Impact of an acceptance facilitating intervention on diabetes patients’ acceptance of Internet-based interventions for depression: A randomized controlled trial

Aims

To (1) determine diabetes patients’ acceptance of Internet-based interventions (IBIs) for depression, to (2) examine the effectiveness of an acceptance facilitating intervention (AFI) and to (3) explore subgroup specific effects.

Methods

141 diabetes patients from two inpatient rehabilitation units and one outpatient clinic in Germany were randomly allocated to an intervention (IG) and a no-intervention control group (CG). The IG received an AFI consisting of a personal information session before filling-out a questionnaire on patients’ acceptance of IBIs, predictors of acceptance (performance expectancy, effort expectancy, social influence, facilitating conditions, and Internet anxiety) as well as sociodemographic, depression-related and diabetes-related variables. The CG filled out the questionnaire immediately. Patients’ acceptance of IBIs was measured with a four-item scale (sum-score ranging from 4 to 20).

Results

The CG showed a low (50.7%) to medium (40.8%) acceptance with only 8.5% of all diabetes patients reporting a high acceptance of IBIs for depression. The AFI had no significant effect on acceptance (IG: M = 10.55, SD = 4.69, n = 70; KG: M = 9.65, SD = 4.27, n = 71; d = 0.20 [95%-CI: −0.13;0.53]) and the predictors of acceptance. Yet, subgroup analyses yielded a trend for depressed, diabetes-related distressed, female and younger (<59) participants and for those who do not frequently use the Internet to profit from the AFI.

Conclusion

Diabetes patients show a rather low acceptance toward IBIs for depression. Findings indicate that the AFI is likely to be effective in the subgroup of depressed, diabetes-related distressed, female or younger diabetes patients, but not in the whole target population. Hence, AFIs might need to be tailored to the specific needs of subpopulations.     

The use of the Internet by women with breast cancer and men with prostate cancer-results of online research

Introduction Patients are increasingly searching the Internet for information on health-related topics. Research design We examined the use of the Internet by women with breast cancer and men with prostate cancer with an online questionnaire. On the basis of 563 respondents, the ways, the scope, and the targets of the reported Internet search were analyzed, as well as the related expectations and experiences of the users. A special focus was laid on the question of how Internet information influences the illness-related decision-making processes and the doctor-patient relationship. Results While trust in physicans and their medical authority is not being fundamentally questioned, patients are increasingly confronting their doctors with high expectations concerning transparent information, openness, and willingness to shared decision-making; they want to know the doctors’ opinions on various possibilities of treatment, and they expect serious comment on their findings in the Net.     

我国发展电子健康的伦理原则和管理建议

电子健康作为一种全新的医疗保健模式，不仅提高了医疗效率，而且为更多疑难杂症的治疗带来了福音和希望，代表了医疗保健发展的未来。但是，它的发展也会面临许多问题与挑战，如电子健康信息储存的安全性问题、隐私保护问题和卫生资源的分配问题等等。因此，电子健康的研究与发展应遵循一定的规范。我国发展电子健康应该遵循知情同意、安全性、公正、风险一收益以及逐步发展的伦理原则，并从审查、信息储存与信息安全、医患关系、信息传播与隐私保护、效用评估、监督、培训与教育、法律法规等方面提出了管理建议。     

Provision of medical abortion using telemedicine in Brazil

Objective

To evaluate the need for and outcome of self-administered medical abortion with mifepristone and misoprostol in Brazil, provided through Women on Web, a global telemedicine abortion service.

Study Design

A retrospective case review of women from Brazil who contacted Women on Web in 2011. Information from the online consultation, follow-up questionnaire and emails were used to analyze data including demographics, gestational age, outcome of the medical abortion and symptoms that lead to surgical interventions.

Results

The Women on Web website had 109779 unique visitors from Brazil, 2104 women contacted the helpdesk by email. Of the 1401 women who completed the online consultation, 602 women continued their request for a medical abortion. Of the 370 women who used the medicines, 307 women gave follow-up information about the outcome of the medical abortion. Of these, 207 (67.4%) women were 9 weeks or less pregnant, 71 (23.1%) were 10, 11 or 12 weeks pregnant, and 29 (9.5%) women were 13 weeks or more pregnant. There was a significant difference in surgical intervention rates after the medical abortion (19.3% at < 9 weeks, 15.5% at 11–12 weeks and 44.8% at > 13 weeks, p=.06). However, 42.2% of the women who had a surgical intervention had no symptoms of a complication.

Conclusion

There is large need for medical abortion in Brazil. Home use of mifepristone and misoprostol provided through telemedicine is safe and effective. However, after 13 weeks gestation, there is an increased risk of surgical intervention that may be due to the regimen used and local clinical practices in Brazil.

Implications

The current study shows that there is an unmet need for medical abortion in Brazil, a country with legal restrictions on access to safe abortion services. Telemedicine can help fulfill the need and self administration of medical abortion is safe and effective even at late first trimester abortion. Prospective trials are needed to establish safety, effectiveness and acceptability of home use of medical abortion beyond 12 weeks of pregnancy.     

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability

BackgroundChildren with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors.Objective/Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone.MethodsParent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform.ResultsFifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions.ConclusionsE-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.     

Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain

Objective

Online cognitive-behavioral therapy (iCBT) is effective in supporting patients’ self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain.

Design of medical devices--a home perspective

Health care services are moving out to the community and into the home; e-health services, remote monitoring technology and self-management are replacing hospitalization and visits to medical clinics and custom-tailored medicines are making inroads into normative treatment. These developments have great implications for the scope and design of home health care equipment.The paper discusses the unique nature of home medical devices, from a human-environment-machine perspective, focusing on the nature of users, environment and tasks performed.We call for increased awareness and active continuous involvement of health care personnel together with bioengineers, human factors experts, architects, designers and end users—patients and caregivers—in defining the objectives of health care devices and services at home in terms of “all family” use, integrated into the overall surroundings (“smart home”), and as part of a collaborative patient-physician disease management team.