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PURPOSE: We describe the large-scale self-initiated recruitment of patients to a self-monitoring initiative for macular pathologic features during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Observational study with retrospective analysis. PARTICIPANTS: A total of 2272 patients from the Singapore National Eye Centre (SNEC) whose visits were rescheduled over lockdown (April 13-June 1, 2020) were offered participation in a self-monitoring initiative administered by SNEC with the Alleye application (Switzerland) as the testing instrument. METHODS: This was an observational study with retrospective analysis. Demographics and characteristics were compared between those who signed up and those who did not. Similar comparisons were made between patients who complied with the initiative versus those who did not. Outcomes were tracked for 6 months starting from the commencement of lockdown. MAIN OUTCOME MEASURES: Participation and compliance rates and characteristics of patients who were more likely to participate and comply with the initiative. RESULTS: Seven hundred thirty-two patients (32%) participated in this self-monitoring initiative. Those who participated were younger (62 years of age vs. 68 years of age; P < 0.001), men, and living with family. Patients not receiving treatment and those with poorer vision in the worse-seeing eye were more likely to participate. When grouped according to diagnosis, the proportion who participated was highest for diabetic macular edema (52%), nonneovascular age-related macular degeneration (AMD; 42%), diabetic retinopathy (35%), retinal vein occlusions (18%), and neovascular AMD (15%; P < 0.001). Testing compliance rate was 43% (315/732). Patients who complied with the initiative were older, were receiving treatment, and had poorer vision in the worse-seeing eye. Trigger events occurred in 33 patients, with 5 patients having clinically verified disease progression (1.6%). CONCLUSIONS: We provide clinical data on characteristics of patients with stable retinal diseases who were offered, participated in, and complied with a self-monitoring program. The lower participation rate compared with standardized clinical studies reflects the difficulties in implementation for such initiatives in clinical settings. Despite this, self-monitoring continues to show promise in relieving clinic resources, suggesting the feasibility of scaling such programs beyond the COVID-19 pandemic.

Background Self-Monitoring (SM), the act of observing ones’ own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM's effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use. Method A literature search was conducted using MEDLINE/PubMed. Results Out of 2,659 citations, 41 studies with 126 analyses were included. Among analyses from studies rated Moderate ( n = 24) or Strong ( n = 3) quality, SM was shown to have a helpful effect (e.g., reducing substance use) 29% of the time; to have no effect 63.0% of the time; and to be detrimental in 8.0% of analyses. SM's helpful effects were associated with methodological characteristics including longer monitoring and Phone/IVR and EMA/Computer methodologies compared to Paper/Pencil. SM was more helpful in non-treatment-seekers (35.0% of analyses showed SM to be helpful compared to 25.0% of analyses with treatment-seekers). Conclusions Results of this study suggest that SM, under certain circumstances, as the potential to be a low-cost, low-risk research and early intervention strategy for substance users.

Background Effective hand washing (for at least 20 s, with water and soap) is one of the health behaviors protecting against infection transmissions. Behavior change interventions supporting the initiation and maintenance of hand washing are crucial to prevent infection transmissions. Based on the Health Action Process Approach, the aim of this research was to conduct a pre-post analysis of hand washing and related cognitions (i.e., intention, self-efficacy, self-monitoring), measured up to 100 days following an intervention. Methods A convenience sample of N = 123 participants (age: M = 23.96 years; SD = 5.82; 80% women) received a brief intervention (key behavior change techniques: information about health consequences of hand washing; action planning) and responded to daily diaries and questionnaires up to a 100-day follow-up. Two-level models were used to analyze data of n = 89 participants who provided longitudinal data. Results Hand washing and self-monitoring increased, whereas intention and self-efficacy decreased over time. Only self-monitoring was a consistent positive correlate of hand washing on a between-person level. Conclusions Hand washing and self-monitoring considerably increased over several weeks following the intervention. Future research testing the intervention against a control condition is needed to rule out that changes in behavior and cognitions might have been prompted by completing the daily diaries. Trial Registration German Clinical Trials Register; https://www.drks.de; registration number: DRKS00022067.

Fondazione Bruno Kessler is developing a mobile app prototype for empowering citizens to improve their health conditions through different lifestyle interventions that will be incorporated into a mobile application for lifestyle promotion of the Province of Trento in the context of the Trentino Salute 4.0 Competence Center. The envisioned interventions are based on promoting behaviour change in various domains such as physical activity, mental health and nutrition. In particular, the nutrition component is a self-monitoring module that collects dietary habits to analyse them and recommend healthier eating behaviours. Dietary assessment is completed using a Food Frequency Questionnaire on the Mediterranean diet that is presented to the user as a grid of images. The questionnaire returns feedback on 11 aspects of nutrition. Although the questionnaire used in the application only consists of 24 questions, it still could be a bit overwhelming and a bit crowded when shown on the screen. In this paper, we tried to find a machine-learning-based solution to reduce the number of questions in the questionnaire. We proposed a method that uses the user’s previous answers as additional information to find the goals that need more attention. We compared this method with a case where the subset of questions is randomly selected and with a case where the subset is chosen using feature selection. We also explored how large the subset should be to obtain good predictions. All the experiments are conducted as a multi-target regression problem, which means several goals are predicted simultaneously. The proposed method adjusts well to the user in question and has the slightest error when predicting the goals.

Objective:To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.Design:We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.Setting:NA.Participants:NA.Results:We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups.Conclusions:Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other.

BACKGROUND: Professional societies have recommended against use of self-monitoring blood glucose (SMBG) in non-insulin-treated type 2 diabetes (NITT2D) to control blood sugar levels, but patients are still monitoring. OBJECTIVE: To understand patients’ motivation to monitor their blood sugar, and whether they would stop if their physician suggested it. DESIGN: Cross-sectional in-person and electronic survey conducted between 2018 and 2020. PARTICIPANTS: Adults with type 2 diabetes not using insulin who self-monitor their blood sugar. MAIN MEASURES: The survey included questions about frequency and reason for using SMBG, and the impact of SMBG on quality of life and worry. It also asked, “If your doctor said you could stop checking your blood sugar, would you?” We categorized patients based on whether they would stop. To identify the characteristics independently associated with desire to stop SMBG, we performed a logistic regression using backward stepwise selection. KEY RESULTS: We received 458 responses. The common reasons for using SMBG included the doctor wanted the patient to check (67%), desire to see the number (65%), and desire to see if their medications were working (61%). Forty-eight percent of respondents stated that using SMBG reduced their worry about their diabetes and 61% said it increased their quality of life. Fifty percent would stop using SMBG if given permission. In the regression model, respondents who said that they check their blood sugar levels because “I was told to” were more likely to want to stop (AOR: 1.69, 95%CI: 1.11, 2.58). Those that used SMBG due to habit and to understand their diabetes better had lower odds of wanting to stop (AOR: 0.33, 95%CI: 0.18–0.62; AOR: 0.60, 95%CI: 0.39–0.93, respectively). CONCLUSIONS: Primary care physicians should discuss patients’ reasons for using SMBG and offer them the option of discontinuing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-021-07047-2.

ObjectiveExecutive function deficits (EFD) are a central mechanism underlying negative outcomes in ADHD. This study examined awareness of EFD manifested in “real-time” task performance (Online Awareness) and in general self-knowledge of daily activities, outside the context of a specific task (Intellectual Awareness) among adolescents with and without ADHD.Methods102 adolescents with ( n = 52) and without ( n = 50) ADHD were administered Weekly Calendar Planning Activity (WCPA) and Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF parent version. Awareness was defined using the discrepancy paradigm: performance versus estimation on WCPA for online awareness; self versus parent report on the BRIEF for intellectual awareness.ResultsAdolescents with ADHD overestimated their performance on the WCPA and underestimated their EFD on the BRIEF compared to parent’s ratings. The discrepancy scores in both types of awareness were significantly larger among ADHD than controls ( p ConclusionsAdolescents with ADHD demonstrate significantly lower rates of online and intellectual awareness of EFD compared to controls.

Highlights • Chronic hypertension and gestational hypertension groups had good adherence to self monitoring of blood pressure (SMBP). • There was no evidence of adherence varying in different socio-demographic groups. • The differences between SMBP and clinic BP readings were small., Objectives To assess adherence to self-monitoring of blood pressure (SMBP), and differences between SMBP and clinic readings, in a self-monitoring intervention for managing pregnancy hypertension. Study design OPTIMUM-BP was an unmasked randomised controlled clinical trial. 154 women with pregnancy hypertension from four maternity units in England were recruited and randomised to SMBP or usual care. This secondary analysis included 91 women randomised to self-monitoring who provided BP readings. Trial instructions were for daily SMBP. Main outcome measures Adherence was calculated as proportion of days on which SMBP readings were taken. Proportion of weeks in which at least 4 and at least 2 SMBP readings were taken was also calculated. Mean differences between clinic and SMBP measurements were calculated. Results Self-monitored BP data were available for 49 women with chronic hypertension and 42 women with gestational hypertension. Median percentage of days with SMBP readings was 77% (IQR 51, 89) in the chronic hypertension group and 85% (IQR 52, 95) in the gestational hypertension group. Adherence did not vary by different socio-demographic groups. Mean difference (95% CI) between clinic and SMBP for systolic BP was 0.99 mmHg (−1.44, 3.41; chronic hypertension) and 3.76 mmHg (0.75, 6.78; gestational hypertension) and for diastolic BP was 3.03 mmHg (0.93, 5.12; chronic hypertension) and 3.27 mmHg (0.56, 5.98; gestational hypertension). Conclusions Adherence to self-monitoring was good and differences between SMBP and clinic readings were small. These findings offer reassurance about the use of self-monitoring at a time when it is being increasingly implemented in maternity settings.

Background Addressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men’s desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss. Methods In a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40–69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis. Results Of 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported. Conclusions This National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial. Trial registration The trial was prospectively registered with ClinicalTrials NCT03329079. 11/1/2017.

High levels of stress at work may have serious consequences for employee functioning and mental health. By providing employees with an easily accessible instrument to regularly evaluate stressors and resources, employee self-monitoring and guidance to support can be accommodated. We evaluated an online self-monitoring tool Brief Assessment of Stress and Energy (BASE). Through their organization, 139 railway emergency services employees were invited to complete BASE and six wellbeing measures. We assessed BASE in two ways: using multiple regression analysis (N = 102, 73.4%), as well as by telephone follow-up interviews during which experts and respondents evaluated the BASE outcome (N = 67, 65.7%). Explained variances of BASE on the six wellbeing measures ranged between 26.6% and 49.9%. Telephone interviews confirmed the BASE outcome. The results indicate that BASE is associated with several measures of wellbeing and accurately refers respondents to counseling. This study shows that BASE is a promising instrument to encourage employees to self-monitor stressors and resources and identify those who need counseling.

Observing modern decompression protocols alone cannot fully prevent diving injuries especially in repetitive diving. Professional audio Doppler bubble measurements are not available to sports scuba divers. If those non-professionals were able to learn audio Doppler self-assessment for bubble grading, such skill could provide significant information on individual decisions with respect to diving safety. We taught audio Doppler self-assessment of subclavian and precordial probe position to 41 divers in a 45-min standardized, didactically optimized training. Assessment before and after air dives within sports diving limits was made through 684 audio Doppler measurements in dive-site conditions by both trained divers and a medical professional, plus additional 2D-echocardiography reference. In all dives (average maximum depth 22 m; dive time 44 min), 33% of all echocardiography measurements revealed bubbles. The specificity of audio bubble detection in combination of both detection sites was 95%, and sensitivity over all grades was 40%, increasing with higher bubble grades. Dive-site audio-Doppler-grading underestimated echo-derived bubble grades. Bubble detection sensitivity of audio Doppler self-assessments, compared to an experienced examiner, was 62% at subclavian and 73% at precordial position. 6 months after the training and 4.5 months after the last measurement, the achieved Doppler skill level remained stable. Audio Doppler self-assessment can be learned by non-professionals in a single teaching intervention. Despite accurate bubble grading is impossible in dive-site conditions, relevant high bubble grades can be detected by non-professionals. This qualitative information can be important in self-evaluating decompression stress and assessing measures for increased diving safety.

BackgroundPhysical activity (PA) is a primary factor in reducing the risk of chronic diseases, yet only half of U.S. adults meet recommended levels.ObjectiveTo evaluate a PA self-monitoring pilot intervention using technology in obese adult primary care patients.MethodsThe project had a prospective, single group, pretest/posttest design using an accelerometer with a smartphone app. Obese adult primary care patients (N = 31) were followed over 6 months. Demographic (age, race, sex, marital status, educational level) and PA-relevant (PA, body mass index [BMI], self-efficacy for exercise [SEE]) data were collected at enrollment. PA and BMI were recorded monthly for 6 months. SEE was reassessed at 6 months.ResultsPA and BMI showed gradual improvement; however, changes in PA (p = .130), BMI (p = .326), and SEE (p = .877) at 6 months were not statistically significant. A strong, negative relationship was found between PA and BMI (r = −.727, p < .01). Anecdotal data indicated the smartphone app was acceptable to patients.ConclusionsData-supported clinician-initiated PA self-monitoring with a smartphone app was acceptable and showed favorable trends in improving PA and BMI in obese adult patients.Implications for NursingPrescribing PA self-monitoring using technology may be easily implemented.

Error monitoring allows for the efficient performance of goal-directed behaviors and successful learning. Furthermore, error monitoring as a metacognitive ability may play a crucial role for neuropsychological interventions, such as rehabilitation. In the past decades, research has suggested two electrophysiological markers for error monitoring: the error-related negativity (ERN) and the error positivity (Pe), thought to reflect, respectively, error detection and error awareness. Studies on several neurological diseases have investigated the alteration of the ERN and the Pe, but these findings have not been summarized. Accordingly, a systematic review was conducted to understand what neurological conditions present alterations of error monitoring event-related potentials and their relation with clinical measures. Overall, ERN tended to be reduced in most neurological conditions while results related to Pe integrity are less clear. ERN and Pe were found to be associated with several measures of clinical severity. Additionally, we explored the contribution of different brain structures to neural networks underlying error monitoring, further elaborating on the domain-specificity of error processing and clinical implications of findings. In conclusion, electrophysiological signatures of error monitoring could be reliable measures of neurological dysfunction and a robust tool in neuropsychological rehabilitation.

Objective To evaluate how English maternity units implemented self-monitoring of blood pressure (SMBP) in pregnancy in response to the COVID-19 pandemic. Design Mixed methods including surveys, anonymised patient data and in-depth interviews with women. Setting Maternity units across England. Participants 45 maternity units completed a survey about the implementation of SMBP (supported by the provision of guidance and blood pressure monitors) during the pandemic, 166 women completed a survey about their experiences of SMBP, and 23 women took part in in-depth interviews. Clinical data from 627 women undertaking SMBP were available from 13 maternity units. Results SMBP was predominantly used to provide additional BP monitoring for hypertensive or high-risk pregnant women. Overall maternity units and women were positive about its use in terms of reducing the need for additional face-to-face contacts and giving women more control and insight into their own BP. However, there were challenges in setting up SMBP services rapidly and embedding them within existing care pathways, particularly around interpreting readings and managing the provision of monitors. Conclusions A considerable proportion of maternity units in England commenced a SMBP service for hypertensive or high-risk women from March 2020. There is a need for further research into appropriate care pathways, including guidance around white coat or masked hypertension and the use of SMBP postnatally.

Background: Blended-care behavior change interventions (BBCI) are a combination of digital care and coaching by health care professionals (HCP), which are proven effective for weight loss. However, it remains unclear what specific elements of BBCI drive weight loss. Objectives: This study aims to identify the distinct impact of HCP-elements (coaching) and digital elements (self-monitoring, self-management, and education) for weight loss in BBCI. Methods: Long-term data from 25,706 patients treated at a digital behavior change provider were analyzed retrospectively using a ridge regression model to predict weight loss at 3, 6, and 12 months. Results: Overall relative weight loss was −1.63 kg at 1 month, −3.61 kg at 3 months, −5.28 kg at 6 months, and −6.55 kg at 12 months. The four factors of BBCI analyzed here (coaching, self-monitoring, self-management, and education) predict weight loss with varying accuracy and degree. Coaching, self-monitoring, and self-management are positively correlated with weight losses at 3 and 6 months. Learn time (i.e., self-guided education) is clearly associated with a higher degree of weight loss. Number of appointments outside of app coaching with a dietitian (coach) was negatively associated with weight loss. Conclusions: The results testify to the efficacy of BBCI for weight loss-with particular positive associations per time point-and add to a growing body of research that characterizes the distinct impact of intervention elements in real-world settings, aiming to inform the design of future interventions for weight management.

Self-selection of different employment opportunities was predicted to be a function of dispositional differences in self-monitoring. In two studies, participants read two job descriptions containing attributes that matched the skills and needs of either high self-monitors or low self-monitors. Participants then indicated which job they would accept if offered both jobs and subsequently completed the 25-item Self-Monitoring Scale. Scale responses were used to create univariate/categorical (high vs. low self-monitors) and bivariate/two dimensional (acquisitive, protective) indices of self-monitoring. In Study 1, low self-monitors and high self-monitors chose personally congruent jobs. These divergent choices were observed regardless of the way (univariate model, alternative bivariate model) self-monitoring was assessed. In Study 2, these self-monitoring differences were moderated by job status. These moderated choices of jobs were obtained when self-monitoring was assessed in its conventional and acquisitive (i.e., impression management for gain) forms but not in its protective (i.e., impression management for self-defense) form. In both studies, sex differences did not account for self-monitoring differences. These findings suggest on-the-job differences between high and low self-monitors may represent self-selection processes occurring before job-based experiences.

Poor adherence to inhaled corticosteroids (ICSs) and overuse of short-acting betaTo assess whether patient self-monitoring via electronic medication monitoring and smartphone application plus remote clinician feedback influences ICS and SABA use.Adults with uncontrolled asthma and prescribed ICS and SABA were enrolled in this 14-week study. Inhalers were fitted with electronic medication monitoring to track real-time usage. After a 14-day baseline, participants were randomly assigned to the treatment group where they received reminders and feedback on ICS and SABA use via a smartphone application and clinician phone calls, or control group without feedback. Linear mixed models compared the baseline percentage of SABA-free days and ICS adherence to the last 14 study days.Participants (n = 100) had a mean age of 48.5 years, 80% were female, 68% white, and 80% privately insured. The percentage of SABA-free days increased significantly in the treatment group (19%; 95% CI, 12 to 26; P.01) and nonsignificantly in the control group (6%, 95% CI, -3 to 16; P = .18), representing a 13% (95% CI, 1-26; P = .04) difference. ICS adherence changed minimally in the treatment group (-2%; 95% CI, -7 to 3; P = .40), but decreased significantly (-17%; 95% CI, -26 to -8; P.01) in the control group, representing a 15% (95% CI, 4 to 25; P.01) difference.Patient self-monitoring via a digital platform plus remote clinician feedback maintained high baseline ICS adherence and decreased SABA use.

Preeclampsia is associated with significant morbidity and mortality. Women who experienced preeclampsia require close blood pressure surveillance postpartum. Remote monitoring of blood pressure using a mobile health application may be a viable method of surveillance in this population. The purpose of this project was to assess the feasibility of using the MyWellSpan mobile application to engage postpartum women who experienced preeclampsia in blood pressure self-monitoring. Women who chose to participate were provided an automatic blood pressure cuff and educational materials and were enrolled in MyWellSpan. A survey created by the authors asked participants to rate by Likert scale their satisfaction with the program and ease of use of the blood pressure cuff and self-monitoring. The electronic health record was reviewed retrospectively to assess utilization of the MyWellSpan mobile application to document blood pressure. The majority of women who participated reported that operating the blood pressure cuff was very easy and felt that it would be very easy to monitor their blood pressure twice daily. Sixty-nine percent of those women in the program electronically submitted at least 1 blood pressure measurement, thus confirming the feasibility of self-monitoring and reporting using a mobile application.

Background Individuals receiving behavioral weight loss treatment frequently fail to adhere to prescribed dietary and self-monitoring instructions, resulting in weight loss clinicians often needing to assess and intervene in these important weight control behaviors. A significant obstacle to improving adherence is that clinicians and clients sometimes disagree on the degree to which clients are actually adherent. However, prior research has not examined how clinicians and clients differ in their perceptions of client adherence to weight control behaviors, nor the implications for treatment outcomes. Purpose In the context of a 6-month weight-loss treatment, we examined differences between participants and clinicians when rating adherence to weight control behaviors (dietary self-monitoring; limiting calorie intake) and evaluated the hypothesis that rating one’s own adherence more highly than one’s clinician would predict less weight loss during treatment. Methods Using clinician and participant-reported measures of self-monitoring and calorie intake adherence, each assessed using a single item with a 7- or 8-point scale, we characterized discrepancies between participant and clinician adherence and examined associations with percent weight change over 6 months using linear mixed-effects models. Results Results indicated that ratings of adherence were higher when reported by participants and supported the hypothesis that participants who provided higher adherence ratings relative to their clinicians lost less weight during treatment (p < 0.001). Conclusions These findings suggest that participants in weight loss treatment frequently appraise their own adherence more highly than their clinicians and that participants who do so to a greater degree tend to lose less weight.

Objective: To analyze impact of implementation of an oral anticoagulation self-monitoring and self-management program among patients with mechanical valve prosthesis. Materials & methods: Observational and retrospective study performed in Hospital Moises Broggi, Barcelona, Spain. The program started on June 2019. The study compared 6-month period before and after the implementation of the program. Results: The study included 44 patients. There was a numerical increase of time in therapeutic range from 53.6 ± 21.3% to 57.1 ± 15.7% (p = 0.30). Proportion of patients with international normalized ratio (INR) >5 significantly decreased from 3.9 to 2.0% (p = 0.04). No significant differences were observed in thromboembolic or bleeding complications. Visits to emergency department decreased from (29.5 to 22.7%; p = 0.41). Conclusion: Oral anticoagulation self-monitoring and self-management program seems an appropriate approach that could provide additional benefits in selected patients with mechanical valve prosthesis.

Background Excess gestational weight gain is common and an important risk factor for adverse pregnancy outcomes. Regular weighing can be used to assess and manage weight gain, but NICE guidelines do not recommend routine weighing during antenatal care. Trials that have tested the effectiveness of self-weighing to manage GWG have been unsuccesful in engaging women in regular self-weighing, although the reasons for lack of engagement are not fully understood. This study aimed to understand why this lack of engagement occurred by exploring the naturally occurring thoughts and feelings of pregnant women (9 to 15 weeks gestational age) who were asked to weigh themselves at home. Methods Twenty-five women were recruited to take part. Participants completed short questionnaires at their first-trimester and 20-week scans. After recruitment, participants were asked to weigh themselves at roughly the same time each week for 8 weeks. Whilst they weighed themselves they were asked to audio-record their current weight and describe any thoughts or feelings that occurred as they weighed themselves. These audio recordings were then sent to researchers using a secure messaging service. Results Most of the recruited women (56%) were unaware of guidelines for gestational weight gain, and only 40% could identify the ideal rate of GWG for their BMI group. Thematic analysis of the think-aloud recordings resulted in three main themes: “understanding weight gain in pregnancy”, “taking action to prevent weight gain” and “reactions to self-weighing”. Overall, there was a relatively positive response to self-weighing and some participants used self-weighing to reflect on the reasons for weight gain and plan actions they could take to avoid excess gain. Negative emotional responses tended to be related to a lack of guidance about what level of weight gain or loss was “healthy”, or to other worries about the pregnancy. Of the women recruited who submitted at least one think aloud recording (n 10), 80% found self-weighing to be useful, and said they would likely continue to self-weigh at home. Conclusions Women had complex emotions about self-weighing during pregnancy but overall found it useful, suggesting it could be encouraged as part of self-regulatory interventions to control GWG. Clear guidelines about appropriate gestational weight gain could help to reduce anxiety. Trial registration The study was prospectively registered with ISRCTN ISRCTN10035244.

OBJECTIVE: To understand the current prevalence of, and attitudes to, self-monitoring of blood pressure (BP) during pregnancy. METHODS: 5555 pregnant women from antenatal clinics in 16 hospitals in England were invited to complete a survey. MAIN OUTCOME MEASURES: The primary outcome was the proportion of women currently BP self-monitoring. Secondary outcomes included self-monitoring schedules and women’s interactions with clinicians regarding self-monitoring. Population characteristics including risk factors for pre-eclampsia, ethnicity and deprivation level were considered. RESULTS: Completed surveys were received and analysed from 5181 pregnant women (93% response rate). Comparison to hospital demographic data suggests that respondents were representative of the UK population. 983/5181 (19%) of women were currently self-monitoring their BP, comprising 189/389 (49%) hypertensive women and 794/4792 (17%) normotensive women. However, only 482/983 (49%) reported ever sharing this information with antenatal care teams. Of those who self-monitored, 68% (668/983) were able to provide a previous BP reading, compared to 1% (67/5181) of those who did not self-monitor. CONCLUSION: Many women are now choosing to self-monitor their BP during pregnancy and clinicians should enquire about this proactively and consider providing better information on BP monitoring. Those who self-monitor appear to have better knowledge about their blood pressure. If these findings were replicated nationwide, around 125,000 pregnant women would be currently self-monitoring BP in the UK, yet only half of these women may communicate their readings to their antenatal care teams, suggesting a missed opportunity for enhanced care. Current trials will make the place of self-monitoring in pregnancy clearer.

We aimed to explore how women with gestational diabetes mellitus (GDM) experience advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordination and collaboration between healthcare professionals. Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using thematic analysis. Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with sufficient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more individually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women’s daily lives; however, they perceived the training in PHC and SHC as adequate. The women experienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own care.KEY POINTSCurrent awareness•The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionalsMain statements•Pregnant women’s need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis•Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care•Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus•Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved Current awareness •The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionals Main statements •Pregnant women’s need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis •Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care •Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus •Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved

BACKGROUND: Disruption of sleep occurs in up to 50% of individuals above the age of 65 with chronic health conditions. Actigraphy-based personal sleep monitoring devices (PSMD) have been used as objective measures of sleep in clinical trials. Yet, the feasibility of PSMD use to improve knowledge and awareness as part of a comprehensive sleep self-management intervention in older adults has not been explored. PURPOSE: The purpose of this study was to establish feasibility of PSMD use as an intervention for sleep self-management in older adults. METHODS: This feasibility study followed a mixed-methods experimental design based upon the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) and the proposed conceptual model of symptom management in a social context. RESULTS: Results showed an acceptable recruitment and retention rate of participants, and acceptability of PSMD by users. Participants were able to meaningfully interpret PSMD data as evidenced by the numeracy evaluation scores, initiate sleep goals, and share their sleep data and goals with friends or relatives. CONCLUSION: Findings of this study support extending this research protocol to a larger sample size. Future studies for sleep health self-management and personally tailored interventions using personal sleep monitoring are recommended. PSMDs are becoming increasingly popular, and can be used as self-management tools in older persons with sleep disturbances, to gain insight into their sleep, and tailor individual and shared sleep self-management interventions.

Background: Older adults with Type 2 diabetes (T2D) are more likely to be frail, which increases the risk for disability and mortality. Objectives: To determine the feasibility of a behavioral lifestyle intervention, enhanced with mobile health technology for self-monitoring of diet and activity, to improve frailty in overweight/obese older adults (≥65 years) diagnosed with T2D. Design, Setting, and Participants: Single arm, 6-month study of a behavioral lifestyle intervention in 20 overweight/obese (BMI>25) older adults (≥ 65 years) with self-reported T2D diagnosis who owned a smartphone. A Fitbit tracker was provided to all participants for self-monitoring of diet and physical activity. Our primary outcome of feasibility was measured by session attendance, adherence to Fitbit usage to self-monitor diet and physical activity, and study retention. Secondary outcomes included the preliminary efficacy of the intervention on frailty, physical function, quality of life, and T2D-related outcomes. Results: Eighteen participants completed the study. The mean age was 71.5 (SD ± 5.3) years, 56% were female, and half were Hispanic. At baseline, 13 (72%) were pre-frail, 4 (22%) were frail, and 1 (6%) were non-frail. At follow-up, frailty scores improved significantly from 1.61 ± 1.15 to 0.94 ± 0.94 (p=0.01) and bodyweight improved from 205.66 ± 45.52 lbs. to 198.33 ± 43.6 lbs. (p=

Introduction Using WebQuit as a case study, a smoking cessation website grounded in Acceptance and Commitment Therapy, we aimed to identify sequence clusters of content usage and examine their associations with baseline characteristics, change to a key mechanism of action, and smoking cessation. Methods Participants were adult smokers allocated to the WebQuit arm in a randomized controlled trial (n = 1,313). WebQuit contains theory-informed content including goal setting, self-monitoring and feedback, and values- and acceptance-based exercises. Sequence analysis was used to temporally order 30-s website usage segments for each participant. Similarities between sequences were assessed with the optimal matching distance algorithm and used as input in an agglomerative hierarchical clustering analysis. Associations between sequence clusters and baseline characteristics, acceptance of cravings at 3 months and self-reported 30-day point prevalence abstinence at 12 months were examined with linear and logistic regression. Results Three qualitatively different sequence clusters were identified. “Disengagers” (576/1,313) almost exclusively used the goal-setting feature. “Tryers” (375/1,313) used goal setting and two of the values- and acceptance-based components (“Be Aware,” “Be Willing”). “Committers” (362/1,313) primarily used two of the values- and acceptance-based components (“Be Willing,” “Be Inspired”), goal setting, and self-monitoring and feedback. Compared with Disengagers, Committers demonstrated greater increases in acceptance of cravings (p = .01) and 64% greater odds of quit success (ORadj = 1.64, 95% CI = 1.18, 2.29, p = .003). Discussion WebQuit users were categorized into Disengagers, Tryers, and Committers based on their qualitatively different content usage patterns. Committers saw increases in a key mechanism of action and greater odds of quit success. Implications This case study demonstrates how employing sequence and cluster analysis of usage data can help researchers and practitioners gain a better understanding of how users engage with a given eHealth intervention over time and use findings to test theory and/or to improve future iterations to the intervention. Future WebQuit users may benefit from being directed to the values- and acceptance-based and the self-monitoring and feedback components via reminders over the course of the program.

Purpose This feasibility study explored older adults’ use of a nutrition app called Appetitus (https://apps.apple.com/us/app/appetitt/id1001936854?ign‐mpt=uo%3D2; https://play.google.com/store/apps/details?id=no.nr.appetitt&hl=e) and addressed their engagement in technology‐mediated self‐monitoring of diet. Undernutrition is a significant challenge among older adults and is associated with poorer health experiences. Digital health for self‐monitoring of diet has the potential to increase awareness of personal nutrition, and the scarcity of research reporting older adults’ ability and willingness to engage in technology‐mediated dietary self‐monitoring warranted this study. Design and Methods An explorative mixed‐methods design combining descriptive analysis of log data with qualitative analysis of interviews with Appetitus users was implemented. Findings Twenty‐five older adults self‐monitored their diet using Appetitus over an 8‐week trial period. Eighty percent of the participants used the app regularly in the trial period. The most engaged users recorded their food consumption daily for 8 weeks. Personal interest in nutrition and commitment to the project facilitated regular use of Appetitus. Poor health and the perception that using a nutrition app lacked personal relevance contributed to irregular self‐monitoring. For inexperienced technology users, participation in this project became a springboard to using tablet technology and the Internet beyond the Appetitus app. Conclusions The majority of the participants regularly used Appetitus for self‐monitoring of diet; they found the tablet technology and Appetitus app easy to use. Clinical Relevance Older adults are able and willing to use self‐monitoring tools. Nutrition apps can empower older adults to make better informed decisions about their diet. Patients’ self‐monitoring can provide valuable and detailed health‐related information to healthcare professionals and mediate patient‐centered care practices.

Summary Background Managing oral anticoagulant therapy with vitamin K antagonists remains challenging in paediatric medicine. Aims This study aimed to assess the correlation between time in therapeutic range and quality of life in children participating in a non-selective International Normalised Ratio self-monitoring and vitamin K antagonist education programme. Methods Children aged from 2 to 18 years and receiving vitamin K antagonist therapy were eligible for this prospective multicentre study. Clinical and demographic data were collected. Health-related quality of life was assessed using the PedsQL™ 4.0 questionnaire. Correlations between quality of life scores and time in therapeutic range were measured. Results A total of 121 children were included in the study (mean age 9.6 ± 4.9 years). Cardiac conditions were the predominant indication for vitamin K antagonists. The mean time in therapeutic range was 0.78 ± 0.15 overall, and 0.76 ± 0.24 over the 3-month period before quality of life assessment. The mean total quality of life score was 76.2 ± 18 in self reports, 71.4 ± 22 in mother reports and 73.5 ± 19 in father reports. The time in therapeutic range correlated with the total quality of life scores in self reports (r = 0.22; P = 0.04), mother reports (r = 0.23; P = 0.02) and father reports (r = 0.28; P = 0.02). The time in therapeutic range predominantly correlated with school functioning in self reports (r = 0.38; P = 0.002) and mother reports (r = 0.40; P Conclusions Time in therapeutic range correlated with quality of life in children participating in a non-selective International Normalised Ratio self-monitoring and vitamin K antagonist education programme. Regular assessment of quality of life in patient education programmes contributes towards understanding the concerns and needs of patients.

Importance Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. Objective To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. Design, Setting, and Participants Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks’ gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. Interventions Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. Main Outcomes and Measures The primary outcome was time to first recorded hypertension measured by a health care professional. Results Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, −1.6 days [95% CI, −8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). Conclusions and Relevance Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. Trial Registration ClinicalTrials.gov Identifier: NCT03334149

Background: Gestational diabetes mellitus (GDM) management using self-monitoring blood glucose (SMBG) does not normalize pregnancy outcomes. Objective: We aimed to conduct an observational study to...

Background There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. Objectives To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. Design A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). Setting Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. Participants There were 450 participants aged 16–74 years, with a body mass index of 30–40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. Intervention e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven ‘steps to health’. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. Primary outcome measure Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. Secondary outcomes Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. Results Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval –2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval –£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. Limitations A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. Future work The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. Conclusions Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. Trial registration Current Controlled Trials ISRCTN15644451. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.

Online self-presentation refers to the ways in which individuals share aspects of the self to portray a particular image. Being online presents opportunities for individuals to experiment with different versions of the self as part of identity development but also to manage how others perceive them. Research has shown that personality can influence online self-presentation behaviors, but these studies have mainly focused on internal characteristics, and more research is needed exploring the relational facets of personality. This study aims to investigate the extent to which an individual's self-concept clarity, self-monitoring tendency, self-esteem, and social anxiety predict different presentations of the online self. A cross-sectional online survey was conducted with 405 adult participants from Australia, the United Kingdom, and the United States. Results show that individuals with higher self-concept clarity and self-monitoring are more likely to present a single consistent online and offline self. Younger adults and those with greater social anxiety are more likely to present idealized self-images online, and participants with higher social anxiety and lower self-esteem are more likely to prefer online, rather than offline, communication. Findings are broadly consistent with the literature, and suggest the need for more systematic investigation into a variety of personality variables that take into account the relational nature of identity formation and impression management. This research emphasizes the multifaceted nature of online self-presentation behaviors, and the ways in which they are differentially influenced by personality variables.

Background: This study aimed to test the efficacy of a messaging intervention targeting psychological or physical benefits plus goal setting and self-monitoring strategies to promote walking activity in the university context. Methods: Two hundred and thirty university students from the University of Naples Federico II were randomly allocated to one of four conditions: physical health messages + self-monitoring, psychological health (well-being) messages + self-monitoring, self-monitoring, and no messages. All three intervention conditions were exposed to goal setting (doing at least 7,000 steps a day) and participants were required to monitor their daily progress through the specific step counting app. Participants’ walking activity and related psychological variables were assessed at T1 and T2. We ran ANCOVAs and mediation analysis to test our research questions and hypotheses. Analyses were based on the N = 156 who completed all measures at both time points. Results: Participants in the three experimental (message) conditions reported improvement in psychological variables and behaviour. In particular, the messages focused on the physical health benefits, combined with self-monitoring, were the most effective. Conclusions: Our study provides new information on the factors that could be usefully targeted to promote walking activity (i.e. intention, past behaviour, action control, and persuasive messages on the physical benefits of walking).

Homeless young adults are more likely than their never-homeless counterparts to abuse substances and engage in sexual risk behaviors. This study evaluated the feasibility and preliminary effectiveness of OnTrack, a smartphone application to self-monitor substance use and sexual risk behaviors, plus a brief motivational intervention (BMI), in reducing substance use and sexual risk among homeless young adults. A randomized controlled pilot trial (N = 60) compared OnTrack + BMI to treatment as usual (TAU) at an inner-city crisis shelter for homeless young adults (aged 18-21 years). Participants were assessed at baseline and 2 weeks, 4 weeks, and 6 weeks after baseline to evaluate substance use and sexual risk behaviors. Kruskal-Wallis tests determined differences between baseline and postintervention assessments. Logistic regression models examined treatment effect on change in outcomes between baseline and postintervention follow-up assessment, controlling for baseline levels. Participants in OnTrack + BMI significantly reduced past 2-week number of drinks (p = .023), times used marijuana (p = .046), times engaged in unprotected sex (p = .012), and times used drugs before sexual activity (p = .019). No reductions of substance use or sexual risk behaviors were found among participants in TAU (all ps > .05). After adjusting for baseline levels of substance use and sexual risk, participants in OnTrack + BMI had significantly lower odds than those in TAU for drinking alcohol (adjusted OR = 0.14; p = .01) and having unprotected sex (adjusted OR = 0.151; p = .032). OnTrack + BMI is feasible and effective in reducing past 2-week alcohol use and unprotected sex among homeless young adults. A larger randomized trial is warranted to replicate and extend present results. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background In order to achieve improved weight status, behavioral pediatric obesity treatment is resource intensive. Mobile Health (mHealth) is more accessible than standard care but effective approaches are scarce. Therefore, the aim of this feasibility trial was to study trial design, mHealth usage, compliance, and acceptability of a novel mHealth approach in pediatric obesity treatment. Methods This six-month parallel two-arm feasibility trial took place at three pediatric outpatient clinics in Stockholm, Sweden. Participants, 5–12 years, starting obesity treatment were randomized to using an mHealth support system as an addition to standard care (intervention) or to standard care alone (control). The intervention included daily self-monitoring of weight transferred to a mobile application (app) used by parents, a website in which clinicians could track treatment progress, prespecified treatment goals for change in degree of obesity shown in the app and on the website, and text message interactions between clinicians and parents. The main outcome was description of feasibility. Height and weight were measured at baseline, three, and 6 months to explore changes in body mass index standard deviation score (BMI SDS). Results Of 40 children eligible for inclusion, 28 agreed to participate (54% girls) and were randomized to intervention (n = 15) or control (n = 13). Weight was measured at home regularly throughout the entire trial period by 12/15 children in the intervention group. Attendance at appointments were better in the intervention group (p = 0.024). Both parents and clinicians had a positive experience and found the mHealth support system accessible. At 6 months the intervention group had a greater reduction of 0.24 units in BMI SDS than standard care (− 0.23 vs. 0.01, p = 0.002). Conclusions The mHealth support system was a feasible and innovative treatment approach which, in addition to standard care, generated better treatment results than standard care alone. Future research should evaluate the treatment effects over a longer follow-up time in a larger study sample. Trial registration This trial was retrospectively registered at ClinicalTrials.gov, ID: NCT03380598, on November 8, 2017.

Background Self-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management in women with medicated hypertensive disorders of pregnancy. Methods A mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews at 4 weeks and 6 months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of normalisation process theory. Participants provided a score (Likert scale 1–5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach. Results Sixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both 4 weeks and 6 months: adjusted differences 0.6 (95% confidence interval [CI] 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively. Conclusions Interviews and quantitative data showed that self-management enhanced women’s sense of control and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible and reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum and reinforce the effectiveness of the intervention used in this study. Trial registration ClinicalTrials.gov: NCT02333240. Prospectively registered on 7 January 2015.

Objective This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dysregulation in patients with binge eating disorder (BED). Method Forty non-BED-obese and 46 BED-obese patients completed a battery of tests assessing metacognition and psychopathology. To test our hypothesized model, a structural equation model (SEM) using maximum likelihood estimation was conducted. Results BED-obese patients had significantly higher scores in BES, UPPS-P Negative urgency, and DERS total score, and lower MSAS self-monitoring than non-BED-obese, while no differences emerged in the MSAS others-monitoring subscale. The structural model demonstrated very good fit indexes (χ2 = 1.377, df = 2; p = .502, CMIN/DF = 0.688, CFI = 1.000, RMSEA = 0.000, TLI = 1.047) and all paths were significant in the predicted directions. Conclusions These preliminary findings show that, low self-monitoring and high negative urgency lead BED-obese patients to express the worsening of binge severity through the mediation of emotional dysregulation. This knowledge may be helpful in the clinical practice to develop a tailor-made treatment. Accordingly, an approach through Metacognitive Interpersonal Therapy could be attempted in BED-obese patients with these characteristics. Highlights Patients with BED exhibited low self-monitoring and high negative urgency. Binge severity was mediated by high level of emotional dysregulation. Metacognitive Interpersonal Therapy may be useful for BED patients.