twitter with respect to a particular health-related topic. Furthermore, using newer machine learning techniques and a limited number of manually labeled tweets, an entire body of collected tweets can be classified to indicate what topics are driving the virtual, online discussion. The resulting classifier can also be used to efficiently explore collected tweets by category and search for messages of interest or exemplary content.     

Effectiveness of a Web-Based Tailored Interactive Health Communication Application for Patients With Type 2 Diabetes or Chronic Low Back Pain: Randomized Controlled Trial

BackgroundThe prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising. Patient empowerment is a key strategy in the management of chronic diseases. Patient empowerment can be fostered by Web-based interactive health communication applications (IHCAs) that combine health information with decision support, social support, and/or behavioral change support. Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness.ObjectiveThe main objective was to test the effectiveness of a Web-based, tailored, fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring (control condition) on patients’ knowledge and empowerment.MethodsWe performed a blinded randomized trial with a parallel design. In the intervention group, the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group, the sections of the text were presented in a content tree without any tailoring. Participants were recruited online and offline and were blinded to their group assignments. Measurements were taken at baseline (t₀), directly after the first visit (t₁), and at 3-month follow-up (t₂). The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment (primary outcomes) than the control website. The secondary outcomes were decisional conflict and preparation for decision making. All measurements were conducted by online self-report questionnaires. Intention-to-treat (ITT) and available cases (AC) analyses were performed for all outcomes.ResultsA total of 561 users agreed to participate in the study. Of these, 179 (31.9%) had type 2 diabetes and 382 (68.1%) had chronic low back pain. Usage was significantly higher in the tailored system (mean 51.2 minutes) than in the control system (mean 37.6 minutes; P<.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in the ITT analysis. In the AC analysis, participants using the tailored system displayed significantly more knowledge at t₁ (P=.02) and more emotional well-being (subscale of empowerment) at t₂ (P=.009). The estimated mean difference between the groups was 3.9 (95% CI 0.5-7.3) points for knowledge and 25.4 (95% CI 6.3-44.5) points for emotional well-being on a 0-100 points scale.ConclusionsThe primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes.

Trial Registration

International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitation.org/6WPO0lJwE).     

Psychosocial impact of COVID-19

BackgroundAlong with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, termed as “coronaphobia”, has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19.MethodsPubmed and GoogleScholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Psychology”, “Psychosocial”, “Psychitry”, “marginalized”, “telemedicine”, “mental health”, “quarantine”, “infodemic”, “social media” and” “internet”. Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context.ResultsDisease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an “infodemic” spread via different platforms of social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children’s usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention.ConclusionFor better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.     

深圳市基于移动互联网交友的MSM肛交性行为特征及相关研究

目的 了解基于移动互联网的男男性行为者（MSM）肛交性行为特点及影响要素,为疾病的防治提供依据。方法 2017年1月—2018年12月,在MSM聚集的移动互联网社交平台上,选择18周岁以上,最近1年内有过肛交同性性行为的男性810人为调查对象,分析肛交性行为特征及影响因素。结果 最近6个月MSM人群同性肛交性行为比例为82.1%（665/810）,HIV感染率为18.1%（147/810）;无保护肛交的比例为45.6%（303/665）,HIV感染率为26.1%（79/303）;最近6个月与无保护肛交有影响的因素有：已婚（OR=0.938, 95%CI:0.642~0.971）、获得同伴教育（OR=0.376, 95%CI:0.262~0.539）,居住时间>6~12个月（OR=0.276, 95%CI:0.120~0.634）、居住时间>12~24个月（OR=0.544, 95%CI:0.292~0.743）、居住时间24个月以上（OR=0.347, 95%CI:0.256~0.767）、感染性病（OR=0.401, 95%CI:0.201~0.800）、知晓艾滋病防治相关知识（OR=0.443, 95%CI:0.104~0.773）。结论 MSM无保护性肛交发生比例高,虽然婚姻对无保护性肛交有制约作用,但艾滋病健康促进至关重要;基于互联网抽样和干预是MSM艾滋病流行病学研究和控制的有效途径。     

基于互联网的新型冠状病毒肺炎健康咨询服务分析

目的 分析2020年1月我国新型冠状病毒肺炎(corona virus disease 2019,COVID-19,简称新冠肺炎)疫情初期,政府,医院,公司如何启动互联网技术参与医疗服务,为进一步利用信息技术改善疫情中后期和后疫情时期的医疗服务提出建议.方法: 利用百度等搜索引擎以"互联网+肺炎"等为关键词,搜索2020年1月20日至2月3日的疫情相关互联网健康服务项目信息,由双人背对背提取关键信息并编码,录入信息并进行描述性分析.结果: 10余天时间中,有27家医院,19个公司开通新冠肺炎线上咨询服务,有9个省市组织了区域性线上服务.大多数项目在1月24日至27日启动,集中在少数省份,100.00%的医院和90.48%的公司项目开通发热及肺炎咨询服务,37.04%的医院和66.67%的公司项目提供衍生健康问题咨询,少数项目开展远程会诊,有个别项目提供针对居家隔离人员的线上健康管理.医师是线上工作的主力,也有护士,药师等专业技术人员参与.结论: 互联网技术为改善医疗服务体系在疫情初期的快速反应提供了条件,具备制度和技术可行性,但地区发展不均衡,基层医疗机构参与度不高,没有通过互联网实现医疗体系的联动与协同.应推动省级卫生健康委员会组织远程会诊,推进基层卫生机构开展"互联网+医疗",促进机构之间的协同联动,缓解疫情时期的诊疗压力,改善后疫情时代的医疗服务.     

联网远程疾病管理对RA患者治疗依从性和疾病活动度的影响

【摘要】 目的 探讨互联网远程疾病管理对类风湿关节炎(RA)患者治疗依从性和疾病活动度的影响。 方法 选取2017年6月～2018年2月在绵阳市中心医院风湿免疫科住院及门诊就诊的RA患者250例行前瞻性研究,将患者随机分为远程管理组和对照组,通过入选标准和排除标准,对照组最终纳入104例,远程管理组最终纳入102例。确定治疗方案后对治疗方案不做重大调整,随诊6个月后比较两组患者治疗依从性及DAS 28评分。 结果 DAS-28评分与风湿病治疗依从性CQR评分（Compliance questionnaire rheumatology,CQR）呈负相关性（P＜0.001）,且远程管理组治疗依从性CQR评分显著高于对照组（P＜0.001）。远程管理组遵从专科医师建议及服药医嘱的患者较对照组更多(P＜0.05)。采取特殊的方式记录和提醒自己服药及能够接受部分药物副作用的患者比例较对照组更高(P＜0.05),外出忘记带药和服药的情况较对照组更少(P＜0.05)。治疗后远程管理组病情好转比例较对照组更高(P＜0.05),而愿意选择其他治疗方法替代风湿病专科医师治疗的患者较对照组更少(P＜0.05)。两组患者治疗后DAS-28评分均较治疗前显著降低(P＜0.05),但远程管理组患者DAS 28评分较对照组更低（P＜0.001）,整体达标率更高（P＜0.001）。 结论 基于互联网的远程管理可以提高RA患者治疗依从性,降低患者疾病活动度,提高治疗达标率。