Rebecca Bartlett Ellis

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https://hdl.handle.net/1805/17675

Management of Medications and Adherence in People with Multiple Chronic Conditions

Taking medications as prescribed is challenging and remains a considerable barrier to people with chronic conditions realizing the full health benefits of prescribed treatments. Not adhering to a prescribed medication regimen involves missing doses, taking medications too early or late, or missing several days' doses. Many reasons can explain this nonadherence, but not developing reliable routine habits that ensure medications are taken and at the right time(taking and timing adherence) remains a significant barrier. Even minor deviations in dosing adherence can affect patient outcomes and may lead to erroneous conclusions about treatment efficacy, thus precipitating potentially unnecessary prescription changes (e.g. dose escalation, addition of medications, switching medications).

Dr. Rebecca Bartlett Ellis and her transdisciplinary team have developed a smart pillbox, known as InterACT Pillbox (patent pending), with embedded sensors that track medication-taking behaviors and provide feedback directly to users via their smart phone. The novelty of InterACT Pillbox lies in the integration of technology with widely used traditional pillboxes to provide continuous feedback to patients on how well they are taking medications as prescribed. InterACT Pillbox was co-designed with input from patients and is being used in intervention work to improve medication taking.

Dr. Ellis's work to improve patient medication taking is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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Behavior change interventions: the potential of ontologies for advancing science and practice
(Springer Nature, 2017-02) Larsen, Kai R.; Michie, Susan; Hekler, Eric B.; Gibson, Bryan; Spruijt-Metz, Donna; Ahern, David; Cole-Lewis, Heather; Bartlett Ellis, Rebecca J.; Hesse, Bradford; Moser, Richard P.; Yi, Jean; School of Nursing
A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated using "ontologies." In information science, an ontology is a systematic method for articulating a "controlled vocabulary" of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine's Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science.
Beyond Traditional Newspaper Advertisement: Leveraging Facebook-Targeted Advertisement to Recruit Long-Term Smokers for Research
(JMIR Publications, 2016) Carter-Harris, Lisa; Bartlett Ellis, Rebecca J.; Warrick, Adam; Rawl, Susan; IU School of Nursing
BACKGROUND: Smokers are a stigmatized population, but an important population to reach for the purpose of research. Therefore, innovative recruitment methods are needed that are both cost-effective and efficacious in recruiting this population. OBJECTIVE: The aim of the present article was to evaluate the feasibility of Facebook-targeted advertisement to recruit long-term smokers eligible for lung cancer screening for a descriptive, cross-sectional survey. METHODS: A social media recruitment campaign was launched using Facebook-targeted advertisement to target age and keywords related to tobacco smoking in the Facebook users profile, interests, and likes. A 3-day newspaper advertisement recruitment campaign was used as a comparison. The study that used both recruitment methods aimed to test the psychometric properties of 4 newly developed lung cancer screening health belief scales. Data were collected via cross-sectional survey methodology using an Web-based survey platform. RESULTS: The Facebook-targeted advertisements were viewed 56,621 times over an 18-day campaign in 2015 in the United States. The advertisement campaign yielded 1121 unique clicks to the Web-based survey platform at a cost of $1.51 per completed survey. Of those who clicked through to the study survey platform, 423 (37.7%) consented to participate; 92 (8.2%) dropped out during completion of the survey yielding a final study pool of 331 completed surveys. Recruitment by newspaper advertisement yielded a total of 30 participants in response to a 3-day advertisement campaign; recruitment efficacy resulted in 10 participants/day at $40.80 per completed survey. Participants represented current (n=182; 51%) and former smokers (n=178; 49%) with a mean age of 63.4 years (SD 6.0). Cost of the advertisement campaign was $500 total for the 18-day campaign. CONCLUSIONS: Recruitment by Facebook was more efficacious and cost-effective compared with newspaper advertisement. Facebook offers a new venue for recruitment into research studies that offer the potential for wider reach at a lower cost while providing privacy and flexibility for potential study participants. The study's findings extend recent work of other researchers who have demonstrated Facebook's utility with younger smokers, and Facebook is an effective tool to recruit older smokers. Furthermore, Facebook is a cost-effective alternative to traditional newspaper advertisement offering a new, affordable venue to recruit large numbers of older smokers efficiently.
Building the case for actionable ethics in digital health research supported by artificial intelligence
(Springer Nature, 2019-07-17) Nebeker, Camille; Torous, John; Bartlett Ellis, Rebecca J.; School of Nursing
The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients ‘in the wild’ and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the ‘Wild West’ of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.
A Business Case Framework for Planning Clinical Nurse Specialist-led Interventions
(Lippincott Williams & Wilkins, 2015-11) Bartlett Ellis, Rebecca J.; Embree, Jennifer L.; Ellis, Kurt G.; Department of Nursing, IU School of Nursing
Purpose: The purpose of this article is to describe a business case framework that can guide clinical nurse specialists (CNS) in clinical intervention development. Background: Increased emphasis on cost-effective interventions in healthcare requires skills in analyzing the need to make the business case, especially for resource-intensive interventions. This framework assists the CNS to anticipate resource use and then consider if the intervention makes good business sense. Business Case Framework: We describe a business case framework that can assist the CNS to fully explore the problem and determine if developing an intervention is a good investment. We describe several analyses that facilitate making the business case to include the following: problem identification and alignment with strategic priorities, needs assessment, stakeholder analysis, market analysis, intervention implementation planning, financial analysis, and outcome evaluation. The findings from these analyses can be used to develop a formal proposal to present to hospital leaders in a position to make decisions. By aligning intervention planning with organizational priorities and engaging patients in the process, interventions will be more likely to be implemented in practice and produce robust outcomes. Conclusion: The business case framework can be used to justify to organization decision makers the need to invest resources in new interventions that will make a difference for quality outcomes as well as the financial bottom line. This framework can be used to plan interventions that align with organizational strategic priorities, plan for associated costs and benefits, and outcome evaluation. Implications for CNS Practice: Clinical nurse specialists are well positioned to lead clinical intervention projects that will improve the quality of patient care and be cost-effective. To do so requires skill development in making the business case.
Chronic Disease Self-Management: A Hybrid Concept Analysis
(Elsevier, 2015-03) Miller, Wendy R.; Lasiter, Sue; Bartlett Ellis, Rebecca J.; Buelow, Janice M.; School of Nursing
BACKGROUND: Chronic diseases require chronic disease self-management (CDSM). Existing CDSM interventions, while improving outcomes, often do not lead to long-lasting effects. To render existing and new CDSM interventions more effective, an exploration of the concept of CDSM from both the literature and patient perspectives is needed. The purpose of this study was to describe the current conceptualization of CDSM in the literature, identify potential inadequacies in this conceptualization based on a comparison of literature- and patient-based CDSM descriptions, and to offer a more comprehensive definition of CDSM. METHODS: A hybrid concept analysis was completed. DISCUSSION: In the literature, CDSM is defined as behaviors influenced by individual characteristics. Patients in the fieldwork phase discussed aspects of CDSM not well represented in the literature. CONCLUSIONS: CDSM is a complex process involving behaviors at multiple levels of a person's environment. Pilot work to develop and test CDSM interventions based on both individual and external characteristics is needed.
Creating a Professional Development Plan for a Simulation Consortium
(Elsevier, 2013-06) Jeffries, Pamela R.; Battin, Jim; Franklin, Michelle; Savage, Rhonda; Yowler, Hollace; Sims, Caroline; Hall, Tamara; Eisert, Shelly; Lauber, Cynthia; Brown, Stephanie; Werskey, Karen; Bartlett Ellis, Rebecca J.; Everage, Terri; Dorsey, Laurie; School of Nursing
As the United States struggles with health care reform and a nursing education system that inadequately prepares students for practice, dramatic advances in educational technology signal opportunities for both academic and practicing nurses to affect our profession as never before. Simulation technologies provide large and small institutions with the means to educate health care students and novice professionals effectively and efficiently through hands-on experience, but the costs of such a venture can be prohibitive. A simulation consortium offers a venue for different health care and educational institutions with shared goals to pool knowledge, monies, and labor toward health care education throughout a geographic area. This article details one Midwestern U.S. region's work in creating a professional development plan for a new simulation consortium.
Development of patient-centric linguistically tailored psychoeducational messages to support nutrition and medication self-management in type 2 diabetes: a feasibility study
(Dove Press Ltd, 2014-10-07) Bartlett Ellis, Rebecca J.; Connor, Ulla; Marshall, James; School of Nursing
Purpose: This study evaluated the feasibility of developing linguistically tailored educational messages designed to match the linguistic styles of patients segmented into types with the Descriptor™, and to determine patient preferences for tailored or standard messages based on their segments. Patients and methods: Twenty patients with type 2 diabetes (T2DM) were recruited from a diabetes health clinic. Participants were segmented using the Descriptor™, a language-based questionnaire, to identify patient types based on their control orientation (internal/external), agency (high/low), and affect (positive/negative), which are well studied constructs related to T2DM self-management. Two of the seven self-care behaviors described by the American Association of Diabetes Educators (healthy eating and taking medication) were used to develop standard messages and then linguistically tailored using features of the six different construct segment types of the Descriptor™. A subset of seven participants each provided feedback on their preference for standard or linguistically tailored messages; 12 comparisons between standard and tailored messages were made. Results: Overall, the tailored messages were preferred to the standard messages. When the messages were matched to specific construct segment types, the tailored messages were preferred over the standard messages, although this was not statistically significant. Conclusion: Linguistically tailoring messages based on construct segments is feasible. Furthermore, tailored messages were more often preferred over standard messages. This study provides some preliminary evidence for tailoring messages based on the linguistic features of control orientation, agency, and affect. The messages developed in this study should be tested in a larger more representative sample. The present study did not explore whether tailored messages were better understood. This research will serve as preliminary evidence to develop future studies with the ultimate goal to design intervention studies to investigate if linguistically tailoring communication within the context of patient education influences patient knowledge, motivation, and activation toward making healthy behavior changes in T2DM self-management.
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 Nursing
BACKGROUND: 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.
Implications for Training on Smartphone Medication Reminder App Use by Adults With Chronic Conditions: Pilot Study Applying the Technology Acceptance Model
(JMIR, 2017) Park, Daniel Y.; Goering, Elizabeth M.; Head, Katharine J.; Bartlett Ellis, Rebecca J.; School of Nursing
Background: The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients’ smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients’ app use. Objective: The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients’ intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting. Methods: A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group. Results: Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=−1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants’ perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants’ SMRA use in primary care settings (or during routine medical checkups). Conclusions: Intervention training session, guided by TAM, appeared feasible in targeting patients’ perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients’ perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app. [JMIR Formativ Res 2017;1(1):e5]
In vitro comparison of gastric aspirate methods and feeding tube properties on the quantity and reliability of obtained aspirate volume
(2013-11-20) Bartlett Ellis, Rebecca J.; Ellett, Marsha; Bakas, Tamilyn; Beckstrand, Janis; Fuehne, Joseph; Lu, Yvonne
Gastric residual volume (GRV) is a clinical assessment to evaluate gastric emptying and enteral feeding tolerance. Factors such as the tube size, tube material, tube port configuration, placement of the tube in the gastric fluid, the amount of fluid and person completing the assessment may influence the accuracy of residual volume assessment. Little attention has been paid to assessing the accuracy of GRV measurement when the actual volume being aspirated is known, and no studies have compared the accuracy in obtaining RV using the three different techniques reported in the literature that are used to obtain aspirate in practice (syringe, suction, and gravity drainage). This in vitro study evaluated three different methods for aspirating feeding formula through two different tube sizes (10 Fr [small] and 18 Fr [large]), tube materials (polyvinyl chloride and polyurethane), using four levels of nursing experience (student, novice, experienced and expert) blinded to the five fixed fluid volumes of feeding formula in a simulated stomach, to determine if the RV can be accurately obtained. The study design consisted of a 3x2x2x4x5 completely randomized factorial ANOVA (with a total of 240 cells) and 479 RV assessments were made by the four nurse participants. All three methods (syringe, suction and gravity) used to aspirate RV did not perform substantially well in aspirating fluid, and on average, the methods were able to aspirate about 50% of the volume available. The syringe and suction techniques were comparable and produced higher proportions of RVs, although the interrater reliability of RV assessment was better with the syringe method. The gravity technique generally performed poorly. Overall, the polyvinyl chloride material and smaller tubes were associated with higher RV assessments. RV assessment is a variable assessment and the three methods did not perform well in this in vitro study. These findings should be further explored and confirmed using larger samples. This knowledge will be important in establishing the best technique for assessing RV to maximize EN delivery in practice and will contribute to future research to test strategies to optimize EN intake in critically ill patients.

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