Browsing by Author "Peek, Monica E"
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- ItemDeveloping a behavioral model for mobile phone-based diabetes interventions.(2012-12-14) Nundy, Shantanu; Dick, Jonathan J; Solomon, Marla C; Peek, Monica EOBJECTIVES Behavioral models for mobile phone based diabetes interventions are lacking This study explores the potential mechanisms by which a text message based diabetes program affected self management among African Americans METHODS We conducted in depth individual interviews among 18 African American patients with type 2 diabetes who completed a 4 week text message based diabetes program Each interview was audio taped transcribed verbatim and imported into Atlas ti software Coding was done iteratively Emergent themes were mapped onto existing behavioral constructs and then used to develop a novel behavioral model for mobile phone based diabetes self management programs RESULTS The effects of the text message based program went beyond automated reminders The constant daily communications reduced denial of diabetes and reinforced the importance of self management Rosenstock Health Belief Model Responding positively to questions about self management increased mastery experience Bandura Self Efficacy Most surprisingly participants perceived the automated program as a friend and support group that monitored and supported their self management behaviors Barrera Social Support CONCLUSIONS A mobile phone based diabetes program affected self management through multiple behavioral constructs including health beliefs self efficacy and social support PRACTICE IMPLICATIONS Disease management programs that utilize mobile technologies should be designed to leverage existing models of behavior change and can address barriers to self management associated with health disparities
- ItemFeasibility and usability of a text message-based program for diabetes self-management in an urban African-American population.(2011-10-26) Dick, Jonathan J; Nundy, Shantanu; Solomon, Marla C; Bishop, Keisha N; Chin, Marshall H; Peek, Monica EPURPOSE We pilot tested a text message based diabetes care program in an urban African American population in which automated text messages were sent to participants with personalized medication foot care and appointment reminders and text messages were received from participants on adherence METHODS Eighteen patients participated in a 4 week pilot study Baseline surveys collected data about demographics historical cell phone usage and adherence to core diabetes care measures Exit interview surveys using close coded and open ended questions were administered to patients at the end of the program A 1 month follow up interview was conducted surveying patients on perceived self efficacy Wilcoxon signed rank tests were used to compare baseline survey responses about self management activities to those at the pilot s end and at 1 month follow up RESULTS Eighteen urban African American participants completed the pilot study The average age was 55 and the average number of years with diabetes was 8 Half the participants were initially uncomfortable with text messaging Example messages include Did you take your diabetes medications today and How many times did you check your feet for wounds this week Participants averaged 220 text messages with the system responded to messages 80 of the time and on average responded within 6 minutes Participants strongly agreed that text messaging was easy to perform and helped with diabetes self care Missed medication doses decreased from 1 6 per week to 0 6 p 003 Patient confidence in diabetes self management was significantly increased during and 1 month after the pilot p 002 p 008 CONCLUSIONS Text messaging may be a feasible and useful approach to improve diabetes self management in urban African Americans
- ItemHow do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study.(2014-11-11) Nundy, Shantanu; Mishra, Anjuli; Hogan, Patrick; Lee, Sang Mee; Solomon, Marla C; Peek, Monica EPURPOSE The purpose of this study was to investigate the behavioral effects of a theory driven mobile phone based intervention that combines automated text messaging and remote nursing using an automated interactive text messaging system METHODS This was a mixed methods observational cohort study Study participants were members of the University of Chicago Health Plan UCHP who largely reside in a working class urban African American community Surveys were conducted at baseline 3 months mid intervention and 6 months postintervention to test the hypothesis that the intervention would be associated with improvements in self efficacy social support health beliefs and self care In addition in depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention RESULTS The intervention was associated with improvements in 5 of 6 domains of self care medication taking glucose monitoring foot care exercise and healthy eating and improvements in 1 or more measures of self efficacy social support and health beliefs perceived control Qualitatively participants reported that knowledge attitudes and ownership were also affected by the program Together these findings were used to construct a new behavioral model CONCLUSIONS This study s findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change
- ItemMobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.(2014-02-04) Nundy, Shantanu; Dick, Jonathan J; Chou, Chia-Hung; Nocon, Robert S; Chin, Marshall H; Peek, Monica EEven with the best health care available patients with chronic illnesses typically spend no more than a few hours a year in a health care setting while their outcomes are largely determined by their activities during the remaining 5 000 waking hours of the year As a widely available low cost technology mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self care between visits We examined the impact of a six month mobile health mHealth demonstration project among adults with diabetes who belonged to an academic medical center s employee health plan In addition to pre post improvements in glycemic control p 0 01 and patients satisfaction with overall care p 0 04 we observed a net cost savings of 8 8 percent Those early results suggest that mHealth programs can support health care organizations pursuit of the triple aim of improving patients experiences with care improving population health and reducing the per capita cost of health care
- ItemUsing mobile health to support the chronic care model: developing an institutional initiative.(2013-01-10) Nundy, Shantanu; Dick, Jonathan J; Goddu, Anna P; Hogan, Patrick; Lu, Chen-Yuan E; Solomon, Marla C; Bussie, Arnell; Chin, Marshall H; Peek, Monica EBackground Self management support and team based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation Program Development An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders Patients identified having a human face to the pilot program as essential Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time Program Description Nurse administrators at a university affiliated health plan use automated text messaging to provide personalized self management support for member patients with diabetes and facilitate care coordination with the primary care team For example when a patient texts a request to meet with a dietitian a nurse administrator coordinates with the primary care team to provide a referral Conclusion Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology The program supports self management and team based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators
- ItemUsing Patient-Generated Health Data From Mobile Technologies for Diabetes Self-Management Support: Provider Perspectives From an Academic Medical Center.(2014-05-30) Nundy, Shantanu; Lu, Chen-Yuan E; Hogan, Patrick; Mishra, Anjuli; Peek, Monica EBACKGROUND Mobile health and patient generated health data are promising health IT tools for delivering self management support in diabetes but little is known about provider perspectives on how best to integrate these programs into routine care We explored provider perceptions of a patient generated health data report from a text message based diabetes self management program The report was designed to relay clinically relevant data obtained from participants responses to self assessment questions delivered over text message METHODS Likert type scale response surveys and in depth interviews were conducted with primary care physicians and endocrinologists who pilot tested the patient generated health data report in an actual clinical encounter Interview guides were designed to assess providers perceptions of the feasibility and utility of patient generated health data in routine clinical practice Interviews were audiotaped transcribed and analyzed using the constant comparative method RESULTS Twelve providers successfully piloted the summary report in clinic Although only a minority of providers felt the report changed the care they provided 3 of 12 or 25 most were willing to use the summary report in a future clinical encounter 9 of 12 or 75 Perceived benefits of patient generated health data included agenda setting assessment of self care and identification of patient barriers Major themes discussed included patient selection reliability of patient generated health information and integration into clinical workflow CONCLUSION Providers perceived multiple benefits of patient generated health data in overcoming common barriers to self management support in clinical practice and found the summary report feasible and usable in a clinical context