K4Health
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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.
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- ItemAdvanced communication infrastructure for pre-hospital EMS care.(2008-11-12) Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, MarcieThe traditional communication infrastructure of the pre hospital Emergency Medical System EMS is limited to voice communication using radio or cell phone technologies With the emergence of 3rd Generation wireless networks 3G and enhanced mobile devices capable of data communication e g mobile tablets PDAs with cell phones or cell phones with PDA capabilities the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication However video requires substantially more bandwidth which 4th Generation 4G systems are promising However their availability is limited We present an infrastructure that allows dynamic selection of the best data transport mode in the pre hospital EMS environment
- ItemAfrican American adolescents and new media: associations with HIV/STI risk behavior and psychosocial variables.(2011-07-13) Whiteley, Laura B; Brown, Larry K; Swenson, Rebecca R; Romer, Daniel; DiClemente, Ralph J P; Salazar, Laura E; Vanable, Peter A; Carey, Michael P; Valois, Robert FOBJECTIVES Cell phones and online media are used frequently but we know little about their use among African American adolescents This study examines the frequency of such use and its relationship to psychosocial variables and STI HIV risk behavior SETTING PARTICIPANTS 1 518 African American aged 13 18 years from 2 Northeast US cities Providence RI Syracuse NY and 2 Southeast US cities Columbia SC Macon GA were assessed from 2008 2009 DESIGN Participants were assessed on frequency of cell phone and Internet use psychological constructs ie depression life satisfaction impulsivity and HIV STI risk behaviors ie history of intercourse sexual sensation seeking attitudes peer sexual risks norms with reliable scales and measures using an audio computer assisted self interview RESULTS Over 90 of African American adolescents used cell phones every day or most days and 60 used social networking sites every day or most days 96 used Myspace Greater frequency of cell phone use was associated with sexual sensation seeking P 000 riskier peer sexual norms P 000 and impulsivity P 016 Greater frequency of Internet use was associated with a history of oral vaginal anal sex OR 1 03 CI 1 0 1 05 and sexual sensation seeking P 000 CONCLUSION These findings suggest that riskier youth are online and using cell phones frequently The Internet and cell phones may be useful platforms for targeted health promotion and prevention efforts with AA adolescents
- ItemAligning health information technologies with effective service delivery models to improve chronic disease care.(2014-08-06) Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, PatriciaOBJECTIVE Healthcare reforms in the United States including the Affordable Care and HITECH Acts and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology HIT and the integration of general medical and mental health services These developments which aim to improve chronic disease care have largely occurred in parallel with little attention to the need for coordination In this article the fundamental connections between HIT and improvements in chronic disease management are explored We use the evidence based collaborative care model as an example with attention to health literacy improvement for supporting patient engagement in care METHOD A review of the literature was conducted to identify how HIT and collaborative care an evidence based model of chronic disease care support each other RESULTS Five key principles of effective collaborative care are outlined care is patient centered evidence based measurement based population based and accountable The potential role of HIT in implementing each principle is discussed Key features of the mobile health paradigm are described including how they can extend evidence based treatment beyond traditional clinical settings CONCLUSION HIT and particularly mobile health can enhance collaborative care interventions and thus improve the health of individuals and populations when deployed in integrated delivery systems
- ItemAssessing adolescent asthma symptoms and adherence using mobile phones.(2013-07-18) Mulvaney, Shelagh A; Ho, Yun-Xian; Cala, Cather M; Chen, Qingxia; Nian, Hui; Patterson, Barron L; Johnson, Kevin BBACKGROUND Self report is the most common method of measuring medication adherence but is influenced by recall error and response bias and it typically does not provide insight into the causes of poor adherence Ecological momentary assessment EMA of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving OBJECTIVE To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making METHODS We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system Adolescents aged 12 18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center A survey including barriers to mobile phone use the Illness Management Survey and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month The Asthma Control Test ACT was administered at 2 study time points baseline and 1 month after baseline RESULTS The sample consisted of 53 adolescents who were primarily African American 34 53 64 and female 31 53 58 with incomes US 40K year or lower 29 53 55 The majority of adolescents 37 53 70 reported that they carried their phones with them everywhere but only 47 25 53 were able to use their mobile phone at school Adolescents responded to an average of 20 1 SD 8 1 of the 30 daily calls received 67 Response frequency declined during the last week of the month b 0 29 PUnder 001 and was related to EMA reported levels of rescue inhaler adherence r 0 33 P 035 Using EMA adolescents reported an average of 0 63 SD 1 2 asthma symptoms per day and used a rescue inhaler an average of 70 of the time SD 35 when they experienced symptoms About half 26 49 53 of the instances of nonadherence took place in the presence of friends The EMA measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT r 0 33 P 034 CONCLUSIONS Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents The EMA method was consistent with the ACT a widely established measure of asthma control and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web based support system
- ItemAssessing the feasibility and sample quality of a national random-digit dialing cellular phone survey of young adults.(2013-12-17) Gundersen, Daniel A; Zuwallack, Randal S; Dayton, James; Echeverría, Sandra E; Delnevo, Cristine DThe majority of adults aged 18 34 years have only cellular phones making random digit dialing of landline telephones an obsolete methodology for surveillance of this population However 95 of this group has cellular phones This article reports on the 2011 National Young Adult Health Survey NYAHS a pilot study conducted in the 50 US states and Washington DC that used random digit dialing of cellular phones and benchmarked this methodology against that of the 2011 Behavioral Risk Factor Surveillance System BRFSS Comparisons of the demographic distributions of subjects in the NYAHS and BRFSS aged 18 34 years with US Census data revealed adequate reach for all demographic subgroups After adjustment for design factors the mean absolute deviations across demographic groups were 3 percentage points for the NYAHS and 2 8 percentage points for the BRFSS nationally and were comparable for each census region Two sided z tests comparing cigarette smoking prevalence revealed no significant differences between NYAHS and BRFSS participants overall or by subgroups The design effects of the sampling weight were 2 09 for the NYAHS and 3 26 for the BRFSS Response rates for the NYAHS and BRFSS cellular phone sampling frames were comparable Our assessment of the NYAHS methodology found that random digit dialing of cellular phones is a feasible methodology for surveillance of young adults
- ItemAudiovisual Presentations on a Handheld PC are Preferred As an Educational Tool by NICU Parents.(2013-04-25) Alur, P; Cirelli, J; Goodstein, M; Bell, T; Liss, JBACKGROUND Health literacy is critical for understanding complex medical problems and necessary for the well being of the patient Printed educational materials PM have limitations in explaining the dynamics of a disease process Multimedia formats may be useful for enhancing the educational process OBJECTIVE To evaluate whether a printed format or animation with commentary on a handheld personal computer PC is preferred as an educational tool by parents of a baby in the NICU METHODS PARENTS EVALUATED TWO FORMATS A 1 page illustrated document from the American Heart Association explaining patent ductus arteriosus PDA and animation with commentary on a handheld PC that explained the physiology of PDA in 1 minute The reading grade level of the PM was 8 6 versus 18 6 for the audio portion of the animated presentation Parents viewed each format and completed a four item questionnaire Parents rated both formats and indicated their preference as printed animation or both RESULTS Forty six parents participated in the survey Parents preferred animation over PM 50 vs 17 4 p 0 02 39 1 expressed that the animation was excellent whereas 4 3 expressed that the PM was excellent pUnder0 001 The order of presentation of formats sex age and educational level of parents did not influence the method preferred p 0 05 CONCLUSION Parents preferred animation on a small screen handheld PC despite a much higher language level Because handheld PCs are portable and inexpensive they can be used effectively at the bedside with low cost animation to enhance understanding of complex disease conditions
- ItemAutomatic identification of apnea through acoustic analysis for at-home screening.(2011-07-19) Nasu, Yasuhiro; Ashida, Nobuyuki; Yamakawa, Miyae; Makimoto, Kiyoko; Tsuji, MasatsuguOBJECTIVE Although many studies have analyzed breathing sounds in the diagnosis of obstructive sleep apnea syndrome the recording of snoring sounds at home is hampered by the various background noises of daily life Recordings also frequently include talking during sleep which may infringe the privacy of patients MATERIALS AND METHODS A recording system used a bone conduction microphone to record snoring sounds This microphone reduced background noise A simple system transmitted recorded breathing sound data for screening at a hospital as envelope data instead of complete sound recordings thereby decreasing data volume and protecting privacy RESULTS In periods in which blood oxygen levels SpO were drastically decreased the probability of apnea as deduced from the envelope curve of breathing sounds was consistent with SpO values CONCLUSIONS This method provides a basis for telemonitoring of sleep apnea syndrome
- ItemAwareness and using of medical students about mobile health technology in clinical areas.(2013-09-23) Ehteshami, Asghar; Hachesu, Peyman Rezaei; Esfahani, Mahtab Kasayi; Rezazadeh, EsmaeilCONFLICT OF INTEREST NONE DECLARED INTRODUCTION Necessity of data transmission and getting contact with specialists is so evident in impassable regions In order to solve such problems there are different solutions one of which is mobile health technology Being small and user friendly easy to enter data and having low expense are some of its advantages This study aims to define the association between awareness of medical students in clinical stage about mobile health technology application and the rate of their using this technology in educational hospital of Isfahan in 2011 METHOD The study is a cross sectional analytical application research Sixty medical students were selected as samples from a society of 240 medical students A researcher made questionnaire was used The questionnaire included 21 multiple choice and 15 yes no questions which were corrected to reach a score A researcher made checklist with 5 fold Likert scale was used to define the rate of applying such technology The reliability of questionnaire was confirmed through a test retest The collected data were analyzed with the help of SPSS software in descriptive and deductive statistics level FINDINGS The highest percentage of awareness about mobile health technology among medical students in the clinical stage of Azzahra educational hospital is 45 6 in nature areas and their lowest percentage of awareness is 17 8 in the infrastructure area In addition their mean awareness of all areas is 54 4 The highest percentage of using mobile health technology by medical students is 14 6 in the education area and their lowest percentage of usage is 6 8 in the treatment area Their mean usage of all areas is 9 4 as well CONCLUSION The rate of awareness and application of mobile health technology is not favorable Except for treatment there is no significant association between the rate of awareness and application of mobile health technology
- ItemBarriers to the implementation of mobile phone reminders in pediatric HIV care: a pre-trial analysis of the Cameroonian MORE CARE study.(2014-11-14) Bigna, Jean J; Noubiap, Jean J; Plottel, Claudia S; Kouanfack, Charles; Koulla-Shiro, SinataBACKGROUND Mobile health mhealth has emerged as a powerful resource in the medical armamentarium against human immunodeficiency virus HIV infection We sought to determine among adult caregivers of HIV exposed infected children the extent of mobile phone ownership the ability to communicate in Cameroon s national official languages NOL and the refusal to receive such reminders METHODS We conducted a pre trial analysis of potentials participants of the MORE CARE trial MORE CARE took place from January through March 2013 in three geographic locations in Cameroon We included caregivers aged 18 years or older Written communication was assessed by the ability to read and understand information presented in the consent form Verbal communication was assessed during a two way conversation and in a discussion about HIV infection A question about mobile phone ownership and another about refusal to receive reminders via mobile phone were phrased to allow Yes or No as the only possible reply A p Under0 05 was considered statistically significant RESULTS We enrolled 301 caregivers of HIV exposed infected children from rural n 119 semi urban n 142 and urban n 40 areas of Cameroon The mean caregiver age was 42 9 years SD 13 4 and 85 were women A fifth of our study population overall had at least one of the three obstacles to mobile phone reminders By region 39 5 in rural 6 3 in semi urban and 7 5 in urban setting had at least one obstacle with significant differences between the rural and urban settings pUnder0 001 and the rural and semi urban settings pUnder0 001 The acceptability of SMS was 96 3 and of mobile phone calls 96 p 0 054 The ability to communicate in NOL orally was 89 7 and 84 4 in writing p 0 052 Mobile phone ownership pUnder0 001 p 0 03 and the ability to communicate in an NOL orally pUnder0 001 p 0 002 or in writing both pUnder0 001 were significantly lower in rural compared to semi urban and urban settings respectively CONCLUSIONS The use of mHealth was limited in about one fifth of our population The greatest obstacle was the inability to use oral or written NOL followed by non ownership of a mobile phone These impediments were higher in a rural setting as compared to urban or semi urban areas
- ItemBreath sounds, asthma, and the mobile phone.(2001-10-30) Anderson, K; Qiu, Y; Whittaker, A R; Lucas, MThe sounds generated by breathing in asthma are widely accepted as an indicator of disease activity We have investigated the use of a mobile phone and electronic signal transfer by e mail and voice mail to study tracheal breath sounds in individuals with normal lung function and patients with chronic or exercise induced asthma Spectrograms from patients with active asthma and impaired lung function were significantly different from people without asthma pUnder0 0001 Our results suggest that mobile phone recordings clearly discriminate tracheal breath sounds in asthma and could be a non invasive method of monitoring airway diseases
- ItemCan mobile health technologies transform health care?(2013-12-11) Steinhubl, Steven R; Muse, Evan D; Topol, Eric J
- ItemCellular telephone networks in developing countries.(2008-02-25) Byass, Peter; D'Ambruoso, Lucia
- ItemCollecting maternal health information from HIV-positive pregnant women using mobile phone-assisted face-to-face interviews in Southern Africa.(2013-06-10) van Heerden, Alastair; Norris, Shane; Tollman, Stephen; Richter, Linda; Rotheram-Borus, Mary JaneBACKGROUND Most of the world s women living with human immunodeficiency virus HIV reside in sub Saharan Africa Although efforts to reduce mother to child transmission are underway obtaining complete and accurate data from rural clinical sites to track progress presents a major challenge OBJECTIVE To describe the acceptability and feasibility of mobile phones as a tool for clinic based face to face data collection with pregnant women living with HIV in South Africa METHODS As part of a larger clinic based trial 16 interviewers were trained to conduct mobile phone assisted personal interviews MPAPI These interviewers participant group 1 completed the same short questionnaire based on items from the Technology Acceptance Model at 3 different time points Questions were asked before training after training and 3 months after deployment to clinic facilities In addition before the start of the primary intervention trial in which this substudy was undertaken 12 mothers living with HIV MLH took part in a focus group discussion exploring the acceptability of MPAPI participant group 2 Finally a sample of MLH n 512 enrolled in the primary trial were asked to assess their experience of being interviewed by MPAPI participant group 3 RESULTS Acceptability of the method was found to be high among the 16 interviewers in group 1 Perceived usefulness was reported to be slightly higher than perceived ease of use across the 3 time points After 3 months of field use interviewer perceptions of both perceived ease of use and perceived usefulness were found to be higher than before training The feasibility of conducting MPAPI interviews in this setting was found to be high Network coverage was available in all clinics and hardware software cost and secure transmission to the data center presented no significant challenges over the 21 month period For the 12 MHL participants in group 2 anxiety about the multimedia capabilities of the phone was evident Their concern centered on the possibility that their privacy may be invaded by interviewers using the mobile phone camera to photograph them For participants in group 3 having the interviewer sit beside vs across from the interviewee during the MPAPI interview was received positively by 94 7 of MHL Privacy 6 3 and confidentiality 5 3 concerns were low for group 3 MHL CONCLUSIONS Mobile phones were found both to be acceptable and feasible in the collection of maternal and child health data from women living with HIV in South Africa TRIAL REGISTRATION Clinicaltrials gov NCT00972699 http clinicaltrials gov ct2 show NCT00972699 Archived by WebCite at http clinicaltrials gov ct2 show NCT00972699
- ItemCommunication technology use and mHealth acceptance among HIV-infected men who have sex with men in Peru: implications for HIV prevention and treatment.(2015-01-24) Krishnan, Archana; Ferro, Enrico G; Weikum, Damian; Vagenas, Panagiotis; Lama, Javier R; Sanchez, Jorge; Altice, Frederick LThe HIV epidemic in Peru is concentrated among men who have sex with men MSM Given that MSM have been documented as early adopters of emerging technology we examined communication technology access and utilization and mobile health mHealth acceptance among Peruvian MSM and transgender women TGW in order to gauge opportunities for mHealth enabled HIV interventions A convenience sample of 359 HIV infected MSM and TGW recruited from three sites in Lima Peru completed standardized assessments of alcohol use disorders AUDs risky sexual behavior and antiretroviral therapy ART adherence along with self constructed measures of communication technology access and utilization and mHealth acceptance Most participants 86 had daily access to any cell phone including smartphones 30 The most frequent communication activities were receiving and making calls and receiving and sending text messages using cell phones On a 5 point Likert scale participants expressed interest in using mHealth for medication reminders M 3 21 SD 1 32 and engaging in anonymous online interactions with health professionals to discuss HIV related issues M 3 56 SD 1 33 Importantly no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs depression and suboptimal ART adherence all of which are associated with poor HIV treatment outcomes Findings show support for implementing mHealth based intervention strategies using cell phones to assess and reduce HIV risk behaviors among HIV infected MSM and TGW
- ItemA computer-aided telephone system to enable five persons with Alzheimer's disease to make phone calls independently.(2013-04-29) Perilli, Viviana; Lancioni, Giulio E; Laporta, Dominga; Paparella, Adele; Caffò, Alessandro O; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, DorettaThis study extended the assessment of a computer aided telephone system to enable five patients with a diagnosis of Alzheimer s disease to make phone calls independently The patients were divided into two groups and exposed to intervention according to a non concurrent multiple baseline design across groups All patients started with baseline in which the technology was not available and continued with intervention in which the technology was used The technology involved a net book computer provided with specific software a global system for mobile communication modem GSM a microswitch and lists of partners to call with related photos All the patients learned to use the system and made phone calls independently to a variety of partners such as family members friends and caregivers A social validation assessment in which care and health professionals working with persons with dementia were asked to rate the patients performance with the technology and with the help of a caregiver provided generally more positive scores for the technology assisted performance The positive implications of the findings for daily programs of patients with Alzheimer s disease are discussed
- ItemDesign and methods of a longitudinal study investigating the impact of antiretroviral treatment on the partnerships and sexual behaviour of HIV-infected individuals in rural KwaZulu-Natal, South Afric...(2011-03-07) McGrath, Nuala; Richter, Linda; Newell, Marie-LouiseBACKGROUND Diagnosed HIV infected people form an increasingly large sub population in South Africa one that will continue to grow with widely promoted HIV testing and greater availability of antiretroviral therapy ART For HIV prevention and support understanding the impact of long term ART on family and sexual relationships is a health research priority This includes improving the availability of longitudinal demographic and health data on HIV infected individuals who have accessed ART services but who are not yet ART eligible DESIGN AND METHODS The aim of the study is to investigate the impact of ART on family and partner relationships and sexual behaviour of HIV infected individuals accessing a public HIV treatment and care programme in rural South Africa HIV infected men and women aged 18 years or older attending three clinics are screened Those people initiating ART because they meet the criteria of WHO stage 4 or CD4 200 cells L are assigned to an ART initiator group A Monitoring group is composed of people whose most recent CD4 count was 500 cells L and are therefore not yet eligible for ART During the four year study data on both groups is collected every 6 months during clinic visits or where necessary by home visits or phone Detailed information is collected on social demographic and health characteristics including living arrangements past and current partnerships sexual behaviour HIV testing and disclosure stigma self efficacy quality of family and partner relationships fertility and fertility intentions ART knowledge and attitudes and gender norms Recruitment for both groups started in January 2009 As of October 2010 600 participants have been enrolled 386 in the ART initiator group 141 37 male and 214 in the Monitoring group 31 14 male Recruitment remains open for the Monitoring group DISCUSSION The data collected in this study will provide valuable information for measuring the impact of ART on sexual behaviour and for the planning and delivery of appropriate interventions to promote family and partner support and safe sexual behaviour for people living with HIV in this setting and elsewhere in sub Saharan Africa
- ItemDevelopment and feasibility of a text messaging and interactive voice response intervention for low-income, diverse adults with type 2 diabetes mellitus.(2013-06-13) Osborn, Chandra Y; Mulvaney, Shelagh ALow income racial ethnic minorities are often nonadherent to diabetes medications have uncontrolled glycemia and have high rates of diabetes related morbidity Cell phones provide a viable modality to support medication adherence but few cell phone based interventions have been designed for low income persons a population with more feature phone penetration than smartphone penetration In an effort to reach the broadest range of patients we leveraged the voice and text messaging capabilities shared by all cell phones to design the MEssaging for Diabetes intervention We specifically advanced and adapted an existing tailored text messaging system to include interactive voice response functionality and support the medication adherence barriers of low income diverse adults with type 2 diabetes mellitus We report on the design process and feasibility testing results i e technical use patterns and subjective user experiences from patients from the target population who used the intervention in one of three user centered design iterations The types of challenges encountered in design were related to providing text message content with valued information and support that engages patients The design process also highlighted the value of obtaining mixed methods data to provide insight into legitimate versus illegitimate missing data patterns of use and subjective user experiences The iterative testing process and results outlined here provide a potential template for other teams seeking to design technology based self care support solutions for comparable patient populations
- ItemA digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): randomized controlled trial.(2008-12-17) Brendryen, Håvar; Drozd, Filip; Kraft, PålBACKGROUND Happy Ending HE is an intense 1 year smoking cessation program delivered via the Internet and cell phone HE consists of more than 400 contacts by email Web pages interactive voice response and short message service technology HE includes a craving helpline and a relapse prevention system providing just in time therapy All the components of the program are fully automated OBJECTIVE The objectives were to describe the rationale for the design of HE to assess the 12 month efficacy of HE in a sample of smokers willing to attempt to quit without the use of nicotine replacement therapy and to explore the potential effect of HE on coping planning and self efficacy prior to quitting and whether coping planning and self efficacy mediate treatment effect METHODS A two arm randomized controlled trial was used Subjects were recruited via Internet advertisements and randomly assigned to condition Inclusion criteria were willingness to quit on a prescribed day without using nicotine replacement and being aged 18 years or older The intervention group received HE and the control group received a 44 page self help booklet Abstinence was defined as not even a puff of smoke for the last seven days and was assessed by means of Internet surveys or telephone interviews 1 3 6 and 12 months postcessation The main outcome was repeated point abstinence ie abstinence at all four time points Coping planning and self efficacy were measured at baseline and at the end of the preparation phase ie after 2 weeks of treatment but prior to cessation day RESULTS A total of 290 participants received either the HE intervention n 144 or the control booklet n 146 Using intent to treat analysis participants in the intervention group reported clinically and statistically significantly higher repeated point abstinence rates than control participants 20 versus 7 odds ratio OR 3 43 95 CI 1 60 7 34 P 002 Although no differences were observed at baseline by the end of the preparation phase significantly higher levels of coping planning t 261 3 07 P 002 and precessation self efficacy t 261 2 63 P 01 were observed in the intervention group compared with the control group However neither coping planning nor self efficacy mediated long term treatment effect For point abstinence 1 month after quitting however coping planning and self efficacy showed a partial mediation of the treatment effect CONCLUSIONS This 12 month trial documents a long term treatment effect of a fully automated smoking cessation intervention without the use of nicotine replacement therapy The study adds to the promise of using digital media in supporting behavior change
- ItemEcological momentary assessment in addiction.(2007-08-06) Lukasiewicz, M; Fareng, M; Benyamina, A; Blecha, L; Reynaud, M; Falissard, BNumerous symptoms in psychiatry are subjective e g sadness anxiety craving or fatigue fluctuate and are environment dependent Accurate measurement of these phenomena requires repeated measures and ideally needs to be performed in the patient s natural environment rather than in an artificial laboratory environment or a protected hospital environment The usual paper and pencil questionnaires do not meet these two conditions for reasons of logistics A recently developed method ecological momentary assessment EMA made it possible to implement these field assessments via ingenious use of various devices most frequently an electronic diary coupling an auditory signal with computerized data capture The subject carries the device with him her at all times and data is recorded in vivo in real time The programming of repeated measures in the form of a Likert scale or pull down menu is easily achieved A recall alarm system can help increase compliance Compared with classical self report EMA improves the validity of the assessment of certain symptoms which are the main evaluation criteria in clinical trials concerning certain pathologies e g craving and treatment of addiction where measurement was previously liable to bias This article sets out to present this method its advantages and disadvantages and the interest it presents in psychiatry in particular via three original applications developed by the authors including measurement of reaction time without the knowledge of the subject in order to test certain cognitive models use of a graphic solution for the data recorded for functional analysis of disorders and the use of data collection via mobile phone and text messages which also enables therapeutic interventions in real time by text messages personalized on the basis of the situational data collected e g in the case of craving the associated mood solitary or group consumption or concomitant occupations
- ItemEffect of mobile phone reminders on follow-up medical care of children exposed to or infected with HIV in Cameroon (MORE CARE): a multicentre, single-blind, factorial, randomised controlled trial.(2014-06-26) Bigna, Jean Joel R; Noubiap, Jean Jacques N; Kouanfack, Charles; Plottel, Claudia S; Koulla-Shiro, SinataBACKGROUND Missed scheduled HIV appointments lead to increased mortality resistance to antiretroviral therapy and suboptimum virological response We aimed to assess whether reminders sent to carers by text message mobile phone call or concomitant text message and mobile phone call increase attendance at medical appointments for HIV care in a population of children infected with or exposed to HIV in Cameroon We also aimed to ascertain the most cost effective method of mobile phone based reminder METHODS MORE CARE was a multicentre single blind factorial randomised controlled trial in urban semi urban and rural settings in Cameroon Carers of children who were infected with or had been exposed to HIV were randomly assigned electronically in blocks of four and allocated 1 1 1 1 sequentially to receive a text message and a call a text message only a call only or no reminder control Investigators were masked to group assignment Text messages were sent and calls made 2 or 3 days before a scheduled follow up appointment The primary outcomes were efficacy the proportion of patients attending a previously scheduled appointment and efficiency attendance measures of staff working time cost of the reminders as a measure of cost effectiveness The primary analysis was by intention to treat This study is registered with the Pan African Clinical Trials Register number PACTR201304000528276 FINDINGS The study took place between Jan 28 and May 24 2013 We randomly assigned 242 adult child carer patient pairs into four groups text message plus call n 61 call n 60 text message n 60 and control n 61 54 participants 89 in the text message plus call group 51 85 in the call group 45 75 in the text message group and 31 51 in the control group attended their scheduled appointment Compared with control the odds ratios for improvement in the primary efficacy outcome were 7 5 95 CI 2 9 19 0 pUnder0 0001 for text message plus call 5 5 2 3 13 1 p 0 0002 for call and 2 9 1 3 6 3 p 0 012 for text message No significant differences were seen in comparisons of the three intervention groups with each other and there was no synergism between text messages and calls For the primary efficiency outcome the mean difference for text message versus text message plus call was 1 5 95 CI 0 7 to 2 4 p 0 002 for call versus text message plus call was 1 2 0 7 to 1 6 pUnder0 0001 and for call versus text message was 0 4 1 3 to 0 6 p 0 47 INTERPRETATION Mobile phone based reminders of scheduled HIV appointments for carers of paediatric patients in low resource settings can increase attendance The most effective method of reminder was text message plus phone call but text messaging alone was the most efficient ie cost effective method FUNDING No external funding