Browsing by Author "Sevick, Mary Ann"
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- ItemDesign, feasibility, and acceptability of an intervention using personal digital assistant-based self-monitoring in managing type 2 diabetes.(2008-04-21) Sevick, Mary Ann; Zickmund, Susan; Korytkowski, Mary; Piraino, Beth; Sereika, Susan; Mihalko, Shannon; Snetselaar, Linda; Stumbo, Phyllis; Hausmann, Leslie; Ren, Dianxu; Marsh, Rita; Sakraida, Teresa; Gibson, Jolynn; Safaien, Mehry; Starrett, Terry J; Burke, Lora EBACKGROUND The information processing demands associated with behavioral self management of diabetes are extensive Pairing personal digital assistant PDA based self monitoring with a behavioral self management intervention may improve adherence and patient outcomes METHODS ENHANCE is a randomized controlled trial to test an intervention designed to improve regimen adherence in adults with type 2 diabetes The intervention based on Social Cognitive Theory SCT is paired with PDA based self monitoring In this paper we describe the a manner in which PDA based self monitoring is integrated within the SCT based intervention b feasibility and acceptability of PDA based dietary self monitoring and c issues encountered in teaching participants to self monitor using a PDA RESULTS During the first 30 months of this 5 year study 232 participants were screened and 151 were randomized To date 6 cohorts have completed the study The retention rate is 85 n 129 Of those randomized to the intervention n 74 and completing the study n 61 88 reported understanding the usefulness of PDA monitoring 85 reported ease in entering foods into the device 70 reported ease in interpreting feedback graphs and 82 indicated that they would continue to use the PDA for self monitoring after the study concluded Assuming 3 meals per day participants entered an average of 58 of their meals in their PDA and 43 were entered assuming 4 meals per day If we eliminate from the analysis those individuals who entered less than 10 of their expected meals n 12 the average rate of self monitoring was 69 assuming 3 meals per day and 52 assuming 4 meals per day CONCLUSIONS PDA based dietary monitoring is perceived by participants to be useful and acceptable The approach used to instruct participants in use of the PDA and lessons learned are discussed PDA technology shows promise as a tool for assisting those with type 2 diabetes in their efforts to manage their disease
- ItemFactors associated with probability of personal digital assistant-based dietary self-monitoring in those with type 2 diabetes.(2010-07-20) Sevick, Mary Ann; Stone, Roslyn A; Zickmund, Susan; Wang, Yuanyuan; Korytkowski, Mary; Burke, Lora EKnowledge of factors associated with the use of technology could inform the design of technology based behavioral interventions This study examined modifiable and nonmodifiable factors associated with technology based self monitoring 123 participants with type 2 diabetes self monitored diet using a personal digital assistant in a 6 month behavioral intervention Multinomial logistic regression was used to examine probability of nonadherent and suboptimally adherent behavior relative to adherent behavior Sociodemographic characteristics were not associated with probability of self monitoring Probability of adherence generally was greater in the weeks preceding no group session and lower in the weeks following no group session or following skipped sessions Non modifiable factors suggested by the literature to be associated with poorer access to technology lower income older age minority race and lower education were not associated with probability of self monitoring in this population
- ItemA PDA-based dietary self-monitoring intervention to reduce sodium intake in an in-center hemodialysis patient.(2009-11-20) Sevick, Mary Ann; Stone, Roslyn A; Novak, Matthew; Piraino, Beth; Snetselaar, Linda; Marsh, Rita M; Hall, Beth; Lash, Heather; Bernardini, Judith; Burke, Lora EOBJECTIVE The purpose of the BalanceWise hemodialysis study is to determine the efficacy of a dietary intervention to reduce dietary sodium intake in patients receiving maintenance in center hemodialysis HD Personal digital assistant PDA based dietary self monitoring is paired with behavioral counseling The purpose of this report is to present a case study of one participant s progression through the intervention METHODS The PDA was individually programmed with the nutritional requirements of the participant With 25 minutes of personalized instruction the participant was able to enter his meals into the PDA using BalanceLog R software Nutritional counseling was provided based on dietary sodium intake reports generated by BalanceLog R RESULTS At initiation of the study the participant required 4 HD treatments per week The participant entered 342 meals over 16 weeks 3 meals per day BalanceLog R revealed that the participant consumed restaurant fast food on a regular basis and consumed significant amounts of corned beef as well as canned foods high in sodium The study dietitian worked with the participant and his wife to identify food alternatives lower in sodium Baseline sodium consumption was 4 692 mg and decreased at a rate of 192 mg week on average After 11 weeks of intervention interdialytic weight gains were reduced sufficiently to permit the participant to reduce HD treatments from 4 to 3 per week Because of a low serum albumin at baseline 2 9 g dL the study dietitian encouraged the participant to increase his intake of high quality protein Serum albumin level at 16 weeks was unchanged 2 9 g dL Because of intense pruritis and a high baseline serum phosphorus 6 5 mg dL BalanceLog R electronic logs were reviewed to identify sources of dietary phosphorus and counsel the participant regarding food alternatives At 16 weeks the participant s serum phosphorus fell to 5 5 mg dL CONCLUSIONS Self monitoring rates were excellent In a HD patient who was willing to self monitor his dietary intake BalanceLog R allowed the dietitian to target problematic foods and provide counseling that appeared to be effective in reducing sodium intake reducing interdialytic weight gain and alleviating hyperphosphatemia and hyperkalemia Additional research is needed to evaluate the efficacy of the intervention
- ItemPersonal digital assistant-based self-monitoring adherence rates in 2 dialysis dietary intervention pilot studies: BalanceWise-HD and BalanceWise-PD.(2011-10-24) Stark, Susan; Snetselaar, Linda; Piraino, Beth; Stone, Roslyn A; Kim, Sunghee; Hall, Beth; Burke, Lora E; Sevick, Mary AnnOBJECTIVE The dialysis dietary regimen is complicated and computer based dietary self monitoring may be useful for helping dialysis patients manage their dietary regimen In this report we describe dietary self monitoring rates among study participants randomized to the intervention arms of 2 pilot studies METHODS Both studies tested similar interventions involving dietary counseling paired with personal digital assistant based self monitoring One study was performed in hemodialysis HD and one in peritoneal dialysis PD patients RESULTS HD intervention participants entered an average of 244 9 meals median 288 interquartile range IQR 186 to 342 over the 16 week intervention 2 2 meals per day median 2 6 IQR 1 7 to 3 1 and 73 of expected meals median 86 IQR 55 to 102 assuming intake of 3 meals per day At least some meals were entered in 87 of the observed weeks median 100 IQR 81 to 100 PD intervention participants entered an average of 212 1 meals median 203 IQR 110 to 312 over the 16 week intervention 1 9 meals per day median 1 8 IQR 1 to 2 8 and 63 of expected meals median 60 IQR 33 to 93 assuming 3 meals per day At least some meals were entered in 80 of the observed weeks median 94 IQR 50 to 100 CONCLUSION These HD and PD patients demonstrated excellent rates of self monitoring Additional research with a larger sample is required to confirm these findings
- ItemA preliminary study of PDA-based dietary self-monitoring in hemodialysis patients.(2005-07-11) Sevick, Mary Ann; Piraino, Beth; Sereika, Susan; Starrett, Terry; Bender, Catherine; Bernardini, Judith; Stark, Susan; Burke, Lora EOBJECTIVE The purpose of this study was to pilot test an intervention to enhance the adherence of study participants to the hemodialysis dietary regimen DESIGN A single case study design was used to examine the potential effectiveness of the intervention over a 4 month period of time SETTING A dialysis center in southwestern Pennsylvania PATIENTS Of the five individuals entered into the study one was male and four were female four were black and one was white Participants were 63 to 70 years of age and had been receiving dialysis for a median of 36 months range 18 to 84 months INTERVENTION The intervention included counseling to enhance self efficacy by a renal dietitian paired with personal digital assistant based dietary self monitoring Participants met twice per week with interventionists during the first 6 weeks weekly during the second 6 week period and biweekly in the final 4 week period MAIN OUTCOME MEASURES Monthly laboratory data regarding serum albumin potassium and phosphorus levels Kt V and data on average monthly interdialytic weight gain were abstracted from the participants medical records C reactive protein level was determined at baseline and at 4 months RESULTS Four of five study participants had an increase in serum albumin level from baseline to their final measurement and one participant maintained a stable albumin level Four of five participants also experienced a small increase in serum phosphorus level Mixed results were obtained with regard to serum potassium and average monthly interdialytic weight gain CONCLUSIONS Because of the small sample and single case study design caution must be used in drawing firm conclusions from this study Data suggest that the intervention may result in improved dietary intake and improved serum albumin levels With increased dietary intake serum phosphorus levels may increase Additional research is needed to determine the potential efficacy and cost effectiveness of this intervention for improving dietary adherence
- ItemSelf-monitoring dietary intake: current and future practices.(2005-07-11) Burke, Lora E; Warziski, Melanie; Starrett, Terry; Choo, Jina; Music, Edvin; Sereika, Susan; Stark, Susan; Sevick, Mary AnnThis article reviews the literature on the use of paper diaries for self monitoring food intake identifies the strengths and limitations of paper and pencil diaries and their new counterpart the electronic diary or personal digital assistant PDA and reports how participants were trained to use a PDA with dietary software in two pilot studies one with hemodialysis patients and the other with participants in a weight loss study The report of the pilot studies focuses on the practical issues encountered in training participants in the use of a PDA and addresses the pros and cons of different dietary software programs Six hemodialysis patients were trained in the first study and seven participants attempting to lose or maintain their weight were trained in the second pilot study The training focused on how to use a PDA and how to navigate the dietary software to self monitor food intake The goals of using the PDA were to improve adherence to the therapeutic diets and to self monitoring Lessons learned from the pilot studies are shared
- ItemSelf-monitoring in weight loss: a systematic review of the literature.(2010-12-27) Burke, Lora E; Wang, Jing; Sevick, Mary AnnSelf monitoring is the centerpiece of behavioral weight loss intervention programs This article presents a systematic review of the literature on three components of self monitoring in behavioral weight loss studies diet exercise and self weighing This review included articles that were published between 1993 and 2009 that reported on the relationship between weight loss and these self monitoring strategies Of the 22 studies identified 15 focused on dietary self monitoring one on self monitoring exercise and six on self weighing A wide array of methods was used to perform self monitoring the paper diary was used most often Adherence to self monitoring was reported most frequently as the number of diaries completed or the frequency of log ins or reported weights The use of technology which included the Internet personal digital assistants and electronic digital scales were reported in five studies Descriptive designs were used in the earlier studies whereas more recent reports involved prospective studies and randomized trials that examined the effect of self monitoring on weight loss A significant association between self monitoring and weight loss was consistently found however the level of evidence was weak because of methodologic limitations The most significant limitations of the reviewed studies were the homogenous samples and reliance on self report In all but two studies the samples were predominantly white and women This review highlights the need for studies in more diverse populations for objective measures of adherence to self monitoring and for studies that establish the required dose of self monitoring for successful outcomes
- ItemSMART trial: A randomized clinical trial of self-monitoring in behavioral weight management-design and baseline findings.(2009-10-28) Burke, Lora E; Styn, Mindi A; Glanz, Karen; Ewing, Linda J; Elci, Okan U; Conroy, Margaret B; Sereika, Susan M; Acharya, Sushama D; Music, Edvin; Keating, Alison L; Sevick, Mary AnnBACKGROUND The primary form of treatment for obesity today is behavioral therapy Self monitoring diet and physical activity plays an important role in interventions targeting behavior and weight change The SMART weight loss trial examined the impact of replacing the standard paper record used for self monitoring with a personal digital assistant PDA This paper describes the design methods intervention and baseline sample characteristics of the SMART trial METHODS The SMART trial used a 3 group design to determine the effects of different modes of self monitoring on short and long term weight loss and on adherence to self monitoring in a 24 month intervention Participants were randomized to one of three conditions 1 use of a standard paper record PR 2 use of a PDA with dietary and physical activity software PDA or 3 use of a PDA with the same software plus a customized feedback program PDA FB RESULTS We screened 704 individuals and randomized 210 There were statistically but not clinically significant differences among the three cohorts in age education HDL cholesterol blood glucose and systolic blood pressure At 24 months retention rate for the first of three cohorts was 90 CONCLUSIONS To the best of our knowledge the SMART trial is the first large study to compare different methods of self monitoring in a behavioral weight loss intervention and to compare the use of PDAs to conventional paper records This study has the potential to reveal significant details about self monitoring patterns and whether technology can improve adherence to this vital intervention component
- ItemSociodemographic and clinical correlates of key outcomes from a Mobile Insulin Titration Intervention (MITI) for medically underserved patients.(0000-00-00) Langford, Aisha T; Wang, Binhuan; Orzeck-Byrnes, Natasha A; Aidasani, Sneha R; Hu, Lu; Applegate, Melanie; Moloney, Dana N; Sevick, Mary Ann; Rogers, Erin S; Levy, Natalie KBACKGROUND Insulin titration is typically done face to face with a clinician however this can be a burden for patients due to logistical issues associated with in person clinical care The Mobile Insulin Titration Intervention MITI used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose OID OBJECTIVE To evaluate sociodemographic and clinical correlates of reaching OID text message response rate and days needed to reach OID METHODS Primary care providers referred patients to MITI and nurses delivered the program Three multivariable regression models quantified relationships between various correlates and primary outcomes RESULTS The sample included 113 patients from 2 ambulatory clinics with a mean age of 50 years SD 10 45 female 79 Hispanic 43 unemployed and 46 uninsured In regression models baseline fasting blood glucose FBG was negatively associated with odds of reaching OID and 100 text responses and positively associated with days to reach OID p Under 05 CONCLUSIONS Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs PRACTICAL IMPLICATIONS Basic cell phone technology can be used to adjust patients insulin remotely thereby reducing logistical barriers to care
- ItemTransition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study.(0000-00-00) Levy, Natalie Koch; Orzeck-Byrnes, Natasha A; Aidasani, Sneha R; Moloney, Dana N; Nguyen, Lisa H; Park, Agnes; Hu, Lu; Langford, Aisha T; Wang, Binhuan; Sevick, Mary Ann; Rogers, Erin SBACKGROUND The Mobile Insulin Titration Intervention MITI program helps patients with type 2 diabetes find their correct basal insulin dose without in person care Requiring only basic cell phone technology text messages and phone calls MITI is highly accessible to patients receiving care in safety net settings MITI was shown in a randomized controlled trial RCT to be efficacious at a New York City NYC safety net clinic where patients often have challenges coming for in person care In 2016 MITI was implemented as usual care at Bellevue Hospital the site of the original RCT and at Gouverneur Health a second NYC safety net clinic under 2 different staffing models OBJECTIVE This implementation study examined MITI s transition into real world settings To understand MITI s flexibility generalizability and acceptability among patients and providers we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations outside of an RCT setting METHODS Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose FBG values and a weekly titration call The goal was for patients to reach their optimal insulin dose OID defined either as the dose of once daily basal insulin required to achieve either an FBG of 80 130 mg dL 4 4 7 2 mmol L or as the reaching of the maximum dose of 50 units After 12 weeks if OID was not reached the patients were asked to return to the clinic for in person care and titration MITI program outcomes clinical outcomes process outcomes and patient satisfaction were assessed RESULTS MITI was successful at both sites each with a different staffing model Providers referred 170 patients to the program 129 of whom 75 9 129 170 were eligible Of these 113 87 6 113 129 enrolled Moreover 84 1 95 113 of patients reached their OID and they did so in an average of 24 days Clinical outcomes show that mean FBG levels fell from 209 mg dL 11 6 mmol L to 141 mg dL 7 8 mmol L PUnder 001 HbA1clevels fell from 11 4 101 mmol mol to 10 0 86 mmol mol PUnder 001 Process outcomes show that 90 1 of MITI s text message prompts received a response nurses connected with patients 81 9 of weeks to provide titration instructions and 85 of attending physicians made at least one referral to the MITI program Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin check their sugar and make healthy food choices CONCLUSIONS This implementation study showed MITI to have continued success after transitioning from an RCT program into real world settings MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program
- ItemThe use of mHealth to deliver tailored messages reduces reported energy and fat intake.(2014-12-05) Ambeba, Erica J; Ye, Lei; Sereika, Susan M; Styn, Mindi A; Acharya, Sushama D; Sevick, Mary Ann; Ewing, Linda J; Conroy, Molly B; Glanz, Karen; Zheng, Yaguang; Goode, Rachel W; Mattos, Meghan; Burke, Lora EBACKGROUND Evidence supports the role of feedback in reinforcing motivation for behavior change Feedback that provides reinforcement has the potential to increase dietary self monitoring and enhance attainment of recommended dietary intake OBJECTIVE The aim of this study was to examine the impact of daily feedback DFB messages delivered remotely on changes in dietary intake METHODS This was a secondary analysis of the Self Monitoring And Recording using Technology SMART Trial a single center 24 month randomized clinical trial of behavioral treatment for weight loss Participants included 210 obese adults mean body mass index 34 0 kg m who were randomized to either a paper diary PD personal digital assistant PDA or PDA plus daily tailored feedback messages PDA FB To determine the role of daily tailored feedback in dietary intake we compared the self monitoring with DFB group DFB group n 70 with the self monitoring without DFB group no DFB group n 140 All participants received a standard behavioral intervention for weight loss Self reported changes in dietary intake were compared between the DFB and no DFB groups and were measured at baseline and at 6 12 18 and 24 months Linear mixed modeling was used to examine percentage changes in dietary intake from baseline RESULTS Compared with the no DFB group the DFB group achieved a larger reduction in energy 22 8 vs 14 0 P 02 and saturated fat 11 3 vs 0 5 P 03 intake and a trend toward a greater decrease in total fat intake 10 4 vs 4 7 P 09 There were significant improvements over time in carbohydrate intake and total fat intake for both groups P values Under 05 CONCLUSION Daily tailored feedback messages designed to target energy and fat intake and delivered remotely in real time using mobile devices may play an important role in the reduction of energy and fat intake
- ItemUsing mHealth technology to enhance self-monitoring for weight loss: a randomized trial.(2012-06-18) Burke, Lora E; Styn, Mindi A; Sereika, Susan M; Conroy, Molly B; Ye, Lei; Glanz, Karen; Sevick, Mary Ann; Ewing, Linda JBACKGROUND Self monitoring for weight loss has traditionally been performed with paper diaries Technologic advances could reduce the burden of self monitoring and provide feedback to enhance adherence PURPOSE To determine if self monitoring diet using a PDA only or the PDA with daily tailored feedback PDA feedback FB was superior to using a paper diary on weight loss and maintenance DESIGN The Self Monitoring and Recording Using Technology SMART Trial was a 24 month randomized clinical trial participants were randomly assigned to one of three self monitoring groups SETTING PARTICIPANTS From 2006 to 2008 a total of 210 overweight obese adults 84 8 female 78 1 white were recruited from the community Data were analyzed in 2011 INTERVENTION Participants received standard behavioral treatment for weight loss that included dietary and physical activity goals encouraged the use of self monitoring and was delivered in group sessions MAIN OUTCOME MEASURES Percentage weight change at 24 months adherence to self monitoring over time RESULTS Study retention was 85 6 The mean percentage weight loss at 24 months was not different among groups paper diary 1 94 95 CI 3 88 0 01 PDA 1 38 95 CI 3 38 0 62 PDA FB 2 32 95 CI 4 29 0 35 only the PDA FB group p 0 02 demonstrated a significant loss For adherence to self monitoring there was a time by treatment group interaction between the combined PDA groups and the paper diary group p 0 03 but no difference between PDA and PDA FB groups p 0 49 Across all groups weight loss was greater for those who were adherent 60 versus Under30 of the time pUnder0 001 CONCLUSIONS PDA FB use resulted in a small weight loss at 24 months PDA use resulted in greater adherence to dietary self monitoring over time However for sustained weight loss adherence to self monitoring is more important than the method used to self monitor A daily feedback message delivered remotely enhanced adherence and improved weight loss which suggests that technology can play a role in improving weight loss TRIAL REGISTRATION This study is registered at clinicaltrials gov NCT00277771