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BackgroundThe preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. ObjectiveThe aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. MethodsWe conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. ResultsA total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. ConclusionsParticipants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app.

Objective: Among primary care patients with chronic physical conditions and comorbid depressive symptoms, to assess (1) the effect of lay telephone coaching on adherence to a psycho-educational intervention for depression, (2) demographic characteristics that predict adherence and (3) the association between adherence and 6-month outcomes. Design: Single blind randomised pragmatic trial of a lay telephone-supported depression self-care intervention compared to an unsupported intervention. Methods: All patients received a multimedia toolkit of paper and audiovisual materials on depression that provided education on depression and on self-care for depression. Core tools included a cognitive-behavioural therapy (CBT)-based workbook and a mood monitoring notebook, with opportunities for written exercises and notes, and a video. Intervention group patients were additionally offered telephone coaching. Self-reported use of the materials was assessed at 3 and 6 months post-randomisation; 6-month outcomes were patient satisfaction and change from baseline in depression severity. Results: In all, 223 patients were randomised; 165 (74.0%) completed follow-up. Coached versus uncoached patients reported significantly greater use of the workbook, but not of other tools. Men used more audiovisual tools; women used more paper tools. Self-reported completion of written exercises and a greater number of coach contacts were associated with greater satisfaction, but not with improvement in depression. Conclusion: Telephone coaching can increase adherence to CBT-based tools for depression self-care; however, use of these tools may not improve depression outcomes. Many patients are capable of self-directed use of self-care educational materials. Sex differences in patterns of tool use may be helpful in the targeting of tools.

Objective: The objective of this study was to synthesise and describe adherence to intervention in published studies of supported self-care for depression or anxiety, and to identify participant characteristics associated with higher adherence. Methods: We searched the databases EMBASE, MEDLINE, CINAHL, and PSYCINFO for the period from January 1986 until September 2010. Eligible studies reporting on adherence to supported self-care interventions for depression or anxiety symptoms were identified. Results: We identified 40 studies of supported self-care interventions for depression and anxiety, of which 22 (55%) reported any measure of adherence to the intervention. Among these 22 studies, 18 (82%) reported the percentage of participants completing the entire self-care tool (20%-93%; Mean = 66%, SD 17), 13 studies reported the amount of self-care tools completed by the average participant (50.6%-96.4%; Mean = 80%, SD 11.6). Four studies (18%) reported the frequency of contacts with the self-care guide. Three (14%) studies reported participant characteristics associated with adherence. Conclusion: Overall, reported adherence levels to supported self-care interventions for depression and anxiety indicate a significant amount of patient involvement in these interventions. Routine reporting of adherence will improve our understanding of adherence to supported self-care interventions, and will allow researchers to link adherence with intervention outcome.

Objectives/Hypothesis: To identify barriers in access to care for head and neck cancer (H&NC) patients in low‐ and middle‐income countries (LMICs), specifically within Dakar, Senegal, using both quantitative and qualitative data. Study Design: Descriptive observational study. Methods: Patients with H&NC were selected from two independent university hospitals in Dakar, Senegal. A mixed‐methods descriptive study was performed using a specifically tailored questionnaire and a focused ethnographic qualitative approach to identify factors that delay patient presentation, referral, and treatment. Quantitative data were analyzed using descriptive statistics and qualitative using a deductive approach based on a systematic review of the literature. Results: Thirty‐three patients with a mean age of 57.8 years were included. Presentation delay was 5.7 months, mainly attributed to cost of consultation (39%), waiting time at doctor's office (15%), and distance to healthcare facility (12%). Referral delay greater than 3 months was observed in 60% of participants, secondary to misdiagnosis and lack of appropriate referral. Treatment delay was associated with limited local treatment capacity and securing cost of treatment. Cost of transportation impacted all delays. Conclusions: This work used an evidence‐based approach to identify barriers in access to care for H&NC patients in sub‐Saharan Africa. It suggests the feasibility and transferability of this methodology which combined a quantitative approach based on the literature with a qualitative analysis. Insight provided by this study will be used to guide development of implementation strategies for early detection of H&NC in LMICs. Level of Evidence: 4 Laryngoscope, 132:1219–1223, 2022 [ABSTRACT FROM AUTHOR]