ORCID Profile
0000-0002-4560-9253
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 11-07-2021
DOI: 10.1111/DME.14625
Abstract: To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. A systematic review of qualitative studies reporting both groups’ views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self‐management requires a trustful PWD–HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD’s fears. Different sources of social support can influence PWD’s ability to self‐manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD’s and HCP’s views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence‐based guidelines are important but can detract from personalised care. We hypothesise that including PWD’s and HCP’s complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals.
Publisher: JMIR Publications Inc.
Date: 25-03-2023
Abstract: he prevalence of gestational diabetes mellitus is rapidly increasing at epidemic proportions making it the most common metabolic disorder of pregnancy. Many disparities exist between target recommendations from various international professional organisations resulting in a lack of global consensus. Further, GDM treatment largely relies on self-management and rapid adaptations within a short timeframe. Some studies have reported women’s experiences of having GDM, but little is known how this relates to self-management. he aim of this study was to identify enablers and barriers for women with GDM to self-management in the current Australian healthcare system. n this study, 4 databases were searched and a total of 16 studies, consisting of 799 stakeholder views were finally included. he single most reported barriers echoed by both healthcare professionals and women with GDM was the fractured healthcare system. This barrier far surpassed the second and third most common barriers, insufficient education, and dietary limitations, respectively. On the other hand, the most common enablers to GDM self-management were a lack of diabetes education or guidance, and the motivation to live healthier. This was reassuring as motivation is often driven by empowerment or intrinsic factors. Utilising digital health interventions provides convenience and improves health literacy thereby overcoming some of these barriers. Due to the high heterogeneity of the studies, a meta-analysis could not be performed highlighting the need for increased research in this space. lthough self-management of GDM remains challenging, there are motivating enablers that the healthcare system can work on to improve health outcomes for women with GDM. Empowering women to become active stakeholders, whilst also addressing better communication, alignment, and accountability is essential to enhancing GDM self—management.
Publisher: JMIR Publications Inc.
Date: 25-06-2021
Abstract: hronic diseases are the leading cause of global mortality and morbidity, yet majority of the disease burden is poorly self-managed.(1) The rate and cost of chronic disease on the healthcare system is ever-increasing and there has been a recent emphasis on self-management in future healthcare.(2) With the quick advances in information sharing and technology, telehealth has become a useful tool and mode of intervention for health systems.(3) It has been proposed that mhealth can aid ‘compliant self-management’, where patients adhere to clinical recommendations and assimilate their own knowledge of their condition with clinical recommendations to adopt an integrated self-management regime.(2) While secondary prevention is essential in reducing associated mortality and morbidity rates, there is a case for primary prevention in reducing the preventable death and disability rates.(4) Mhealth is an emerging area of intervention delivery that has shown promise in the management of chronic diseases due to its prevalence, portability and capacity for variability and applicability.(1) As of May 2014, seven billion mobile phone subscriptions were in use worldwide.(5) The increased use of mobile phone and modern technologies has created a new medium for digital health interventions delivered by mobile devices.(5) “User-centred mobile health tracking apps have gained widespread popularity by facilitating the maintenance of health and management of chronic conditions and by empowering in iduals to contribute to their own well-being and health.”(6) Majority of the World Health Organization member countries make use of mhealth for bi-directional communication between healthcare practioners and patients, emergency response, health management and information access.(3) Although interest in mhealth is increasing, and there is a sufficient research on the use of SMS or phone calls to manage health,(5) specific research into the efficacy of smartphone applications is limited. Furthermore, applications for the prevention of onset of disease is still being developed and, to the best of our knowledge, the current knowledge has not been systematically reviewed. Disease onset is defined as the first time a change has been noted in a patient’s health status with identified signs or symptoms directly attributable to a specific disease process.(7) he aim of this study was to systematically review the evidence surrounding the use of smartphone applications to prevent onset of chronic disease by improving self-management to understand the current gaps in knowledge. earch strategy Several databases including The Cochrane Library, PubMed, Google Scholar, the UQ library and Science Direct were searched. To be as inclusive as possible, following search terms were used in various combinations in all databases: “smartphone”, “mhealth”, “app”, “intervention”, “prevent*”, “long-term disease” and “chronic disease” were used. To identify other relevant studies, reference lists of similar studies were manually reviewed for additional articles. We limited the search by only including peer-reviewed randomised controlled trials (RCTs) and clinical trials, published in the English language after the year 2012. We only included studies published after 2012 as mobile health tracking technology is a relatively recent advancement.(6) Therefore, by limiting the search dates, we excluded non-smartphone interventions. Inclusion and Exclusion Criteria Additional inclusion criteria were trials that focused on treating patients at risk for future health burden due to chronic disease and trials that primarily used a smartphone application for their intervention. We maintained wide parameters because of the current dearth of literature on smartphone apps for the prevention of onset of future chronic disease. The exclusion criteria were interventions that only used short messaging systems (SMS) or telephone calls and protocols. The study selection process is outlined in the PRISMA chart below (Figure 1). Title and abstract search were performed, and relevant information extracted and tabulated by the first author (UN, Table 1). This information was reviewed independently by a second author (SE). We assessed the quality of evidence with the Joanna Briggs Institute Critical Appraisal Checklist for RCTs (JBI) (Table 2). This review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: CRD42019127184). he search identified 561 papers, of which, 9 RCTs published within 2014 and 2017 met the criteria for review.(Table 1) Study characteristics The smallest studies contained 61 patients,(8, 9) and the largest study was an international and multi-centre trial with 2,086 patients.(10) The studies represent a total of 4,298 patients aged 26(9) to 68.(11) All of the included RCTs were from developing nations (Korea, US, Australia, China, India, Singapore, Ireland), although a trial from Ghana showed improvement in preventing future stoke in stroke survivors,(12) indicating the effectiveness of mhealth interventions in developing nations. Four studies recruited via self-referral(8, 9, 13, 14) and the rest used physician identification and other health markers to target patients. Studies recruited patients at risk for a range of chronic illnesses including cardiac-related diseases, diabetes, and blindness. Three studies aimed to prevent onset of a variety of common chronic diseases.(14-16) One study aimed to prevent disability due to chronic illness.(11) Two studies aimed to prevent diabetes.(8, 17) The remaining three studies focused on preventing cardiac-related diseases including stroke.(9, 10, 13) Delivery methods Two studies used text-messaging as a supportive measure.(13, 16) Additionally, four studies used phone calls as a means of supporting patients.(9, 14, 16, 17) Seven studies incorporated education in their intervention, however only the study by Crossland et al directed education at the health professionals.(11) Two studies had treatment as usual control groups,(11, 13) four used comparator trials(8, 10, 14, 16) and three used a waitlist control.(9, 15, 17) Two studies used a smartphone application exclusively.(14, 15) The rest of the studies used more than one mode of mhealth including traditional telephone calls, email and text messaging. Most studies used the smartphone application as a means of monitoring. Text messages were used as reminders in two trials, a means of education dissemination(13) or to inform participants of updates.(16) Telephone calls were implemented in four studies for update or follow-up interview.(9, 14, 16, 17) Email was utilised in two studies for education dissemination(16) or for communication between healthcare professionals.(11) Additionally, six studies implemented face-to-face contact.(8-11, 16, 17) Four studies objectively measured clinical improvements.(8, 11, 14, 17) However, all the studies reported significantly improved outcomes. Quality of evidence S le sizes of the trial were between 61(8, 9) and 2,086(10), and four studies had a s le size below 100.(8, 9, 13, 16) Quality of evidence in the selected studies varied due to differences in blinding of outcome assessors and s ling bias. However, all the studies reported their trial adequately and majority suffered little attrition. n the past, smartphone applications have often focused on monitoring or educating participants.(3) In more recent times, an observable shift in focus is beginning towards the prevention of disease. However, an effective and thorough review of the current evidence could identify an appropriate audience, parameters and intervention strategies, and identify key gaps in knowledge. This could inform future studies and support the uptake of mhealth in primary care. This study aimed to provide a systematic analysis of the current literature around smartphone applications for disease prevention to inform future research. These nine studies focused on chronic diseases or illnesses with a high health burden, including diabetes, cardiovascular disease, chronic heart disease, stroke, obesity, and blindness. All the studies reported a significant increase in outcomes when using smartphone applications for weight or activity management, glucose levels, atrial fibrillation, disease awareness and knowledge, and screening. Target population Although the studies included in this review focused on the nature of the patient’s disease rather than the suitability of the intervention, participants were either selected who were technology-literate or were given training upon enrolment to the study.(cite) However, the included studies ranged from young to mature adults, indicating the applicability of the intervention mode across age groups. As the studies did not include developing nations, we are unable to conclude if smartphone applications may be generalised across countries. A formal analysis of telemedicine implementation could identify appropriate patients, conditions and settings. Therefore, there is a need for a high-quality evidence-base to support uptake and sustainable integration of telemedicine into routine clinical care. Evaluation of the intervention Only two studies used a pedometer device in addition to the smartphone application.(8, 14) Six studies incorporated education into their intervention, but the study by Crossland et al implemented videoconference education for general practitioners and ophthalmologists.(11) The study by Zhang et al focused their education on the physiology of the heart, risk factors, lifestyle changes and stress management.(13) This was similar to the educational material incorporated into the smartphone app by Tian et al, Tighe et al, Block et al. Glynn et al sent all participants, regardless of randomisation, an educational brochure.(16) Alternatively, Fukuoka et al tailored their education to aiding participants meet their goals.(8) Only four studies incorporated goal setting and majority of the studies used the smartphone application to improve patient monitoring. While majority of the studies did not implement regular contact with the assessors or physicians, the studies by Oh et al and Tian et al had followed patients up at regular intervals. Limitations Some of the limitations of this review included the high number of studies that used self-reporting. Furthermore, there was bias in the recruitment methods of four studies that used self-referral, leading to potential s ling bias. Perhaps the most important limitation of this study is the dearth of published information available. This review only identified nine studies using smartphone applications to prevent the onset of chronic diseases. Additionally, three studies had an intervention period under three months.(9, 13, 16) The studies have identified this as a potential limitation in analysing the effect on long-term behaviour. Conclusion With the trend of rapidly advancing mobile technology, it is important to understand the current evidence to inform future policy aimed at reducing the health burden of a nation. This is especially relevant for policies aimed at integrating mhealth for health service delivery in developed and developing countries. Some illnesses are even associated with one another for ex le, overweight and obesity are associated with several chronic diseases, including type 2 diabetes, hypertension, cardiovascular disease, arthritis, hyperlipidaemia, and asthma.(3) his review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: CRD42019127184).
Publisher: SAGE Publications
Date: 22-10-2018
Abstract: Maternal depression (MD), is an overarching term for depression affecting pregnant women and mothers for up to 12 months postpartum. Because MD may have chronic and long-lasting effects, it is an important public health concern. The extent to which telemedicine may be an effective way to provide services to sufferers of MD is unknown, therefore, this review aimed to assess the available evidence. We conducted a search of The Cochrane Library, PubMed/MEDLINE, PsycINFO, and EMBASE for relevant randomised controlled trials published between 2000 and 2018 we then conducted a systematic review and meta-analysis. We identified 10 studies for inclusion. Therapeutic strategies involved cognitive behavioural therapy (CBT), behavioural activation and other psychoeducation. Eight trials reported significant improvement in depression scores post-intervention four studies that conducted post-intervention follow-up found that these improvements continued. However, high attrition rates and lack of blinding were common problems. This review found limited evidence supporting the delivery of CBT for the treatment of MD and anxiety using telemedicine. However, most of the evidence only studied improvements in postpartum depression, indicating that use of telemedicine to provide MD intervention is still small and an under-researched area.
Publisher: University of Queensland Library
Date: 2023
DOI: 10.14264/240FDF7
No related grants have been discovered for Uthara Nair.