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Emerging Technologies, Medical Devices, Apps, Sensors, and Informatics to Help People with Diabetes.
JMIR Diabetes (JD) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2016: 5.175), focusing on technologies, medical devices, apps, engineering, informatics and patient education for diabetes prevention, self-management, care, and cure, to help people with diabetes. As open access journal we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies, as well as on diabetes epidemiology. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews) covering for example wearable devices and trackers, mobile apps, glucose monitoring (including emerging technologies such as Google contact lens), medical devices for insulin and metabolic peptide delivery, closed loop systems and artificial pancreas, telemedicine, web-based diabetes education and elearning, innovations for patient self-management and "quantified self", diabetes-specific EHR improvements, clinical or consumer-focused software, diabetes epidemiology and surveillance, crowdsourcing and quantified self-based research data, new sensors and actuators to be applied to diabetes.
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Background: Management of type 1 diabetes (T1D) among children under 6 years of age is exceptionally challenging for parents/caregivers. Metabolic and psychosocial outcomes among very young children w...
Background: Management of type 1 diabetes (T1D) among children under 6 years of age is exceptionally challenging for parents/caregivers. Metabolic and psychosocial outcomes among very young children with T1D (YC-T1D) are tightly associated with their parents’ ability to meet these challenges. There is scant research testing interventions targeting these issues and few resources to equip health care providers to offer feasible and effective coping strategies to these parents. User-Centered Design (UCD) of a continuously accessible online resource providing information, problem-solving options, and emotional support to these parents could be a mechanism for helping more parents cope more effectively with the complex challenges they face as parents of YC-T1D. Objective: The objectives of this paper are to: 1. Describe the application of principles of User-Centered Design (UCD) to the development of an online coping intervention designed by and for parents of very young children (< 6 years old) with type 1 diabetes. 2. Illustrate the use of crowdsourcing methods in obtaining the perspectives of parents, health care providers, and web development professionals in designing and creating this resource. 3. Summarize the design of an ongoing randomized controlled trial that will constitute the last step in the UCD process by formally evaluating the effects of parental access to this resource on pertinent child and parent outcomes. Methods: This paper illustrates reliance on UCD principles in the creation of such a resource. The researchers used crowdsourcing methods to create an online coping resource designed by and for parents of YC-T1D. An online Parent Crowd and Health Care Provider Crowd and a Focus Group of minority parents provided input throughout the design process. A formal usability testing session and webinars demonstrating progress in website design provided additional stakeholder input as the design process proceeded. Results: The paper describes the completed website and the randomized controlled trial that is evaluating effects of access to the online resource on pertinent parent and child outcomes. Conclusions: UCD principles and the targeted application of crowdsourcing methods provided the foundation for development, construction and evaluation of a continuously accessible, archived, organic coping resource designed by and for parents of YC-T1D. The process described here could be a template for the development of similar resources for other special populations who are enduring specific medical or psychosocial sources of distress. The completion of an ongoing randomized controlled trial is the final step in the User-Centered Design process to validate the merits of this work. Clinical Trial: www.clinicaltrials.gov: NCT03222180
Background: The burden of obesity is high among U.S. veterans yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the V...
Background: The burden of obesity is high among U.S. veterans yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the Veterans Health Administration (VHA) developed TeleMOVE®, a home-based 82-day curriculum that utilizes in-home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility-based services. Objective: Our primary aims were to establish preliminary evidence for the program to engage the priority population based on the number of patients enrolled per site as well as the program’s clinical effectiveness as demonstrated by average weight lost per patient. A secondary aim was to understand factors influencing implementation variability across demonstration sites to develop recommendations to inform the national TeleMOVE dissemination. Methods: We employed a formative mixed-methods design to evaluate the phased implementation of TeleMOVE programming at nine demonstration sites and to compare patient- and site-level measures of program uptake. Data was collected between October 1, 2009 and September 30, 2012. Twenty-eight stakeholders were recruited to provide contextual details while patient-level program outcomes were extracted from VHA patient care databases. Program stakeholders were recruited to participate in two rounds of semi-structured interviews about aspects of implementation processes, site-level contextual factors, and daily program delivery. Administrative data was used to evaluate program enrollment rates and clinical outcomes. To assess preliminary clinical effectiveness, weight loss outcomes for veterans who enrolled in TeleMOVE were compared to outcomes for participants enrolled in standard MOVE! at each demonstration site as well as to national averages during the first two years of program implementation. Results: Program uptake was high at two sites, delayed-high at one site, low at three sites, and three late-adopting sites declined interviews. At six months post-enrollment, mean weight loss was comparable for TeleMOVE (n=417) and MOVE! (n=1543) participants at -5.2 lb (SD=14.4) and -5.1 lb (SD=12.2), respectively (p=.91). All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE! due to logistical and technical assistance issues related to the devices. High-uptake sites overcame implementation challenges by leveraging strong communication networks with stakeholders, adapting the program to patient needs whenever possible, setting programmatic goals and monitoring feedback of results, and taking time to reflect and evaluate on delivery to foster incremental delivery improvements whereas, low-uptake sites reported less leadership support and effective communication among stakeholders. Conclusions: This evaluation of the phased implementation of a new clinical telehealth program demonstrates the value of partnership-based research in which researchers not only provide operational leaders with rapid and responsive feedback regarding the effectiveness of a new clinical program but also relevant feedback into contextual factors related to implementation to enable adaptations for national rollout of the program.