digital technology: What works for whom, how and why? Dr Adrienne - - PowerPoint PPT Presentation

Dr Adrienne O'Neil Senior Research Fellow & National Heart Foundation Future Fellow Melbourne School of Population & Global Health The University of Melbourne

Behaviour change, chronic disease and digital technology: What works for whom, how and why?

• Prospective cohort study post heart attack
• Baseline
• 12 month
• 24 month interviews
• 416 participants
• Recruited from Monash Heart
• 327 male (79%), 89 (21%) female
• 43% Employed full time at time of cardiac event
• Average age at baseline was 59 years

Not an isolated incident….

Variation in care coordination & quality “I wish there was greater communication between the GP and the cardiologist” (PT004) “I saw my GP every week and the GP and cardiologist were communicating very well”(PT008) “At one hospital I had great follow-up but at another hospital I had no follow-up, no info, not the same staff quality and they didn’t explain outcomes properly” (PT041) “I’d like more frequent visits with the cardiologists. Currently it is only every 6 months” (PT048) “[I wanted] better coordination between doctors – each had different opinions on what medication to take and it was confusing” (PT186)

Variation in access & length of CR

“I was not offered CR It was a glitch in the care. The cardiologist and GP had to follow-up with additional support”(PT226) “ I was offered cardiac rehab but it was during work hours and very inflexible so I didn’t attend” “ I had the option to continue rehab but I didn’t think it was needed” (PT045) “I still go to the gym where I did cardiac rehab [2 years later]” “I wish I had the option to complete cardiac rehab for longer, I had good momentum going to the gym and then it just stopped and there was no option to continue on longer” (PT236) “I would have liked longer cardiac rehab” (PT142) “Rehab could’ve been more informative and longer. Constant checking in is needed” (PT111)

Requests for MH support

“I wish I had access to the HARP scheme earlier. The psychologist is brilliant. Having individual appointments without family is important” (PT144) “Cardiac rehab needed to include help on dealing with how

• ther people in your life deal with heart attack” (PT236)

“They could have introduced mindfulness into patients care and [information on] improving general health and wellbeing” (PT106) “More male perspective in cardiac rehab – there were only female staff” (PT169) “More info on return to work and mental health”(PT062)

Requests for follow-up

“I wanted more follow-up care” (PT224) “I don’t feel I was supported very well. I would have liked someone to check on me by just calling”(PT011) “Very limited support for anything, did not receive any support whatsoever, would’ve like to have someone come by and check up on me like a nurse/doctor (wife was only person to rely on)” (PT140) “I wanted more time with a dietician/physio specialist” “[It would have been helpful] to implement health checks every 3 months to make sure everyone is on track” (PT127)

Why is management of ACS so poor in Australia?

• Treated as an acute, not chronic condition
• Buy in from cardiologist about rehabilitation
• Patients who fall through the cracks
• Mental health issues
• Access, time, motivation barriers

Phone delivered CR: MoodCare

Results: Efficacy

Adjusting for baseline depression, at 6 months the intervention group demonstrated statistically significant improvements in: PHQ9 (but not CDS depression) Effect Size (ES): -0.3.

Results: Feasibility

 Satisfaction: 85%  Good program compliance

• median number of sessions=8

 Acceptability:

• Low study attrition (12%)
• Reasonably high acceptability (68%)

 Convenience:

• 77% of participants stated that travel was a barrier to

attending face-to-face counselling sessions

• 92% stated that using the telephone for counselling was

convenient.

HOWEVER…

• Not cost effectiveness!
• No capacity to integrate into health system
• Willingness of clinicians?

“Silicon Valley”

Why digital health?

What is the evidence? Meta review: 33 systematic reviews (15 meta-analyses)

• Significant reductions in HbA1c over 1 yr for:

– Web-based programs -0.49% [95% CIs:-0.70,-0.29] – mHealth programs -0.50% [95% CIs:-0.73,-0.27] – social media interventions -0.46% [95% CIs:-0.58,-0.34]

• Interactive web + telephone for quitting smoking
• RR: 2.05, 95% CIs:1.42,2.97
• mHealth interventions produced favourable:
• weight (Cohen’s d=0.43)
• physical activity outcomes (Hodge’s g=0.54)

O’Neil et al (2016) JAMIA

Recommendation 1: Interactivity!

Recommendation 2: Uptake!

Recommendation 3: Use & engagement

Usability Engagement Outcomes

Acknowledgement: Shaira Baptista

How do we measure health behaviour change owing to technology use?

Emotions Cognitions

• Knowledge
• Understanding
• Attitudes
• Self-efficacy

Behaviours

• Dietary intake
• Medication adherence
• Physical activity
• Mood management
• Metabolic syndrome
• Smoking cessation
• Alcohol intake

Biological Markers

• LDL-C
• HDL-C
• TC, TG
• Blood Pressure
• Kidney Function
• Inflammation

Social Support Complications

• Cardiovascular
• Peripherovascular
• Cerebrovascular
• Psychological

Health

• utcomes

resulting in readmission

• Recurrent ACS
• Stroke
• Diabetes
• Depression
• Anxiety
• Poor Quality of Life
• Death

How do we measure the population impact of digital health?

• eCONSORT guidelines:

(1) program development; (2) program access; (3) description of intervention(s) (model, theory, content, communications channels, prompts); (4) indication of where resources supplemented interventions; (5) data collection and storage process (security, usage); (6) attrition at various stages (usage, dose, engagement); (7) demographics on digital health divide; and (8) process outcomes

O’Neil et al (2016) JAMIA

Major Issue for “digital public health”

Acknowledgment: Prof Lis Nuebeck U Sydney

THANK YOU!

• Dr. Adrienne O’Neil

Senior Research Fellow Melbourne School of Population & Global Health The University of Melbourne Victoria, AUSTRALIA adrienne.oneil@unimelb.edu.au @DrAdrienneOneil