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TitleEffects of eHealth-Based Multiple Health Behavior Change Interventions on Physical Activity, Healthy Diet, and Weight in People With Noncommunicable Diseases: Systematic Review and Meta-analysis.
AuthorsDuan, Y; Shang, B; Liang, W; Du, G; Yang, M; Rhodes, RE
JournalJournal of medical Internet research
Publication Date22 Feb 2021
Date Added to PubMed23 Feb 2021
AbstractNoncommunicable diseases (NCDs) are associated with the burden of premature deaths and huge medical costs globally. There is an increasing number of studies combining a multiple health behavior change (MHBC) intervention paradigm with eHealth approaches to jointly promote weight-related health behaviors among people with NCD; yet, a comprehensive summary of these studies is lacking. This review aims to meta-analyze the effectiveness and systematically summarize the characteristics of the relevant intervention studies for improving the outcomes of physical activity, healthy diet, and weight among people with NCD. Following PRISMA guidelines, 4 electronic databases (PsycINFO, PubMed, Scopus, SPORTDiscus) were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. Article selection, quality assessment, and data extraction were independently performed by 2 authors. The standardized mean difference (SMD) was calculated to evaluate the effectiveness of interventions for 3 intervention outcomes (physical activity, healthy diet, and weight), and subsequent subgroup analyses were performed for gender, age, intervention duration, channel, and theory. Calculations were conducted, and figures were produced in SPSS 22 and Review Manager 5.3. Of the 664 original hits generated by the systematic searches, 15 eligible studies with moderate to high quality were included. No potential publication bias was detected using statistical analyses. Studies varied in intervention channel, intensity, and content. The meta-analysis revealed that the eHealth MHBC interventions significantly promoted physical activity (SMD 0.85, 95% CI 0.23 to 1.47, P=.008) and healthy diet (SMD 0.78, 95% CI 0.13 to 1.43, P=.02), but did not contribute to a healthy weight status (SMD -0.13, 95% CI= -0.47 to 0.20, P=.43) among people with NCDs, compared to the control conditions. Results from subgroup analysis indicated that theory-based interventions achieved greater effect than nontheory-based interventions in promoting physical activity, and interventions with traditional approaches (SMS, telephone) were more effective than those with modern internet-based approaches in promoting healthy diet. The results of this review indicates that eHealth MHBC interventions achieve preliminary success in promoting physical activity and healthy diet behaviors among people with NCD. Future studies could improve the intervention design to achieve better intervention effectiveness. PROSPERO International Prospective Register of Systematic Reviews CRD42019118629;
TitleAchieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana.
AuthorsOpoku, D; Busse, R; Quentin, W
JournalJMIR mHealth and uHealth
Publication Date3 May 2019
Date Added to PubMed9 May 2019
AbstractA growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored. This study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions. Members of the technical working group responsible for Ghana's national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework. A total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework's categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature. The study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions.
TitleDigital Health Tools for Managing Noncommunicable Diseases During and After the COVID-19 Pandemic: Perspectives of Patients and Caregivers.
AuthorsMonaco, A; Palmer, K; Holm Ravn Faber, N; Kohler, I; Silva, M; Vatland, A; van Griensven, J; Votta, M; Walsh, D; Clay, V; Yazicioglu, MC; Ducinskiene, D; Donde, S
JournalJournal of medical Internet research
Publication Date29 Jan 2021
Date Added to PubMed20 Jan 2021
AbstractA reduction in the number of face-to-face medical examinations conducted for patients with noncommunicable diseases (NCDs) during the first wave of the COVID-19 pandemic has led to health care professionals quickly adopting different strategies to communicate with and monitor their patients. Such strategies include the increased use of digital health tools. However, patient preferences, privacy concerns, a lack of regulations, overregulation, and insufficient evidence on the efficacy of digital health tools may have hampered the potential positive benefits of using such tools to manage NCDs. This viewpoint aims to discuss the views of an advisory board of patient and caregiver association members. Specifically, we aim to present this advisory board's view on the role of digital health tools in managing patients with NCDs during and after the COVID-19 pandemic, and to identify future directions based on patients' perspectives. As an initiative under the NCD Partnership (PARTners in Ncds Engage foR building Strategies to improve Healthy ageing In Patients) model of Upjohn, a web-based advisory board of patient and caregiver advocates was held on July 28, 2020, to bring together key stakeholders from public and private sectors. The following key themes emerged: (1) technology developers should understand that the goals of patients may differ from those of health care professionals and other stakeholders; (2) patients, health care professionals, caregivers, and other end users need to be involved in the development of digital health tools at the earliest phase possible, to guarantee usability, efficacy, and adoption; (3) digital health tools must be better tailored to people with complex conditions, such as multimorbidity, older age, and cognitive or sensory impairment; and (4) some patients do not want or are unable to use digital health care tools, so adequate alternatives should always be available. There was consensus that public-private partnership models, such as the Upjohn NCD Partnership, can be effective models that foster innovation by integrating multiple perspectives (eg, patients' perspectives) into the design, development, and implementation of digital and nondigital health tools, with the main overall objective of improving the life of patients with NCDs.
TitleTelemedicine in Camp Mode While Screening for Noncommunicable Diseases: A Preliminary Report from India.
AuthorsGanapathy, K; Nukala, L; Premanand, S; Tamilmaran, P; Aggarwal, P; Saksena, S; BrindhaDevi, SP
JournalTelemedicine journal and e-health : the official journal of the American Telemedicine Association
Publication Date1 Jan 2020
Date Added to PubMed26 Mar 2019
AbstractIntroduction: Noncommunicable diseases (NCDs) are a major cause of disease burden. NCDs are a global epidemic and India is no exception. Risk factors contributing to NCDs can be detected before symptoms occur. Screening is an effective tool. Real-time teleconsultation during screening is a value-added service. This preliminary report documents the process and observations during teleconsultations provided in NCD screening camps, across multiple locations in India. That real-time teleconsultations in camp mode make a difference and are relevant in India is discussed. Materials and Methods: To provide awareness about risk factors of common NCDs such as diabetes, cardiovascular diseases, and anemia, screening camps were conducted. A 22-member field team organizes internet-enabled camps using point-of-care diagnostics. Software was developed to capture participant details and provide decision support to the field team. This resulted in identification of participants eligible for teleconsultations. Participants with risk factors of the targeted NCDs (hyperglycemia and dyslipidemia) were offered teleconsultations during screening. Currently, the program is active across six locations (Bengaluru, Coimbatore, Delhi National Capital Region, Kolkata, Pune, and Vijayawada) in India. Results: Since program inception from August 27, 2015 to October 31, 2018, a total of 757,325 participants have been screened. Twenty-seven thousand three hundred fifty-three participants were eligible for teleconsultations. Thirteen thousand six hundred fifteen availed onsite teleconsultations; 99.8% of the 1409 teleconsultation beneficiaries surveyed were "extremely satisfied and very happy." Conclusion: Providing real-time teleconsultations to 13,615 individuals "at risk" of specific NCDs from six centers across India is doable and well received by beneficiaries.
TitleToward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions.
AuthorsTighe, SA; Ball, K; Kensing, F; Kayser, L; Rawstorn, JC; Maddison, R
JournalJournal of medical Internet research
Publication Date28 Oct 2020
Date Added to PubMed29 Oct 2020
AbstractDigital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
TitleAn Implementation Framework for Telemedicine to Address Noncommunicable Diseases in Thailand.
AuthorsChattranukulchai, P; Thongtang, N; Ophascharoensuk, V; Muengtaweepongsa, S; Angkurawaranon, C; Chalom, K; Supungul, S; Thammatacharee, J; Kittikhun, S; Shantavasinkul, PC; Leelahavarong, P; Rawdaree, P; Tangsawad, S; Pitayarangsarit, S; Kanaderm, C; Assawamakin, A; Roubsanthisuk, W; Sukonthasarn, A
JournalAsia-Pacific journal of public health
Publication Date19 Apr 2021
Date Added to PubMed20 Apr 2021
AbstractTo maintain the continuity of noncommunicable disease (NCD) services and ascertain the health outcomes of patients with NCDs during the COVID-19 (coronavirus disease 2019) outbreak in Thailand, various telemedicine services have been developed. To achieve this determination, the implementation framework has been constructed based on recommendations from multidisciplinary experts (Thai NCD Collaboration Group). Within the framework, all key elements are illustrated with their priority and expected collaborations. Ultimately, active collaborations from multi-stakeholders are vitally important to ensure that telemedicine services for NCDs will finally become practical, successful, and sustainable.
TitleDevelopment and evaluation of a digital, community-based intervention to reduce noncommunicable disease risk in a low-resource urban setting in Malaysia: a research protocol.
AuthorsKataria, I; Ngongo, C; Lim, SC; Kocher, E; Kowal, P; Chandran, A; Kual, A; Khaw, FM; Mustapha, FI
JournalImplementation science communications
Publication Date1 Dec 2020
Date Added to PubMed10 Oct 2020
AbstractNoncommunicable disease burden is rising in Malaysia, accounting for 72% of all deaths. Urbanization and globalization have contributed to changing patterns of diet and physical activity, creating an obesogenic environment that increases noncommunicable disease risk, especially in low-income populations. Community-based and technological interventions can play an important role in addressing structural determinants that influence noncommunicable disease burden. The Better Health Programme Malaysia aims to co-create and develop a community-based digital intervention for low-income populations to enable community stakeholders to address obesogenic environments and improve people's knowledge, attitudes, and practices related to noncommunicable disease risk. This quasi-experimental study will assess community member and community health volunteer knowledge, attitudes, and practices on noncommunicable disease prevention, risk factors, and health-seeking behavior in three geographical areas of Kuala Lumpur, each representing a different ethnicity (Malay, Indian, and Chinese). Assessment will take place before and after a 9-month intervention period, comparing intervention areas with matched control geographies. We plan to engage 2880 community members and 45 community health volunteers across the six geographic areas. A digital health needs assessment will inform modification of digital health tools to support project aims. Intervention co-creation will use a discrete choice experiment to identify community preferences among evidence-based intervention options, building from data collected on community knowledge, attitudes, and practices. Community health volunteers will work with local businesses and other stakeholders to effect change in obesogenic environments and NCD risk. The study has been approved by the Malaysian Ministry of Health Medical Research Ethical Committee. The Better Health Programme Malaysia anticipates a bottom-up approach that relies on community health volunteers collaborating with local businesses to implement activities that address obesogenic environments and improve community knowledge, attitudes, and practices related to NCD risk. The planned co-creation process will determine which interventions will be most locally relevant, feasible, and needed. The effort aims to empower community members and community health volunteers to drive change that improves their own health and wellbeing. The learnings can be useful nationally and sub-nationally in Malaysia, as well as across similar settings that are working with community stakeholders to reduce noncommunicable disease risk. National Medical Research Register, Malaysia; NMRR-20-1004-54787 (IIR); July 7, 2020.
TitleEthics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration.
AuthorsAli, J; Labrique, AB; Gionfriddo, K; Pariyo, G; Gibson, DG; Pratt, B; Deutsch-Feldman, M; Hyder, AA
JournalJournal of medical Internet research
Publication Date5 May 2017
Date Added to PubMed10 May 2017
AbstractMobile phone coverage has grown, particularly within low- and middle-income countries (LMICs), presenting an opportunity to augment routine health surveillance programs. Several LMICs and global health partners are seeking opportunities to launch basic mobile phone-based surveys of noncommunicable diseases (NCDs). The increasing use of such technology in LMICs brings forth a cluster of ethical challenges; however, much of the existing literature regarding the ethics of mobile or digital health focuses on the use of technologies in high-income countries and does not consider directly the specific ethical issues associated with the conduct of mobile phone surveys (MPS) for NCD risk factor surveillance in LMICs. In this paper, we explore conceptually several of the central ethics issues in this domain, which mainly track the three phases of the MPS process: predata collection, during data collection, and postdata collection. These include identifying the nature of the activity; stakeholder engagement; appropriate design; anticipating and managing potential harms and benefits; consent; reaching intended respondents; data ownership, access and use; and ensuring LMIC sustainability. We call for future work to develop an ethics framework and guidance for the use of mobile phones for disease surveillance globally.
TitleEnd User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review.
AuthorsSlater, H; Campbell, JM; Stinson, JN; Burley, MM; Briggs, AM
JournalJournal of medical Internet research
Publication Date12 Dec 2017
Date Added to PubMed14 Dec 2017
AbstractChronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative. The aim of this study was to identify, appraise, and synthesize available qualitative evidence on users' experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers). A systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived. Twelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma, chronic self-harm, and attention deficit hyperactivity disorder. Quality ratings were higher for implementer compared with end user studies. Both complementary and unique user themes emerged. Themes derived for end users of mHealth included (1) Experiences of functionality that supported self-management, (2) Acceptance (technical usability and feasibility), (3) Importance of codesign, and (4) Perceptions of benefit (self-efficacy and empowerment). For implementers, derived themes included (1) Characteristics that supported self-management (functional, technical, and behavior change); (2) Implementation challenges (systems level, service delivery level, and clinical level); (3) Adoption considerations for specific populations (training end users; specific design requirements); and (4) Codesign and tailoring to facilitate uptake and person-centered care. Synthesizing available data revealed both complementary and unique user perspectives on enablers and barriers to designing, developing, and implementing mHealth technologies to support young people's management of their chronic NCDs. PROSPERO CRD42017056317; 42017056317 (Archived by WebCite at
TitlemHealth Interventions to Counter Noncommunicable Diseases in Developing Countries: Still an Uncertain Promise.
AuthorsBeratarrechea, A; Moyano, D; Irazola, V; Rubinstein, A
JournalCardiology clinics
Publication Date1 Feb 2017
Date Added to PubMed26 Nov 2016
AbstractmHealth constitutes a promise for health care delivery in low- and middle-income countries (LMICs) where health care systems are unprepared to combat the threat of noncommunicable diseases (NCDs). This article assesses the impact of mHealth on NCD outcomes in LMICs. A systematic review identified controlled studies evaluating mHealth interventions that addressed NCDs in LMICs. From the 1274 abstracts retrieved, 108 articles were selected for full text review and 20 randomized controlled trials were included from 14 LMICs. One-way SMS was the most commonly used mobile function to deliver reminders, health education, and information. mHealth interventions in LMICs have positive but modest effects on chronic disease outcomes.
MNCHFPRHHIV/AIDSMalariaNoncommunicable diseaseCOVID-19Decision-makingEducation & trainingBehavior changeGovernancePrivacy & securityEquityCHWsYouth & adolescentsSystematic reviewsProtocols & research designMedical RecordsLaboratoryPharmacyHuman ResourcesmHealthSMSChatbotsAI