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Ambulatory assessment (AA) studies are frequently used to study emotions, cognitions, and behavior in daily life. But does the measurement itself produce reactivity, that is, are the constructs that are measured influenced by participation? We investigated individual differences in intraindividual change in momentary emotional clarity and momentary pleasant-unpleasant mood over the course of an AA study. Specifically, we experimentally manipulated sampling frequency and hypothesized that the intraindividual change over time would be stronger when sampling frequency was high (vs. low). Moreover, we assumed that individual differences in dispositional mood regulation would moderate the direction of intraindividual change in momentary pleasant-unpleasant mood over time. Students (n = 313) were prompted either three or nine times a day for 1 week (data collection took place in 2019 and 2020). Multilevel growth curve models showed that momentary emotional clarity increased within participants over the course of the AA phase, but this increase did not differ between the two sampling frequency groups. Pleasant-unpleasant mood did not show a systematic trend over the course of the study, and mood regulation did not predict individual differences in mood change over time. Again, results were not moderated by the sampling frequency group. We discuss limitations of our study (e.g., WEIRD sample) and potential practical implications regarding sampling frequency in AA studies. Future studies should further systematically investigate the circumstances under which measurement reactivity is more likely to occur., (© 2024. The Author(s).)

From its inception in 1999, the National Institute for Health and Care Excellence (NICE) committed to including the expertise, experiences, and perspectives of lay people, patients and carers, and patient organizations in its health technology assessments (HTAs). This is our story of patient involvement in HTA: from early methods designed for use when assessing medicines, widening to address the different requirements of HTAs for interventional procedures, medical technologies, and diagnostic technologies. We also chart the evolution and development of all our patient involvement methods over the past 20 years through regular evaluation and by responding to external challenge. However, we know that processes and methods alone are not enough. Through case studies we demonstrate the value of patient involvement in HTA and highlight the unique perspectives and experiences that patients bring to HTA committees. Finally, we discuss the underpinning principles and commitments that have made NICE a world leader in delivering meaningful and legitimate patient involvement.

Healthcare decision makers are increasingly demanding that health technology assessment (HTA) is patient focused, and considers data about patients' perspectives on and experiences with health technologies in their everyday lives. Related data are typically generated through qualitative research, and in HTA the typical approach is to synthesize primary qualitative research through the conduct of qualitative evidence synthesis (QES). Abbreviated HTA timelines often do not allow for the full 6-12 months it may take to complete a QES, which has prompted the Canadian Agency for Drugs and Technologies in Health (CADTH) to explore the concept of "rapid qualitative evidence synthesis" (rQES). In this paper, we describe our experiences conducting three rQES at CADTH, and reflect on challenges faced, successes, and lessons learned. Given limited methodological guidance to guide this work, our aim is to provide insight for researchers who may contemplate rQES. We suggest several lessons, including strategies to iteratively develop research questions and search for eligible studies, use search of filters and limits, and use of a single reviewer experienced in qualitative research throughout the review process. We acknowledge that there is room for debate, though believe rQES is a laudable goal and that it is possible to produce a quality, relevant, and useful product, even under restricted timelines. That said, it is vital to recognize what is lost in the name of rapidity. We intend our paper to advance the necessary debate about when rQES may be appropriate, and not, and enable productive discussions around methodological development.

With advances in technology, wireless and sensor technologies represent a method for continuously recording people's biomedical signals, which may enhance the diagnosis and treatment of users' everyday health conditions. These technologies mostly target older adults. In this study, we examine a smart clothing system targeting clinically high-risk patients, including older adults with cardiovascular disease (31 outpatients) and older adults in general (81 participants), to obtain an understanding of the patients' perception of using wearable healthcare technologies. Given that technology anxiety has been shown to affect users' resistance to using new technology and that perceived ubiquity is considered a characteristic of wearable devices and other mobile wireless technologies, we included three external variables: i.e., technology anxiety, perceived ubiquity, and resistance to change, in addition to the traditional components of the technology acceptance model (TAM). The results of the hypothesized model showed that among older adults in general, technology anxiety had a negative effect on the perceived ease of use and perceived ubiquity. The perceived ubiquity construct affects both user groups' perceived ease of use and perceived usefulness of wearing smart clothes. Most relationships among the original constructs of the TAM were validated in older adults in general. Interestingly, we found that perceived usefulness had an indirect effect on behavioral intention through attitude. These results further confirm the validity of the extended TAM in determining older users' technology acceptance behavior., Competing Interests: The authors have declared that no competing interests exist.

Background: The integration of telehealthcare technologies into geriatric care has clear advantages, but poses challenges for key stakeholders, including the telehealthcare service industry, smart device developers, marketers and, of course, users. The purpose of this study was to gain insight into user experience and acceptance of telehealthcare technology in Taiwan. Materials and Methods: Taking an integrated mixed-methods approach, 51 participants-33 women (64.71%) and 18 men (35.29%) (mean age: 52.1 years)-were examined before, during, and after using a telehealthcare device. A questionnaire was used to assess users' acceptance of the technology. Interviews were conducted to gather feedback. Results: The quantitative analysis revealed that (1) effort expectancy and relatives significantly influenced users' behavior intentions, (2) error and memorability significantly affected users' satisfaction, and (3) intention and satisfaction significantly affected users' behavior. The qualitative analysis revealed two key implications. First, participants generally were not satisfied with the telehealthcare device. Second, participants suggested the redesign of the telehealthcare device to reduce operating errors and time consumption to meet users' needs. Conclusions: Contemporary telehealthcare devices do not meet users' needs. Participants were made to adapt to the equipment rather than the equipment tailored to meet their needs. Although there were key benefits from home telehealthcare, the systems require enhanced technology, improved usability, and an expanded scale of services backed by government before widespread implementation can successfully proceed.

Remote monitoring has often been thought to lead to a highly structured and standardised care process. Several studies have stressed that patient-provider communication could be hindered if mediated by technologies, leading to an impoverished relationship. We argue that while remote monitoring leads to a redefinition of the patient-provider relationship, it could also offer the opportunity to develop a more intimate acquaintance not possible via only routine visits. The study is part of a clinical trial aimed at assessing the acceptability of a remote monitoring platform for type 1 diabetes. Drawing on practice-based studies, we focused our analysis on the practice of text message exchange between patients and providers. The 396 conversations were coded with a template analysis, leading to the identification of two main categories: 'knowing the patient' and 'knowing about the patient'. The analysis reveals that the practice of messaging led to the development of a 'digital intimacy', a relationship characterised by a thorough familiarity made possible by electronic devices that extends to face-to-face encounters. Drawing on our case, we argue that remote monitoring can foster greater intimacy between patients and providers, which is made possible by the overall increase in the quantity and quality of communication between patients and providers., (Chapters © 2019 The Authors. Book Compilation © 2019 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.)

Intensive longitudinal data studies on affective reactivity to daily life stress have used various dimensions of stress. Based on an evidence-based conceptual model of stress, the current study included unpredictability, uncontrollability and unpleasantness, and examined whether and how these predict affective reactivity in depressed and non-depressed individuals in daily life. Participants (27 depressed, 27 non-depressed) completed a diary 3 times a day for a period of 30 days. Multilevel analyses were performed to investigate unpleasantness, uncontrollability and unpredictability of daily events as univariate predictors of negative affect (NA). Multivariable models were composed to determine the optimal combination of stress dimensions, and whether the strength of the predictions differed between the depressed and non-depressed groups. Unpleasantness, uncontrollability and unpredictability each predicted subsequent NA independently. However, a combination of all three dimensions, together with an interaction between unpleasantness and uncontrollability, predicted subsequent NA best. The stress dimensions predicted NA more strongly in the depressed than the non-depressed group. This was mostly accounted for by an increased NA response to unpleasantness. Thus, unpleasantness seems to be the most important aspect of daily stress to distinguish depressed from non-depressed individuals. Nevertheless, for a comprehensive assessment of affective reactivity, a multidimensional model of event stressfulness is recommended., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Smart insole technologies that provide biofeedback on foot health can support foot-care in adults with diabetes. However, the factors that influence patient uptake and acceptance of this technology are unclear. Therefore, the aim of this mixed-methods study was to use an established theoretical framework to determine a model of psychosocial factors that best predicts participant intention to use smart insoles., Methods: Fifty-three adults with diabetes from regional Australia completed the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the psychosocial factors that best predict behavioural intention to adopt a smart insole. Additionally, a focus group was conducted and thematic analysis was performed to explore barriers and enablers to adopting this technology., Results: The multiple regression model that best predicted intention to adopt the smart insole (adjusted R 2  = 0.51, p  < 0.001) identified that self-efficacy (β = 0.67, p  = 0.001) and attitude (β = 0.72, p < 0.001) were significant predictors of behavioural intention, while effort expectancy (β = - 0.52, p  = 0.003) and performance expectancy (β = - 0.40, p  = 0.040) were moderating factors. Thematic analysis illustrates the importance of attitude and self-efficacy on participants' behavioural intentions, influenced by participant's belief in the device's clinical efficacy and anticipated effort expectancy., Conclusions: This mixed-methods study demonstrates that attitude, self-efficacy, performance expectancy and effort expectancy combine to predict intention to adopt smart insole technology. Clinicians should consider these psychosocial factors when they prescribe and implement smart soles with patients at high risk of foot ulceration., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Background: Smart wristbands enable the continuous monitoring of health parameters, for example, in maternity care. Understanding the feasibility and acceptability of these devices in an authentic context is essential. The aim of this study was to evaluate the feasibility of using a smart wristband to collect continuous activity, sleep and heart rate data from the beginning of the second trimester until one month postpartum., Methods: The feasibility of a smart wristband was tested prospectively through pregnancy in nulliparous women (n = 20). The outcomes measured were the wear time of the device and the participants' experiences with the smart wristband. The data were collected from the wristbands, phone interviews, questionnaires, and electronic patient records. The quantitative data were analyzed with hierarchical linear mixed models for repeated measures, and qualitative data were analyzed using content analysis., Results: Participants (n = 20) were recruited at a median of 12.9 weeks of gestation. They used the smart wristbands for an average of 182 days during the seven-month study period. The daily use of the devices was similar during the second (17.9 h, 95% CI 15.2 to 20.7) and third trimesters (16.7 h, 95% CI 13.8 to 19.5) but decreased during the postpartum period (14.4 h, 95% CI 11.4 to 17.4, p = 0.0079). Participants who could not wear smart wristbands at work used the device 300 min less per day than did those with no use limitations. Eight of the participants did not wear the devices or wore them only occasionally after giving birth. Nineteen participants reported that the smart wristband did not have any permanent effects on their behavior. Problems with charging and synchronizing the devices, perceiving the devices as uncomfortable, or viewing the data as unreliable, and the fear of scratching their babies with the devices were the main reasons for not using the smart wristbands., Conclusions: A smart wristband is a feasible tool for continuous monitoring during pregnancy. However, the daily use decreased after birth. The results of this study may support the planning of future studies and help with overcoming barriers related to the use of smart wristbands on pregnant women.

Background: Obstructive sleep apnea syndrome, a chronic respiratory disease, requires regular adherence to Continuous Positive Airway Pressure (CPAP) therapy. Telemonitoring may be relevant to support adherence, but nonetheless this raises ethical issues around the intrusive nature of the daily life of patients Objective: To explore the acceptance of telemonitoring by patients and the impact of this on adherence., Materials and Methods: A prospective and observational study has been performed with 160 patients who initiated their CPAP therapy. The acceptability of telemonitoring was studied using an attitudes' scale of 8 items. A total of 160 patients (111 men, 49 women) responded to the questionnaire at 1 month upon treatment. The adoption of both telemonitoring and adherence behavior were observed at 10 months of therapy., Results: A majority (78%) of patients expressed a favorable attitude toward telemonitoring, but nearly 40% consider this device like intrusive. However, at 10 months of treatment, 78% of patients are still telemonitored. We did not observe a significant difference between telemonitoring patients and nontelemonitoring patients with respect to the mean duration of use of CPAP therapy. However, the risk of stopping CPAP therapy is significantly more important in patients who refused telemonitoring., Discussion and Conclusion: It seems reductive to consider telemonitoring as a simple tool of surveillance to support adherence. It may be preferable to consider telemonitoring as a follow-up proposal. This will allow for more reactive management and close to the needs of the patients, in particular as telemonitoring is, in general, well accepted by patients.

Background: Despite significant advances in type 1 diabetes (T1D) management, achieving targeted glycemic control in pediatric patients remains a struggle. Continuous glucose monitoring (CGM) with remote access holds the promise to address this challenge by allowing caregivers to monitor glucose, even when the child is not directly under their supervision., Objective: To explore real-time and remote CGM practices in homes and schools, including caregiver expectations regarding this technology., Subjects: Parents and daytime caregivers., Methods: Respondents answered an anonymous survey assessing characteristics of CGM use. Cross-sectional data were collected and analyzed using quantitative and qualitative methods., Results: Thirty-three parents and 17 daytime caregivers responded. Threshold alerts (alerts when patients reached certain pre-set high or low limits) were used most frequently, followed by rate of change alerts. Most parents and daytime caregivers responded to low- and high-threshold CGM alerts by confirming with a glucose meter prior to treatment; while about one-third endorsed treating lows without a confirmatory test. Most parents expected their child's daytime caregiver to respond to CGM alerts and daytime caregivers felt the parent's expectations of them were reasonable. All parents and most caregivers reported decreased overall worry/stress. Parents felt positive about CGM use and daytime caregivers felt comfortable with CGM., Conclusion: The positive and collaborative management reported by parents and daytime caregivers sets the stage for CGM to play an important role in the management of children with T1D both in the home and in the school settings., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Little research exists regarding how real-time continuous glucose monitoring (RT-CGM) data sharing plays a role in the relationship between patients and their care partners., Objective: To (1) identify the benefits and challenges related to RT-CGM data sharing from the patient and care partner perspective and (2) to explore the number and type of individuals who share and follow RT-CGM data., Methods: This qualitative content analysis was conducted by examining publicly available blogs focused on RT-CGM and data sharing. A thematic analysis of blogs and associated comments was conducted., Results: A systematic appraisal of personal blogs examined 39 blogs with 206 corresponding comments. The results of the study provided insight about the benefits and challenges related to individuals with diabetes sharing their RT-CGM data with a care partner(s). The analysis resulted in three themes: (1) RT-CGM data sharing enhances feelings of safety, (2) the need to communicate boundaries to avoid judgment, and (3) choice about sharing and following RT-CGM data. RT-CGM data sharing occurred within dyads (n = 46), triads (n = 15), and tetrads (n = 2)., Conclusions: Adults and children with type 1 diabetes and their care partners are empowered by the ability to share and follow RT-CGM data. Our findings suggest that RT-CGM data sharing between an individual with diabetes and their care partner can complicate relationships. Healthcare providers need to engage patients and care partners in discussions about best practices related to RT-CGM sharing and following to avoid frustrations within the relationship.

Background and Aims: To evaluate the clinical accuracy of a flash glucose monitoring device FreeStyle Libre (FSL) among children with type 1 diabetes in real-world settings during a summer camp., Materials and Methods: During a summer camp, children with type 1 diabetes (n = 79, aged 8-18 years) were provided with FSLs for 12 days. On days 3, 7, and 11 of the study, they underwent supervised glucose testing at 8 timepoints. Glycemia was estimated by using FSL and measured with a personal glucometer within a period of 2 min. The glucose trend arrows were recorded., Results: The study was completed by 78 children (median: age 12.8 years, diabetes duration 5.8 years, HbA1c 58.5 mmol/mol). Mean absolute relative difference (MARD) between the FSL and the glucometer was 13.5% ± 12.9%. FSL was the most accurate in stable glycemic conditions: MARD 11.4% ± 10.4%, less accurate when glycemia was falling >2 mg/(dL·min) [0.111 mmol/(L·min)-MARD 22.6% ± 18.6%; P < 0.001 vs. stable conditions] and when the device could not determine the glucose trends (16.5% ± 16.3%, P = 0.01 vs. stable conditions). The FSL demonstrated lower accuracy during the day than the night [MARD 14.9% ± 14% vs. 11.2% ± 10.6%, P < 0.0001]. Out of 1655 data pairs of glucometer and FSL, using the Surveillance Error Grid methodology we determined that 80.36% of FSL readings were associated with no clinical risk, 18.73% with slight risk and only one high-risk measurement was detected., Conclusion: FSL is accurate in children, but its accuracy depends on the glucose trend. Results flagged by the rapid fall flag and "trend undetermined" should be verified by blood glucose measurements.

Enhancing engagement of patients during stroke rehabilitation exercises are in the focus of current research. Various methods and computer supported tools have been developed for this purpose, which try to avoid mundane exercising that is prone to become a routine or even boring for the patients and leads to ineffective training. This paper introduces an engagement enhancing cyber-physical stroke rehabilitation system (CP-SRS) aiming at enhancing the patient's engagement during rehabilitation training exercises. This paper focuses on introducing the implementation and validation of the engagement monitoring subsystem (EMS) in the CP-SRS. The EMS is expected to evaluate the patient's actual engagement levels in motor, perceptive, cognitive and emotional aspects. Experiments in these four aspects were conducted separately, in order to characterize the range and accuracy of the engagement indicators by influencing the subjects into different engaged states. During the experiments, different setups were created to mimic the situations in which the subject was engaged or not engaged. The subjects involved in the experiments were healthy subjects. Results showed that the measurement in motor, perceptive, cognitive, and emotional aspects can represent the corresponding engagement level. More experiments will be conducted in the future to validate the efficiency of the CP-SRS in enhancing the engagement with stroke patients.

Background: Home tele-monitoring (HTM) is used to monitor the clinical signs and symptoms of patients with chronic heart failure (CHF) in order to reduce unplanned hospital admissions. However, not all patients who are referred will agree to use HTM, and some patients choose to withdraw early from its use., Aims: ADaPT-HF will investigate whether depression, anxiety, low perceived control, reduced technology capability, level of education, age or the severity or complexity of a patient's illness can predict refusal of, or early withdrawal from, HTM in patients with CHF., Methods: The study will recruit 288 patients who have been recently admitted to hospital with heart failure who have been referred for HTM. At the time of referral, patients will complete depression (nine-item Patient Health Questionnaire), anxiety (seven-item Generalised Anxiety Disorder questionnaire), perceived control (eight-item revised Controlled Attitudes Scale) and technology capability (ten-item Technology Readiness Index 2.0) screening questionnaires. In addition, data on demographics, diagnosis, clinical examination, socio-economic status, history of comorbidities, medication, biochemistry and haematology will be recorded. The primary outcome will be a composite of refusal of or early withdrawal from HTM. The principle analysis will be made using logistic regression., Conclusion: By establishing which factors influence a patient's decision to refuse or withdraw early from HTM, it may be possible to redesign HTM referral processes. It may be that patients with CHF who also have depression, anxiety, low control and poor technology skills should not be referred until they receive appropriate support or that they should be managed differently when they do receive HTM. The results of ADAPT-HF may provide a way of making more efficient and cost-effective use of HTM services.

Purpose: The purpose of this study was to examine how fear of hypoglycemia (FOH) is associated with glycemic variability (GV) and self-management behavior in young adults (aged 18-35) with type 1 diabetes (T1DM)., Procedures: Using a prospective repeated-measures design, in 35 young adults, within- and between-person and temporal associations of FOH, specific self-management behaviors, and GV were measured. The data were collected using questionnaires and real-time measures using daily diaries, insulin pump downloads, actigraphy, and continuous glucose monitoring., Findings: FOH was associated with greater glycemic variability. Significant temporal associations emerged. Concurrent day (glucose SD, p=.011) and previous-evening fear levels were associated with GV (glucose SD, p=.007). FOH was also associated with greater calorie intake (r=.492, p=.003) and less physical activity (light activity, r=-.341, p=.045)., Conclusions: The significant associations of FOH with GV, dietary patterns, and physical activity provide evidence for FOH as an important psychological factor associated with diabetes care., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to synthesize the available qualitative studies on the meaning of assistive technologies (AT) in elderly people's everyday lives in order to identify central concepts, themes, and findings from existing research., Method: A systematic search of the literature was conducted, using predetermined search strategies. Exclusion criteria were, in accordance with the meta-interpretive approach, developed iteratively during the reading of abstracts and articles. Interpretations from the studies were used as data for thematic analysis and synthesis of findings., Results: Review of these studies show that older people not only have positive attitude towards AT, but also that acceptance of technologies is a potentially stressful process where trust towards technologies and other people are of importance. Older people have ambivalent experiences with technology, as it gives rise to possibilities as well as constraints, and safety as well as worries. AT enact sometimes conflicting values related to self and society., Conclusions: Although AT seem to support societal discourses on active aging, the empirical studies in this field show that the technologies enter older people's lives in complex ways, enacting social values and ambivalences and interact with caretakers, relatives and other actors, within specific institutional settings. Implications for rehabilitation In implementing AT, attention should be paid to ambivalences and conflicting values enacted by AT in older people's lives In implementing AT, attention should be paid not only to independency but also to the eventually dependencies, created by the use of AT.

Background: Cardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR., Methods: A technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations., Results: Of 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = -0.16; p = 0.005)., Conclusions: CVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.

Background: The involvement of users is recommended in the development of health related technologies, in order to address their needs and preferences and to improve the daily usage of these technologies. The objective of this literature review was to identify the nature and extent of research involving older people in the development of fall detection systems., Methods: A scoping review according to the framework of Arksey and O'Malley was carried out. A key term search was employed in eight relevant databases. Included articles were summarized using a predetermined charting form and subsequently thematically analysed., Results: A total of 53 articles was included. In 49 of the 53 articles, older people were involved in the design and/or testing stages, and in 4 of 53 articles, they were involved in the conceptual or market deployment stages. In 38 of the 53 articles, the main focus of the involvement of older people was technical aspects. In 15 of the 53 articles, the perspectives of the elderly related to the fall detection system under development were determined using focus groups, single interviews or questionnaires., Conclusions: Until presently, involvement of older people in the development of fall detection systems has focused mainly on technical aspects. Little attention has been given to the specific needs and views of older people in the context of fall detection system development and usage.

Background: Recently, we demonstrated that transdermal alcohol monitors could be used in a contingency management procedure to reduce problematic drinking; the frequency of self-reported heavy/moderate drinking days decreased and days of no to low drinking increased. These effects persisted for three months after intervention. In the current report, we used the transdermal alcohol concentration (TAC) data collected prior to and during the contingency management procedure to provide a detailed characterization of objectively measured alcohol use., Methods: Drinkers (n=80) who frequently engaged in risky drinking behaviors were recruited and participated in three study phases: a 4-week Observation phase where participants drank as usual; a 12-week Contingency Management phase where participants received $50 each week when TAC did not exceed 0.03g/dl; and a 3-month Follow-up phase where self-reported alcohol consumption was monitored. Transdermal monitors were worn during the first two phases, where each week they recived $105 for visiting the clinic and wearing the monitor. Outcomes focused on using TAC data to objectively characterize drinking and were used to classify drinking levels as either no, low, moderate, or heavy drinking as a function of weeks and day of week., Results: Compared to the Observation phase, TAC data indicated that episodes of heavy drinking days during the Contingency Management phase were reduced and episodes of no drinking and low to moderate drinking increased., Conclusions: These results lend further support for linking transdermal alcohol monitoring with contingency management interventions. Collectively, studies to date indicate that interventions like these may be useful for both abstinence and moderation-based programs., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Technological advances in monitoring vulnerable care-recipients are on the rise. Recent and future development of Smart Wear technology (devices integrated into clothing that monitor care-recipients) might assist family caregivers with tasks related to caring for young children, relatives with disabilities, and frail spouses or parents. However, the development and use of this technology in family caregiving contexts is in its infancy. Focus group interviews of family caregivers were conducted to explore perspectives regarding the potential integration of Smart Wear technology into their family caregiving. Responses were analyzed qualitatively for themes related to perceptions of how Smart Wear could impact relationships between caregivers and care-recipients. Three major themes emerged: quality and quantity of interaction, boundary issues, and implications for anxiety. Implications and recommendations are discussed regarding maximizing the potential benefits of Smart Wear technology in ways that promote and protect healthy relationships among caregivers and care-recipients.

Purpose: We investigated the feasibility and acceptance of electronic monitoring of symptoms and syndromes in oncological outpatient clinics using a PALM (handheld computer)., Methods: The assessment of a combination of symptoms and clinical benefit parameters grouped in four pairs was tested in a pilot phase in advanced cancer patients. Based on these experiences, the software E-MOSAIC was developed, consisting of patient-reported symptoms and nutritional intake and objective assessments (weight, weight loss, performance status and medication for pain, fatigue, and cachexia). E-MOSAIC was then tested in four Swiss oncology centers. In order to compare the methods, patients completed the E-MOSAIC as a paper and a PALM version. Preferences of version and completion times were collected. Assessments were compared using Wilcoxon signed-rank tests , and the test-retest reliability was evaluated., Results: The pilot phase was completed by 22 patients. Most patients and physicians perceived the assessment as useful. Sixty-two patients participated in the feasibility study. Twelve patients reported problems (understanding, optical, tactile), and five patients could not complete the assessment. The median time to complete the PALM-based assessment was 3 min. Forty-nine percent of patients preferred the PALM, 23 % preferred a paper version, and 28 % of patients had no preference. Paper vs. PALM revealed no significant differences in symptoms, but in nutritional intake (p = 0.013). Test-retest (1 h, n = 20) reliability was satisfactory (r = 073-98)., Conclusion: Electronic symptom and clinical benefit monitoring is feasible in oncology outpatient clinics and perceived as useful by patients, oncology nurses, and oncologists. E-MOSAIC is tested in a prospective randomized trial.

Objectives: The aim of the present study was to qualitatively explore users' experiences of home monitoring of health with specific regard to physical activity monitors., Methods: Fourteen participants were randomly selected from a larger sample of individuals with rheumatoid arthritis (RA) who had taken part in a physical activity monitoring study and had worn two physical activity monitors for seven days in their homes. These individuals were assigned to one of two focus groups. Each focus group lasted for between 40 minutes and an hour and was audio-recorded. A semi-structured questioning route was used, followed by subsequent theoretical thematic analysis., Results: No statistically significant differences were noted in the demographic factors between those who took part in the focus groups and the entire RA sample. Three distinct themes were identified: i) Experiences of having health monitored in the home, which was found to be largely positive; ii) Experiences of use of specific technology to monitor physical activity, which was generally reported as unobtrusive and not to impact significantly negatively on their daily life; iii) Perceptions and experiences of physical activity and exercise, which monitoring was reported to facilitate focusing on physical activity choices., Conclusions: These focus groups were the first to highlight the perceptions held by individuals with RA regarding home monitoring and, in particular, physical activity monitoring. This has implications for those planning interventions for this group which involve home monitoring. Interesting findings were also highlighted regarding the perceptions and understanding of physical activity and exercise among people with RA., (Copyright © 2012 John Wiley & Sons, Ltd.)

Objective: To examine whether wearing a pedometer was associated with higher objectively-measured physical activity (PA) among adolescents independent of other behavior change strategies, and whether this association differed by sex or day of wear., Method: In a parallel-group population-based cohort study, 892 adolescents (43.4% male, mean±SD age, 14.5±0.5years) from Eastern England were recruited. PA was measured (in 2005-2006) by accelerometry over four days; a sub-group (n=345) wore a pedometer coterminously with the accelerometer. Three-level (individual, day of wear and school level) multiple linear regression was used to examine the association between accelerometry (counts/min, cpm) and pedometer wear, stratified by sex and adjusted for weekday/weekend., Results: For the entire cohort, there was a significant decline in cpm over four days (p<0.01). Girls wearing pedometers had higher mean cpm than those not wearing a pedometer, independent of BMI z-score, socio-economic status, weekday/weekend, and school clustering (β=5.1; 95% CI: 0.8 to 9.5, p=0.02). This association was not seen in boys., Conclusion: Pedometer wear was associated with higher PA among adolescent girls, but not boys. Findings may support sex-specific intervention strategies. In addition to pedometer monitoring, additional strategies may be required to promote PA levels, especially among boys., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: Effects of self-monitoring depend on how patients engage with readings and how this engagement is used for managing chronic disease. This article reports on a study of how chronic obstructive pulmonary disease (COPD) patients made use of readings during 16 weeks of self-monitoring., Patients and Methods: Semistructured interviews were conducted with 22 COPD patients three times each: at the beginning, halfway through, and after the monitoring device was collected. Spouses of nine interviewees were present during one or more interviews. The analysis of how patients used self-monitored readings was based on critical psychology., Results: Patients used readings to monitor bodily condition, to judge whether and when to contact health professionals, to communicate with health professionals about health management, to revise planned activities, to engage close relatives, and to motivate exercise and other health behavior. Self-monitoring can produce a sense of security as readings provide grounds for explaining symptoms and widen the scope of possibilities for taking action. Patients experienced readings as encouraging, reassuring, depressing, worrisome, and at times disturbing. A few patients involved themselves with readings in ways that are emotionally challenging and contrary to medical advice. Reasons for not making use of self-monitoring include good health or not regarding monitoring as relevant at the time., Conclusions: Results can qualify the support health professionals offer in relation to patients' self-monitoring and self-management.

Background: How does real-time (RT) continuous glucose monitoring (CGM) affect quality of life (QOL)? We explored the types and frequencies of diabetes-specific QOL changes resulting from RT-CGM as reported by current users and investigated what patient-reported factors predict these changes., Subjects and Methods: Current RT-CGM users (n = 877) completed an online questionnaire investigating perceived QOL benefits/losses since RT-CGM initiation and RT-CGM attitudes and behavior. Exploratory factor analysis (EFA) examined the 16 QOL benefit/loss items to identify underlying factors. Regression analyses examined associations between demographics and RT-CGM attitudes and behavior with the QOL factors emerging from the EFA., Results: Three major QOL factors emerged: Perceived Control over Diabetes, Hypoglycemic Safety, and Interpersonal Support. QOL improvement was common for Perceived Control over Diabetes and Hypoglycemic Safety (86% and 85% of respondents, respectively), although less common for Interpersonal Support (37%). Consistent independent predictors of perceived benefits were greater confidence in using RT-CGM data (P<0.001), satisfaction with device accuracy (P ≤ 0.05) and usability (P<0.01), older age (P<0.01), more frequent receiver screen views (P<0.05), and use of multiple daily injections (Hypoglycemic Safety and Interpersonal Support, P ≤ 0.05)., Conclusions: Diabetes-specific QOL benefits resulting from RT-CGM were common. Major predictors of QOL benefits were satisfaction with device accuracy and usability and trust in one's ability to use RT-CGM data, suggesting that "perceived efficacy," for both device and self, are key QOL determinants. Psychoeducational strategies to boost confidence in using RT-CGM data and provide reasonable device expectations might enhance QOL benefits.

Background: Mobile phone based remote monitoring of medication adherence and physiological parameters has the potential of improving long-term graft outcomes in the recipients of kidney transplants. This technology is promising as it is relatively inexpensive, can include intuitive software and may offer the ability to conduct close patient monitoring in a non-intrusive manner. This includes the optimal management of comorbidities such as hypertension and diabetes. There is, however, a lack of data assessing the attitudes of renal transplant recipients toward this technology, especially among ethnic minorities., Objective: To assess the attitudes of renal transplant recipients toward mobile phone based remote monitoring and management of their medical regimen; and to identify demographic or clinical characteristics that impact on this attitude., Methods: After a 10 minute demonstration of a prototype mobile phone based monitoring system, a 10 item questionnaire regarding attitude toward remote monitoring and the technology was administered to the participants, along with the 10 item Perceived Stress Scale and the 7 item Morisky Medication Adherence Scale., Results: Between February and April 2012, a total of 99 renal transplant recipients were identified and agreed to participate in the survey. The results of the survey indicate that while 90% (87/97) of respondents own a mobile phone, only 7% (7/98) had any prior knowledge of mobile phone based remote monitoring. Despite this, the majority of respondents, 79% (78/99), reported a positive attitude toward the use of a prototype system if it came at no cost to themselves. Blacks were more likely than whites to own smartphones (43.1%, 28/65 vs 20.6%, 7/34; P=.03) and held a more positive attitude toward free use of the prototype system than whites (4.25±0.88 vs 3.76±1.07; P=.02)., Conclusions: The data demonstrates that kidney transplant recipients have a positive overall attitude toward mobile phone based health technology (mHealth). Additionally, the data demonstrates that most kidney transplant recipients own and are comfortable using mobile phones and that many of these patients already own and use smart mobile phones. The respondents felt that mHealth offers an opportunity for improved self-efficacy and improved provider driven medical management. Respondents were comfortable with the idea of being monitored using mobile technology and are confident that their privacy can be protected. The small subset of kidney transplant recipients who are less interested in mHealth may be less technologically adept as reflected by their lower mobile phone ownership rates. As a whole, kidney transplant recipients are receptive to the technology and believe in its utility.

We aimed at providing a short review on already published studies addressing psycho-social issues of personal health monitoring (PHM). Both core questions addressed within this review are: What is the impact of PHM on intended psycho-social and health-related outcomes? And which psycho-social issues affected by or related to PHM have already been investigated? This descriptive review based on a literature search using various databases (Psycinfo, Psyndex, Pubmed, SSCI). Resulting 428 abstracts were coded regarding their psycho-social content. Inspection of results was carried out along the relevance of the papers regarding psycho-social issues. Research in PHM focuses on telemonitoring and smart home applications: Tele-monitoring studies are directed to outcome-related questions, smart home studies to feasibility issues. Despite of technological matters, comparability of both systems in psycho-social issues is lacking. Tele-monitoring has been proven for impact on patient groups with chronic diseases, yet smart home still lacks evidence in health-related and psycho-social matters. Smart home applications have been investigated with respect to attitudes, perceptions and concerns of end-users, telemonitoring regarding acceptance and adherence.

This paper presents results of a study to understand potential barriers of geriatric population with chronic illnesses towards adoption of a wireless wearable medication compliance system in the form of a neckwear. The neck being a critical part of the body can serve as a good source to collect a range of health related information on an individual. The primary research question we investigate here is this: for individuals with chronic illnesses especially amongst the elderly population how willing are they to adopt a neckwear system if it can monitor and mitigate health complications? Elderly patients deal with constant prescription changes over time and this further degrades medication compliance and thereby complicates an already wavering health status. A semi-structured interview was conducted to better understand medication adherence, regimen and issues encountered using reminder devices with the goal of informing the design of a new compliance monitoring system. Results show that preserving health is one of the primary concerns of people living with chronic illnesses therefore there is a promising potential for seamless adoption of a neckwear medication compliance system with additional capabilities to monitor general health status.

This contribution to an interdisciplinary methodology on Personal Health Monitoring (PHM) aims at developing a psycho-social module for health technology assessment on PHM applications. It covers important aspects that should be taken into account for conducting a health technology assessment from a psycho-social perspective. As it could be used in addition to other tools within the PHM-Ethics approach to health technology assessment it is considered as a module of the interdisciplinary methodology. As a prerequisite, we provide a conceptual framework on psycho-social issues of PHM applications. From that framework we delineate an integrated module for psycho-social health technology assessment for PHM applications, consisting of a map highlighting selective psycho-social issues that may appear when applying a PHM system. This psycho-social tool is at least twofold in its intention as a sole HTA tool on the one hand and as an integral part of the interdisciplinary PHM methodology on the other hand. It provides a quick overview on potential benefits and risks from the user's point of view.

Background: Despite frequent use of pedometers in interventions targeting youth PA, there is no literature that addresses the prevalence and reasons for protocol nonadherence., Methods: Adherence behaviors of early adolescents (n = 43; Meanage = 12.3 ± 1.0) in an 8-week, faith-based intervention were monitored/recorded. Students provided reasons for various aspects of protocol breach, which were used to develop a post intervention questionnaire. Analyses included calculations of frequency/percentage as well as cross tabulations/chi square to detect gender/age differences., Results: Over the intervention, recording PA in logs decreased by 85% and was attributed to forgetfulness and lack of time. For pedometers, highest-frequency events included error codes (n = 501), incorrect wear (37%, ≥ 1 day), and shaking (58%-69%, ≥ 1 time). Top reasons for shaking were to make up for lost step opportunities and get further along the route. Of permissible stepping strategies, males used ambulatory activity on the playground and stair usage more, while 6th graders used speed stepping in place more than their respective counterparts., Conclusions: Students admit to basal levels of nonadherence, which should be taken into consideration when designing/implementing interventions. Integrating intervention tasks into the regular curriculum and providing sufficient opportunities to perform them may alleviate some barriers to adherence. Future research should attempt to confirm results in other school types/levels as well as quantify these behaviors in free-living or unstructured settings.

In this study two currently relevant aspects of using medical assistive technologies were addressed-security and privacy. In a two-step empirical approach that used focus groups (n = 19) and a survey (n = 104), users' requirements for the use of medical technologies were collected and evaluated. Specifically, we focused on the perceived importance of data security and privacy issues. Outcomes showed that both security and privacy aspects play an important role in the successful adoption of medical assistive technologies in the home environment. In particular, analysis of data with respect to gender, health-status and age (young, middle-aged and old users) revealed that females and healthy adults require, and insist on, the highest security and privacy standards compared with males and the ailing elderly.

Objective: The promotion of dog walking among owners who do not walk their dogs regularly may be a viable physical activity intervention aperture, yet research is very limited and no intervention studies have employed control groups. Therefore, the purpose of this pilot study was to examine the viability of dog walking for physical activity intervention using messages targeting canine exercise., Method: Inactive dog owners (n=58) were randomized to either a standard control condition or the intervention (persuasive material about canine health from walking and a calendar to mark walks) after completing a baseline questionnaire package and wearing a pedometer for one week. Participants (standard condition n=28; intervention condition n=30) completed the six and 12 week follow-up questionnaire packages., Results: Intention to treat analyses showed that both groups increased physical activity significantly across the 12 weeks (η(2)=0.09 to 0.21). The intervention group resulted in significantly higher step-counts compared to the control group (Δ 1823 steps) and showed significantly higher trajectories from baseline to 12 weeks in the self-reported physical activity measures (η(2)=0.11 to 0.27)., Conclusion: The results are promising for the viability of increasing dog walking as a means for physical activity promotion and suggest that theoretical fidelity targeting canine exercise may be a helpful approach., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Pedometers provide a simple, cost effective means of motivating individuals to increase walking yet few studies have considered if short term changes in walking behaviour can be maintained in the long-term. The role of physical activity consultations in such interventions is unclear. The purpose of this study was to assess the sustainability of pedometer-based interventions and empirically examine the role of physical activity consultations using long-term results of a community-based walking study., Methods: 79 low active Scottish men and women (63 women and 16 men) from the Walking for Wellbeing in the West intervention study were randomly assigned to receive either: Group 1; pedometer-based walking programme plus physical activity consultations or Group 2; pedometer-based walking programme and minimal advice. Step counts (Omron HJ-109E Step-O-Meter pedometer), 7 day recall of physical activity (IPAQ long), mood (PANAS) and quality of life (EuroQol EQ-5D) were assessed pre-intervention and 12, 24 and 48 weeks after receiving the intervention. Body mass, body mass index and waist and hip circumference were assessed pre-intervention and 12 and 24 weeks after receiving the intervention. Analyses were performed on an intention to treat basis (baseline value carried forward for missing data) using mixed-factorial ANOVAs and follow-up t-tests., Results: A significant main effect of time (p < 0.001) was found for step-counts attributable to significant increases in steps/day between: pre-intervention (M = 6941, SD = 3047) and 12 weeks (M = 9327, SD = 4136), t(78) = - 6.52, p < 0.001, d = 0.66; pre-intervention and 24 weeks (M = 8804, SD = 4145), t(78) = - 4.82, p < 0.001, d = 0.52; and pre-intervention and 48 weeks (M = 8450, SD = 3855), t(78) = - 4.15, p < 0.001, d = 0.44. Significant effects were found for several variables of self-reported physical activity, mood and quality of life and are discussed. No other significant effects in health related outcomes were found., Conclusion: Both interventions successfully increased and maintained step counts over 12 months. Physical activity consultations may encourage individuals to be active in other ways beyond walking and to reduce sitting time., Trial Registration Number: Current Controlled Trials Ltd ISRCTN88907382.

Aims: The increasing volume of pacemaker (PM) and implantable cardioverter defibrillator (ICD) implants and problems related to their functioning have highlighted the issue of device follow-ups. Patients' convenience regarding device visits has been little investigated. This work aims at surveying patients' efforts in attending the in-office PM/ICD follow-ups and at evaluating their expectations., Methods and Results: In four Italian referral centres, over a 3-month period, a 20-point questionnaire was completed by all consecutive patients at in-hospital PM/ICD visits. In total, 1109 questionnaire/patients were evaluated. Pacemakers were 68%, ICDs 16%, and cardiac resynchronizations (CRTs) (PM + ICD) 16%; 38% were females; mean age was 75 ± 11 years. Almost all were scheduled visits. There was frequent reprogramming and clinical examination, even after 6 months from implant. Perceived inconvenience for the in-office follow-up was relevant in 35% of cases; attitudes towards remote monitoring were positive in 88% of cases. Inter-group analysis showed some significant difference: PM patients were older and more frequently female; ICD carriers were younger, had the highest rate of clinical evaluation, a longer journey time, and the most positive opinion about remote follow-up. Cardiac resynchronization patients had a longer waiting time and the lowest inconvenience. Overall inconvenience was independently predicted by increasing age, lengthy travelling times, and being accompanied; favourable opinions about remote monitoring were predicted by overall inconvenience, and, in ICD carriers only, by lack of clinical examination., Conclusions: Patients' perceptions of in-hospital PM/ICD visits were affected by age and by journey modalities. Individual factors seem to affect both opinions about in-office visits and expectations towards a possible remote follow-up.

As part of the development of a quality of life monitor for women with breast cancer, a qualitative acceptability test was conducted among 10 patients, to assess their suggestions for improvement. Next, a field test was conducted among 50 women with breast cancer receiving radiotherapy, chemotherapy, or both treatments to examine the use of the monitor in daily practice and to assess physicians' and patients' experiences with the monitor. Although patients in general held a positive attitude toward the monitor and compliance was high, patients regularly were unsure about how the quality of life information was used by physicians.

Background: There is conflicting evidence regarding the relationship between socio-economic position (SEP) and physical activity in adolescents. The aim of this study was to investigate associations between SEP and characteristics of physical activity in Australian adolescents using a high-resolution use-of-time tool., Method: Use-of-time and pedometer data were collected on a random sample of 2071 9-16-year-old Australian children. Use-of-time was recorded using a computerised 24-h use-of-time recall, the Multimedia Activity Recall for Children and Adults. Reported household income was used as a marker of SEP., Results: There were no differences in self-reported minutes of moderate to vigorous physical activity (MVPA) across the income bands and only very small differences in the number of daily steps. However, the mix of MVPA components varied across income bands, with adolescents from low-SEP families experiencing less sport but more active transport. Because the mean rate of energy expenditure was greater in sport than in other forms of MVPA (play, active transport or chores), there were significant differences in MVPA-related and total daily energy expenditure across income bands, with the lower bands having significantly lower values. Differences in total daily energy expenditure were almost entirely explained by differences in energy expenditure associated with sport., Conclusion: Physical activity patterns vary across SEP bands in Australian adolescents, with sport being the major locus of differences. Instruments which do not account for the energy costs of various activities may fail to detect important relationships.

The role of physical activity amongst older people in inpatient rehabilitation settings has been little studied. Walking has a number of potential benefits for older people in rehabilitation but it is not known whether increased walking improves outcomes in this population. Until now mobility monitoring has not been possible in routine practice. Recently tri-axial accelerometers have been validated for ambulatory activity monitoring in older adults. Accelerometry has the potential to explore the role of walking in older patients in rehabilitation. Providing data regarding activity levels may improve patient motivation and assist clinicians with activity prescription. Future research could determine the relationship between activity levels and patient outcomes.

Purpose: Cancer cachexia impacts on treatment options, quality of life and survival. New treatments are emerging but need to be assessed using outcomes which patients find meaningful. One approach is the measurement of physical activity levels by small lightweight monitors, but experience is limited in cancer patients., Materials and Methods: This study formally assessed the acceptability of wearing an ActivPAL™ monitor for 1 week using compliance based on analysis of movement data. The optimal period of monitoring was explored by comparing mean values of daily step count and energy expenditure (EE) for 2 or 4 and 6 days of monitoring. The relationships between step count, stepping EE and non-stepping EE were also explored., Results: Sixty patients (mean age 68 years; Eastern Cooperative Oncology Group performance status 0-2) with lung or upper gastrointestinal cancer took part. All but one found that the monitor acceptable and mean [95% CI] compliance was 98% [94-100%]. Median daily step counts and EE scores over 2 or 4 days were significantly higher than those from 6 days (p ≤ 0.01). Step count was strongly related to stepping and non-stepping EE (r = -0.911, p < 0.01)., Conclusions: The ActivPAL™ is acceptable to patients with outcomes obtained over 6 days recommended for use in future studies.

Aims: To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes., Methods: Twenty adult patients (aged 45 +/- 15 years, diabetes duration 25 +/- 19 years, 50% female) followed at our site in the multi-centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into three groups: Glycated haemoglobin (HbA(1c)) Responders who demonstrated an improvement in glycaemic control with continuous glucose monitoring (baseline HbA(1c)> or = 7.0%, HbA(1c) reduction greater than or equal to 0.5%), Hypoglycaemia Responders (baseline HbA(1c) < 7.0%) who demonstrated decreased time < 3.9 mmol/l while remaining within target HbA(1c), and HbA(1c) Non-Responders (baseline HbA(1c)> or = 7.0%, HbA(1c) reduction less than 0.5%). Subjects participated in semi-structured interviews focusing on their psychosocial experiences with continuous glucose monitoring., Results: Three major themes were identified that differentiated Responders (including both the HbA(1c) and Hypoglycaemia groups) from Non-Responders: (i) coping with frustrations-Responders used self-controlled rather than emotions-based coping when faced with continuous glucose monitoring frustrations; (ii) use of information-Responders used retrospective pattern analysis, not just minute-by-minute data analysis, in glycaemic management; (iii) 'significant other'/spousal involvement-Responders endorsed interest, encouragement and participation by their loved ones. Both Responders and Non-Responders expressed body image concerns when wearing continuous glucose monitoring devices., Conclusions: This qualitative study points to the importance of coping skills, retrospective review of data, and 'significant other' involvement in the effective use of continuous glucose monitoring. These findings will inform clinical initiatives to improve patient selection and training in the use of this new technology and have served as the basis for development of quantitative surveys to be used in clinical practice.

in this study we examined the ethical aspects of the use of the Global Positioning Systems (GPS) to track people with dementia. The findings are based on qualitative data gathered from focus groups of family and professional caregivers. The most important theme was the need to balance patients' need for safety with the need to preserve their autonomy and privacy. The main potential benefit of the use of GPS was related to the peace of mind of the caregivers themselves. The findings also suggest that caregivers' views change according to the locus of responsibility of the caregivers for the safety of people with dementia. The caregivers give preference to patients' safety more than autonomy when they are responsible for the patients. When the patients are under the responsibility of other caregivers, they give preference to patients' autonomy more than their safety. Overall, the variety and the depth of the views of different stakeholders toward the use of electronic tracking for people with dementia presented in this article provide a meaningful contribution to the ethical debate on this topic.

This study evaluated older renal transplant recipients' perceptions of electronic medication monitoring and the influence of these perceptions on medication adherence. A sample of 73 older adult renal transplant recipients who used the Medication Event Monitoring System (MEMS(®)) TrackCaps for 12 months provided their perceptions of device use. Participants perceived that the MEMS had a neutral effect on their medication-taking routine (65%), believed the MEMS was practical (56%), and could not describe any instances in which using the MEMS was difficult (56%). No significant difference in medication adherence was found between those who perceived the MEMS's influence negatively/neutrally and those who perceived the MEMS positively (p = 0.22). Medication adherence data from older adult renal transplant recipients can be used regardless of their perceptions of the MEMS's influence on their medication taking without biasing medication adherence data., (Copyright 2009, SLACK Incorporated.)

Background: Limited research has been done on the compliance and acceptability of maintaining pedometer diaries for an extensive time frame in community-based interventions targeting minority populations., Methods: Community "coaches" led participants in a 6-month community-based walking intervention that included wearing pedometers and maintaining pedometer diaries for the study duration. Descriptive statistics and ANOVA tests were used to evaluate compliance rates for maintaining diaries and daily step counts. After the intervention, focus groups were used to explore opinions regarding pedometers. Audiotapes were transcribed and evaluated using systematic content analysis., Results: The 8 coaches and 75 enrolled walking participants were primarily African American (98%) women (94%). Overall, the group (N = 83) submitted 85% of all possible pedometer diaries and recorded 73% of all possible daily step counts. Walking-group members were significantly (P < .01) more compliant if their coach was also compliant. Identified benefits of wearing pedometers and maintaining diaries outnumbered the barriers. Participants were enthusiastic about wearing the pedometers and indicated that the weekly diaries provided a source of motivation., Conclusions: This research suggests pedometer diaries are a viable intervention tool and research method for community-based physical activity interventions targeting African Americans and highlights the need for social support to promote pedometer diary compliance.

Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example - remote parental monitoring of adolescent blood glucose - is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents' decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families.

Background: Optimal control of type 1 diabetes (T1D) in children minimizes long-term complications, but increases hypoglycemic events. A continuous glucose monitor (CGM) can provide real-time information about glucose levels and trends. Little has been published on the characteristics of patients most willing to use CGM., Methods: Online survey software was utilized to administer a 50-item questionnaire to parents of children with T1D. The primary outcome was whether the parent expressed a high level of interest in CGM. The proportion of parents who expressed a high level of interest was compared across demographic and clinical variables via chi(2) tests (alpha = 0.05)., Results: Analysis was performed on 457 surveys. The mean +/- SD age of the children was 10 +/- 4.1 years. Mean reported hemoglobin A1c (HbA1c) was 7.8 +/- 1.3%. Of the respondents, 70% used continuous subcutaneous insulin infusion (CSII). Parents reported an average of eight blood glucose (BG) checks daily. Over 90% of the parents indicated a high level of interest in having their child use a CGM. Primary variables related to interest in a CGM were use of CSII (P = 0.002), checking BG more than six times daily (P = 0.005), and parental worry about high or low BG (P = 0.0012 and P = 0.02, respectively). Age of the child and HbA1c were not related to parental interest in a CGM., Conclusions: Overall parental interest in CGM was high. Use of CSII, frequent BG checks, and parental worry, but not age of the child or diabetes control, were associated with parental interest in using a CGM.

Continuous glucose monitoring (CGM) is becoming increasingly popular and represents the third era of diabetes management. Currently available CGM devices have been studied in youth with type 1 diabetes and show similar accuracy across all age groups. Tolerability of these devices relates to alarm settings, sensor skin irritation, and durability of the device. Youth will be most successful on a CGM regimen if they have a personal investment in wearing the CGM device and have a stable support system for their diabetes care. Data indicate that glycemic control improves the most in youth who wear CGM devices >or=5 days per week, allowing for the ability to make more insulin dose changes. CGM has proven useful in alerting youth to hypoglycemia and may be a valuable tool with exercise. Further studies are needed to assess the utility of CGM for prevention of severe hypoglycemic events and increasing time spent in euglycemia. Fear of hypoglycemia may be ameliorated with CGM use; however, the potential for increased stress in families with continuous feedback must also be considered. In the future, CGM use in youth may couple with insulin pump technology to create a "closed-loop" system in which the CGM device will direct insulin administration without user input.

Objectives: The aim of this study was to describe how people in need of health care at home view technology., Study Design: A qualitative approach was used based on qualitative interviews, followed by qualitative content analysis., Methods: District nurses (DNs) from 4 health care centres in Northern Sweden had access to different kinds of distance-spanning technology with mobile devices and who used it in their health care at home. Persons in whose home the technology was being used were asked to participate in an interview. The interviewed persons were selected consecutively., Results: The results fall into 2 categories: (1) The well-known technology at hospital is new at home, (2) the new technology opens up possibilities but it also has limitations, with seven adherent subcategories., Conclusions: The participants viewed the technology at home as something good and as something that could open up possibilities. At the same time, they placed the use of the technology in the hands of the staff which indicates some degree of dissociation from the technology. The importance of personal meetings between patient and caregiver was very clearly stressed even when distance meetings could be performed and accepted. The participants expressed immense trust in the nursing staff and considered them responsible for the new technology at home.

Background: A 16-week, two-site study evaluated outcomes for a new device (the Paradigm 722 System, Medtronic MiniMed, Northridge, CA) that combines a "smart" continuous subcutaneous insulin infusion (CSII) pump with real-time (RT) continuous glucose monitoring (CGM) and CareLinktrade mark data management software (DMS)., Methods: CSII-naive adults with type 1 diabetes in suboptimal control (mean glycosylated hemoglobin [A1C] = 8.6%) were randomized to the control arm, consisting of multiple daily injections (MDI) and self-monitoring of blood glucose (SMBG), or the study arm (CSII with RT-CGM as an adjunct to SMBG). Participants (n = 28) completed the validated Insulin Delivery System Rating Questionnaire (IDSRQ) and the parallel Blood Glucose (BG) Monitoring System Rating Questionnaire (BGMSRQ) at study start and end. Participants in the study arm (n = 14) also completed newly developed User Acceptance Questionnaires (UAQs) for CSII, RT-CGM, and DMS at study end., Results: A1C reduction from study start to end was significant (P < 0.05) in both arms (-1.7% for study arm;-1.0% for control arm); there was no significant change in weight in either arm. The IDSRQ showed significantly (P < 0.05) greater benefit for the study arm in convenience, acceptability of BG monitoring requirements, BG control efficacy, diabetes worries, and interpersonal hassles, as well as higher overall satisfaction/preference. The BGMSRQ showed significantly (P < 0.05) greater benefit for the study arm in the BG monitoring system's ability to help manage glycemic control and less interest in changing to another BG monitoring system. The Study Arm UAQs showed positive ratings of system features., Conclusions: Several patient-reported outcomes were significantly more positive in the study arm than the control arm; none was significantly more positive in the control arm. The features of the integrated RT-CGM/CSII system were frequently used and highly rated by participants, with high user satisfaction.

Heart failure (HF) is the leading cause of rehospitalization in older adults. The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions, emergency department visits, costs, and risk of hospital readmission for patients with HF. One hundred two patient/caregiver dyads were randomized into 2 groups postdischarge; 84 dyads completed the study. Hospital readmissions, emergency department visits, costs, and days to readmission were abstracted from medical records. Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms, quality of life, and caregiver mastery. There were no significant differences due to telemonitoring for any outcomes. Caregiver mastery, informal social support, and electronic home monitoring were not significant predictors for risk of hospital readmission. Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit.