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Browsing by Subject "Behavior change"
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Item The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback(JMIR, 2019-06-25) Bartlett Ellis, Rebecca J.; Hill, James H.; Kerley, K. Denise; Sinha, Arjun; Ganci, Aaron; Russell, Cynthia L.; School of NursingBACKGROUND: As many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. OBJECTIVE: The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. METHODS: A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants. RESULTS: A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging. CONCLUSIONS: It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases.Item Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills(Springer Berlin Heidelberg, 2013-12) Chaudry, Beenish Moalla; Connelly, Kay; Siek, Katie A.; Welch, Janet L.; IU School of NursingChronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy- accessible liquid portion size estimation mobile interface.Item Perinatal smoking and its related factors(2018-07-12) Jones, Ashley; Shieh, Carol; Staten, Lisa; Carter-Harris, Lisa; Stiffler, Deborah; Macy, JonThe smoking rate of low-income pregnant women is almost 4 times the rate for higher-income women. A better understanding of smoking within the low-income population is needed. The purpose of this dissertation was to study smoking and related factors for pregnant and postpartum women living in poverty. The first component used Rodger’s evolutionary concept analysis method and uncovered three attributes, four antecedents, and three consequences for smoking cessation. The second (N = 1,554) and third (N = 71,944) components were a secondary data analysis of first-pregnancy Medicaid-eligible women enrolled in the Nurse-Family Partnership program from 2011-2016. The second component explored patterns of smoking and depression and their associations. Eight distinct patterns of smoking and depression were found. Smokers were more likely than nonsmokers to have depressive symptoms at the end of pregnancy (OR = 1.37 [1.04, 1.81] and 12 months post-delivery (OR = 1.93 [1.47, 2.51]. The third component investigated covariates present during early pregnancy and their relationships with smoking status and sought to find best fitting predictive models. Multivariable logistic regression showed cigarette use in the 3 months prior to pregnancy and at program intake were significant predictors for smoking status at the end of pregnancy and 12 months post-delivery. Interactive Matrix Language, Structured Query Language, and iterations of logistic regression identified 5 covariates (high school education, cigarette use prior to pregnancy, smoking status at pregnancy baseline, depression, and self-mastery) for the best fitting model at the end of pregnancy and three additional covariates (post-secondary education, marital status, and race) for the 12 months post-delivery model. The area under the receiver operator characteristic curve was 0.9681 for the end of pregnancy model and 0.9269 for 12 months post-delivery model, indicating excellent prediction ability of the models. Results can be integrated in smoking prevention education, screening, and cessation intervention programs.Item Screening, referral, and participation in a weight management program implemented in five CHCs(Johns Hopkins University Press, 2010-05) Clark, Daniel; Chrysler, Lisa; Perkins, Anthony; Keith, Nicole R.; Willis, Deanna R.; Abernathy, Greg; Smith, Faye; Department of Medicine, IU School of MedicineCommunity health centers have the potential to lessen obesity. We conducted a retrospective evaluation of a quality improvement program that included electronic body mass index (BMI) screening with provider referral to an in-clinic lifestyle behavior change counselor with weekly nutrition and exercise classes. There were 26,661 adult patients seen across five community health centers operating the weight management program. There were 23,593 (88%) adult patients screened, and 12,487 (53%) of these patients were overweight or obese (BMI >or=25). Forty percent received a provider referral, 15.6% had program contact, and 2.1% had more than 10 program contacts. A mean weight loss of seven pounds was observed among those patients with more than 10 program contacts. No significant weight change was observed in patients with less contact. Achieving public health impact from guideline recommended approaches to CHC-based weight management will require considerable improvement in patient and provider participation.Item The Impact of Household Context on Self-Perceived Changes in Solo and Partnered Sexual Behaviors During the COVID-19 Pandemic: Findings from a U.S. Probability Survey(Springer, 2023) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Fu, Tsung‑chieh; Herbenick, Debby; Pediatrics, School of MedicineTo understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18–94 years; 62% response rate) from April 10–20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables–including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural). All solo and partnered sexual behaviors showed some amount of significant change–increased activity for some and decreased for others–for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more “normal” (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.