eHEALS: The eHealth Literacy Scale Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. The Development and piloting of an eHealth breastfeeding resource targeting fathers and partners as co-parents. Designing and evaluating a web-based self-management site for patients with type 2 diabetes - systematic website development and study protocol Methodological considerations in evaluating eHealth interventions. Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? Mobile-Web App to Self-Manage Low Back Pain: Randomized Controlled Trial A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial A comparison of pain-assessment tools for use with elderly long-term-care residents. Mapping randomized controlled trials of treatments for eczema - The GREAT database (The Global Resource of Eczema Trials: a collection of key data on randomized controlled trials of treatments for eczema from 2000 to 2010) Evaluation of cognitively accessible software to increase independent access to cellphone technology for people with intellectual disability. Comparing the psychometric properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) instruments. Knowledge translation of the HELPinKIDS clinical practice guideline for managing childhood vaccination pain: usability and knowledge uptake of educational materials directed to new parents Management of Depression in Patients With Cancer: A Clinical Practice Guideline. Randomised controlled trials: an introduction for nurse researchers. Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial NorthStar, a support tool for the design and evaluation of quality improvement interventions in healthcare Development and testing of a mobile application to support diabetes self-management for people with newly diagnosed type 2 diabetes: a design thinking case study
Background Electronic health re sources are helpful only when people are able to use them , yet there remain few tools available to assess consumers ’ capacity for engaging in eHealth . Over 40 % of US and Canadian adults have low basic literacy levels , suggesting that eHealth re sources are likely to be inaccessible to large segments of the population . Using information technology for health requires eHealth literacy — the ability to read , use computers , search for information , underst and health information , and put it into context . The eHealth Literacy Scale ( eHEALS ) was design ed ( 1 ) to assess consumers ’ perceived skills at using information technology for health and ( 2 ) to aid in determining the fit between eHealth programs and consumers . Objectives The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers ’ combined knowledge , comfort , and perceived skills at finding , evaluating , and applying electronic health information to health problems . The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context . A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools . Methods Data were collected at baseline , post-intervention , and 3- and 6-month follow-up using control group data as part of a single session , r and omized intervention trial evaluating Web-based eHealth programs . Scale reliability was tested using item analysis for internal consistency ( coefficient alpha ) and test-retest reliability estimates . Principal components factor analysis was used to determine the theoretical fit of the measures with the data . Results A total of 664 participants ( 370 boys ; 294 girls ) aged 13 to 21 ( mean = 14.95 ; SD = 1.24 ) completed the eHEALS at four time points over 6 months . Item analysis was performed on the 8-item scale at baseline , producing a tight fitting scale with α = .88 . Item-scale correlations ranged from r = .51 to .76 . Test-retest reliability showed modest stability over time from baseline to 6-month follow-up ( r = .68 to .40 ) . Principal components analysis produced a single factor solution ( 56 % of variance ) . Factor loadings ranged from .60 to .84 among the 8 items . Conclusions The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations , showing promise as tool for assessing consumer comfort and skill in using information technology for health . Within a clinical environment , the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or re source . Further research needs to examine the applicability of the eHEALS to other population s and setting s while exploring the relationship between eHealth literacy and health care outcomes Introduction Multimorbidity increases care needs and primary care use among people with chronic diseases .  The Concerto Health Program ( CHP ) has been developed to optimise chronic disease management in primary care services . However , in its current version , the CHP primarily targets clinicians and does not aim to answer directly patients ’ and their informal caregivers ’ needs for chronic disease management . Various studies have shown that interventions that increase patient activation level are associated with better health outcomes . Furthermore , educational tools must be adapted to patients and caregivers in terms of health literacy and usability . This project aims to develop , implement and evaluate a user-centred , multifunctional and personalised eHealth platform ( CONCERTO+ ) to promote a more active patient role in chronic disease management and decision-making . Methods and analysis This project uses a collaborative research approach , aim ing at the personalisation of CHP through three phases : ( 1 ) the development of one module of an eHealth platform based on scientific evidence and user-centred design ; ( 2 ) a feasibility study of CONCERTO+ through a pilot cluster r and omised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and ( 3 ) an analysis of CONCERTO+ potential for scaling up . To do so , we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites , as well as health care managers , information officers and representatives of the Ministry of Health . Ethics and dissemination This study received ethical approval from Ethics Committee of Université Laval . The findings will be used to inform the effectiveness of CONCERTO+  to improve management care in chronic diseases . We will disseminate findings through presentations in scientific conferences and publication in peer- review ed journals . Trial registration number NCT03628963 ; Pre- results BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application OBJECTIVE Traditionally breastfeeding education programs target mothers solely . The objective of this study was to design and pilot test an interactive eHealth breastfeeding co-parenting re source developed to target both mothers and fathers .  eHealth re sources provide an accessible and engaging format on which to educate parents and assist them in meeting their breastfeeding goals . Best practice s to design such re sources are not currently known . DESIGN A three phase pilot study was conducted . The three phases included conducting a needs assessment , creating the re source and pilot testing the re source with mother , father and health care professionals to determine their perspectives regarding the usability and design of the prototype re source . The interactive prototype re source was design ed to provide information to parents on breastfeeding and co-parenting , which included suggestions on how fathers can be involved and support breastfeeding and how the couples can work as a team to meet their breastfeeding goals . Setting : Recruitment took place in a health region in Southern Ontario , Canada between June 2014 and March 2015 . Online question naires were completed by participants in all phases of the study . PARTICIPANTS Participants ( n=149 ) were pregnant or new mothers and their partners in the health region who read and speak English and had access to the internet and health care professionals who work with breastfeeding families in Ontario , Canada . INTERVENTION A prototype eHealth breastfeeding co-parenting re source was developed based on maternal and paternal feedback from Phase I and utilized an interactive interface which included games and multimodal information delivery . The prototype eHealth re source was provided to the parents in Phase II and health care professionals in Phase III . The final re source was created based on feedback from these participants . MEASUREMENTS AND FINDINGS The re source was pilot tested with new and expectant parents using pre- and post-test question naires which included measures for breastfeeding self-efficacy ( Breastfeeding Self-Efficacy Short Form ) , infant feeding attitude ( Iowa Infant Feeding Attitude Scale ) , breastfeeding knowledge ( Breastfeeding Knowledge Question naire ) and co-parenting relationship ( Co-parenting Relationship Scale ) . Maternal and paternal breastfeeding self-efficacy and knowledge and infant feeding attitude scores all increased from pre-test to post-test . However , there was no difference in the co-parenting relationship scores from pretest to post-test . KEY CONCLUSIONS This study has used feedback from parents and health professionals to develop a prototype re source which appears to be effective in increasing parents ' breastfeeding knowledge , attitude and self-efficacy . The prototype re source was rated positively by parents and health care providers . IMPLICATION S FOR PRACTICE An eHealth breastfeeding co-parenting re source design ed with input from the target population is an effective way of providing information to mothers and fathers . Further research with a r and omized controlled design and more diverse population s is needed to determine effectiveness of the re source on breastfeeding duration and exclusivity Background Given that patients provide the majority of their own diabetes care , patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care . However , participation in self management programs is low . In addition , the efficacy of current behavioural interventions wanes over time , reducing the impact of self-management interventions on patient health . Web-based interventions have the potential to bridge the gaps in diabetes care and self-management . Methods Our objective is to improve self-efficacy , quality of life , self-care , blood pressure , cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention . This study consists of five phases : ( 1 ) intervention development ; ( 2 ) feasibility testing ; ( 3 ) usability testing ; ( 4 ) intervention refinement ; and ( 5 ) intervention evaluation using mixed methods . We will employ evidence -based strategies and tools , using a theoretical framework of self-efficacy , then elicit user feedback through focus groups and individual user testing sessions . Using iterative re design the intervention will be refined . Once finalized , the impact of the website on patient self-efficacy , quality of life , self-care , HbA1c , LDL-cholesterol , blood pressure and weight will be assessed through a non-r and omized observational cohort study using repeated measures modeling and individual interviews . Discussion Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care . However , their full potential is hindered by limited knowledge regarding their effectiveness , poor usability , and high attrition rates . Our development and research agenda aims to address these limitations by improving usability , identifying characteristics associated with website use and attrition , and developing strategies to sustain patient use in order to maximize clinical outcomes Advances in information and communication technologies shape consumers ' attitudes towards engagement in their own health and their interface with the health-care system . The use of eHealth tools holds promise for supporting and enabling health behaviour change and the prevention and management of chronic diseases . The authors review issues related to study design , treatment implementation , and outcome measurement in eHealth trials , providing examples from the literature and from their own ongoing studies . Selection of a comparison group and design considerations related to participant preferences are based on the state of the science and current practice in the particular field . R and omized design s allow for control of selection bias and are favoured in both efficacy and effectiveness trials of eHealth interventions . Depending on the choice of comparison groups , eHealth applications must be fairly robust to demonstrate their efficacy above and beyond active controls . Strategies to ensure treatment fidelity and ongoing participant engagement can be challenging and are not always successful . Patient-reported outcomes are common to eHealth studies . Other outcomes , such as the costs associated with new eHealth applications , are equally if not more important for decision-makers . This discussion is intended to inform future trials and thereby serve to advance the science of eHealth Abstract Introduction : Successful population ‐level antiretroviral therapy ( ART ) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale‐up and , ultimately , the end of AIDS . Although many people living with HIV are adhering well , others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy . Despite the importance of ART adherence , supportive interventions have generally not been implemented at scale . The objective of this review is to summarize the recommendations of clinical , research , and public health experts for scalable ART adherence interventions in re source ‐limited setting s. Methods : In July 2015 , the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in re source ‐limited setting s. This article summarizes that discussion with recent up date s. It is not a systematic review , but rather provides practical considerations for programme implementation based on evidence from individual studies , systematic review s , meta‐analyses , and the World Health Organization Consoli date d Guidelines for HIV , which include evidence from r and omized controlled trials in low‐ and middle‐income countries . Interventions are categorized broadly as education and counselling ; information and communication technology‐enhanced solutions ; healthcare delivery restructuring ; and economic incentives and social protection interventions . Each category is discussed , including descriptions of interventions , current evidence for effectiveness , and what appears promising for the near future . Approaches to intervention implementation and impact assessment are then described . Results and discussion : The evidence base is promising for currently available , effective , and scalable ART adherence interventions for re source ‐limited setting s. Numerous interventions build on existing health care infrastructure and leverage available re sources . Those most widely studied and implemented to date involve peer counselling , adherence clubs , and short message service ( SMS ) . Many additional interventions could have an important impact on ART adherence with further development , including st and ardized counselling through multi‐media technology , electronic dose monitoring , de central ized and differentiated models of care , and livelihood interventions . Optimal targeting and tailoring of interventions will require improved adherence measurement . Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence , so that they do not limit the potential of ART to help bring about the end of AIDS UNLABELLED EXECUTIVE SUMMARY : BACKGROUND Across the developed world , we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision . Integrated care pathways ( ICPs ) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration . ICPs map out a patient 's journey , providing coordination of services for users . They aim to have : ' the right people , doing the right things , in the right order , at the right time , in the right place , with the right outcome ' . The value for ICPs in supporting the delivery of care across organisational boundaries , providing greater consistency in practice , improving service continuity and increasing collaboration has been advocated by many . However , there is little evidence to support their use , and the need for systematic evaluations in order to measure their effectiveness has been widely identified . A recent Cochrane review assessed the effects of ICPs on functional outcome , process of care , quality of life and hospitalisation costs of in patients with acute stroke , but did not specifically focus on service integration or its derivatives . To the best of our knowledge , no such systematic review of the literature exists . OBJECTIVES • To systematic ally review all high- quality studies which have evaluated the impact of care pathway technologies on ' service integration ' and its derivatives in stroke care • To examine how elements of service integration are defined in such studies • To examine the type of evidence utilised to measure service integration • To analyse the weight of evidence used to support cl aims about the effectiveness of ICPs on improving service integration • To produce recommendations for ICP developers , users and evaluators . INCLUSION CRITERIA Types of participants The review focused on the care of adult patients who had suffered a stroke . It included the full spectrum of services - acute care , rehabilitation and long-term support - in hospital and community setting s. Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest , defined for the purpose of this review as ' a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and st and ardise the outcome orientated care ' Here ' multidisciplinary ' is taken to refer to the involvement of two or more disciplines . Types of outcomes ' Service integration ' was the outcome of interest however , this was defined and measured in the selected studies . Types of studies This review was concerned with how ' service integration ' was defined in evaluations of ICPs ; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on ' service integration ' . Studies that made an explicit link between ICPs and service integration were included in the review . Evidence generated from r and omised controlled trials , quasi-experimental , qualitative and health economics research was sought . The search was limited to publications after 1980 , coinciding with the emergence of ICPs in the healthcare context . Assessment for inclusion of foreign papers was based on the English- language abstract , where available . These were included only if an English translation was available . EXCLUSION CRITERIA This review excluded studies that : • focused only on a single aspect of stroke care ( e.g. dysphasia ) • evaluated ICPs as part of a wider program of service development • did not make an explicit link between ICPs and service integration • did not meet the definition of ICP utilised for the purpose s of the review • focused exclusively on the outcomes of variance analysis SEARCH STRATEGY In order to avoid replication , the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Data base and the Cochrane Library were search ed to establish that no systematic review s existed and none were in progress . A three-stage search strategy was then used to identify both published and unpublished studies ( see Appendix III ) . DATA COLLECTION Our search strategy located 2123 papers , of which 39 were retrieved for further evaluation . We critically appraised seven papers , representing five studies . These were all evaluation studies and , as is typical in this field , comprised a range of study design s and data collection methods . Owing to the diversity of the study types included in the review , we developed a single- appraisal checklist and data - extraction tool which could be applied to all research design s.(32 ) The tool drew on the Joanna Briggs Institute ( JBI ) appraisal checklists for experimental studies and interpretive and critical research , and also incorporated specific information and issues which were relevant for our purpose s ( see Appendix VI ) . This extends the thinking outlined in Lyne et al.(31 ) in which , drawing on Campbell and Stanley 's classic paper , the case is made for developing an appraisal tool which is applicable to all types of evaluation , irrespective of study design . In assessing the quality of the papers , we were sympathetic to the method ological challenges of evaluating complex interventions such as ICPs . We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare context s. In accordance with the aims of this particular review , we have included studies , which are method ologically weaker than is typical of many systematic review s because , in our view , in the absence of stronger evidence , they yield useful information . DATA SYNTHESIS Given the heterogeneity of the included studies , meta- analysis and /or qualitative synthesis was not possible . A narrative summary of the study findings is presented . RESULTS 1 ICPs can be effective in ensuring that patients receive relevant clinical interventions and /or assessment s in a timely manner , although these improvements may reflect better documentation rather than actual changes in practice . 2 ICPs can be effective in improving the documentation of rehabilitation goals , documentation of communication with patients , carers ( diagnosis , prognosis and follow-up arrangements ) and documentation of notification of primary care physicians of discharge . However , this can create additional burdens of work for staff . 3 Early studies of ICP-managed care in the acute stroke context have demonstrated reduced length of stay without any associated adverse effects on discharge destination , morbidity or mortality . These effects do not reach statistical significance , however , and may reflect wider changes in service provision and a general trend towards reduced length of hospital stay . While later studies in the acute and rehabilitation context s do not reveal any significant reduction in length of stay , they do report greater documented use of certain clinical interventions and assessment s , suggesting that ICPs can be effective in mobilising hospital re sources around the patient . 4 ICPs implemented in the context of acute stroke care can be effective in reducing the occurrence of urinary tract infections , although we do not know whether this can be attributed to improved service integration . 5 ICP management in stroke rehabilitation may not be flexible enough to meet diverse patient needs and can result in insufficient attention to higher-level functioning and carer needs influencing perceptions of quality of life . 6 ICP management may assist in clarifying role boundaries and a shared underst and ing of the work , but this can result in some members of the disciplinary team perceiving that their contribution is not appropriately reflected in the documentation . 7 There is some evidence that ICPs may be effective in changing professional behaviours in the desired direction where there is scope for improvement , but in situations in which multidisciplinary working is effective , their positive effects may be limited . Furthermore , it is far from clear what the active ingredients of ICPs actually are . Kwan et al. suggest that it was the process of ICP development that had most impact on behaviours rather than the use of the artefact per se.(20 ) 8 None of the studies assessed the balance of costs and benefits of ICP  use . Therefore , we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits . CONCLUSIONS Implication s for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care . This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of re sources around the patient without incurring additional increases in length of stay .  ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable . Their value in the context of rehabilitation setting s in which recovery pathways are more variable is less clear . There is some evidence that ICPs may be effective in bringing about behavioural changes in context s where deficiencies in service provision have been identified . Their value in context s where inter-professional working is well established is less clear . While earlier before and after studies show a reduction in length of stay in ICP-managed care , this may reflect wider healthcare trends , and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced . There is some evidence to suggest that ICPs bring about improvements in documentation , but we do not know how far documented practice reflects actual practice . It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use . ( ABSTRACT TRUNCATED Background Nonspecific low back pain ( NLBP ) is the diagnosis for individuals with back pain that has no underlying medical cause ( eg , tumor , infection , fracture , herniated disc , spinal stenosis ) . The American College of Physicians ( ACP ) and American Pain Society ( APS ) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks . This approach , however , is impractical for many physicians to implement , and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines . Objective This study evaluated the efficacy of a mobile-Web intervention called “ FitBack ” to help users implement self-tailored strategies to manage and prevent NLBP occurrences . Methods A total of 597 adults were recruited , screened , consented , and assessed online at baseline , at 2 months ( T2 ) , and at 4 months ( T3 ) . After baseline assessment s , participants were r and omized into three groups : FitBack intervention , alternative care group that received 8 emails urging participants to link to six Internet re sources for NLBP , and control group . The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessment s. The control group was only contacted to do assessment s. Results Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical , behavioral , and worksite outcome measures at 4-month follow-up . In addition , users of the FitBack program performed better than the alternative care group on current back pain , behavioral , and worksite outcomes at 4-month follow-up . For example , subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group ; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up . Further , the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation , constructs of the Theory of Planned Behavior , and attitudes toward pain . Conclusions This research demonstrated that a theoretically based st and -alone mobile-Web intervention that tailors content to users ’ preferences and interests can be an effective tool in self-management of low back pain . When viewed from the RE- AIM perspective ( ie , reach , efficacy/effectiveness , adoption , implementation fidelity , and maintenance ) , this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people . The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign , which might have provided additional support for participants . Still , more research is needed on how self-guided mobile-Web interventions will be used over time and to underst and factors associated with continuing user engagement . Trial Registration Clinical trials.gov NCT01950091 ; http:// clinical trials.gov/ct2/show/NCT01950091 ( Archived by WebCite at http://www.webcitation.org/6TwZucX77 ) ABSTRACT In Thail and , young men who have sex with men ( YMSM ) and transgender women ( TG ) are disproportionately affected by HIV and have suboptimal care continuum outcomes . Although Thai YMSM and young TG are early adopters of emerging technologies and have high Internet and technology access and utilization , the potential of technology has not been harnessed to optimize the HIV treatment cascade . We interviewed 18 behaviorally HIV-infected YMSM and young TG regarding care challenges , identified how eHealth could address care needs , and elicited preferences for eHealth interventions . Participants reported struggling with individual and societal-level stigma which negatively impacted linkage to and retention in care , and antiretroviral therapy adherence . YMSM and young TG described inadequate in-person support services and heavily relied on r and om online re sources to fill information and support gaps , but sometimes viewed them as untrustworthy or inconsistent . Participants universally endorsed the development of eHealth re sources and proposed how they could ameliorate individual-level fears over stigma and improve public perceptions about HIV .  Personalized and integrated eHealth interventions with interactive , user-driven structures , credible content , rewards for engagement , real-time counseling and reminder support could help overcome barriers YMSM and young TG face in traditional HIV healthcare systems and have the potential to improve care outcomes Background Across the developed world , we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision . Integrated care pathways ( ICPs ) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration . ICPs map out a patient 's journey , providing coordination of services for users . They aim to have : ' the right people , doing the right things , in the right order , at the right time , in the right place , with the right outcome ' . The value for ICPs in supporting the delivery of care across organisational boundaries , providing greater consistency in practice , improving service continuity and increasing collaboration has been advocated by many . However , there is little evidence to support their use , and the need for systematic evaluations in order to measure their effectiveness has been widely identified . A recent Cochrane review assessed the effects of ICPs on functional outcome , process of care , quality of life and hospitalisation costs of in patients with acute stroke , but did not specifically focus on service integration or its derivatives . To the best of our knowledge , no such systematic review of the literature exists . Objectives To systematic ally review all high‐ quality studies which have evaluated the impact of care pathway technologies on ' service integration ' and its derivatives in stroke care To examine how elements of service integration are defined in such studies To examine the type of evidence utilised to measure service integration To analyse the weight of evidence used to support cl aims about the effectiveness of ICPs on improving service integration To produce recommendations for ICP developers , users and evaluators . Inclusion criteria Types of participants The review focused on the care of adult patients who had suffered a stroke . It included the full spectrum of services ‐ acute care , rehabilitation and long‐term support ‐ in hospital and community setting s. Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest , defined for the purpose of this review as ' a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and st and ardise the outcome orientated care ' . Here ' multidisciplinary ' is taken to refer to the involvement of two or more disciplines . Types of outcomes Service integration ' was the outcome of interest however , this was defined and measured in the selected studies . Types of studies This review was concerned with how ' service integration ' was defined in evaluations of ICPs ; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on ' service integration ' . Studies that made an explicit link between ICPs and service integration were included in the review . Evidence generated from r and omised controlled trials , quasi‐experimental , qualitative and health economics research was sought . The search was limited to publications after 1980 , coinciding with the emergence of ICPs in the healthcare context . Assessment for inclusion of foreign papers was based on the English‐ language abstract , where available . These were included only if an English translation was available . Exclusion criteria This review excluded studies that : focused only on a single aspect of stroke care ( e.g. dysphasia ) evaluated ICPs as part of a wider program of service development did not make an explicit link between ICPs and service integration did not meet the definition of ICP utilised for the purpose s of the review focused exclusively on the outcomes of variance analysis Search strategy In order to avoid replication , the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Data base and the Cochrane Library were search ed to establish that no systematic review s existed and none were in progress . A three‐stage search strategy was then used to identify both published and unpublished studies ( see Appendix III ) . Data collection Our search strategy located 2123 papers , of which 39 were retrieved for further evaluation . We critically appraised seven papers , representing five studies . These were all evaluation studies and , as is typical in this field , comprised a range of study design s and data collection methods . Owing to the diversity of the study types included in the review , we developed a single‐ appraisal checklist and data ‐ extraction tool which could be applied to all research design s.32 The tool drew on the Joanna Briggs Institute ( JBI ) appraisal checklists for experimental studies and interpretive and critical research , and also incorporated specific information and issues which were relevant for our purpose s ( see Appendix VI ) . This extends the thinking outlined in Lyne et al.31 in which , drawing on Campbell and Stanley 's classic paper , the case is made for developing an appraisal tool which is applicable to all types of evaluation , irrespective of study design . In assessing the quality of the papers , we were sympathetic to the method ological challenges of evaluating complex interventions such as ICPs . We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare context s. In accordance with the aims of this particular review , we have included studies , which are method ologically weaker than is typical of many systematic review s because , in our view , in the absence of stronger evidence , they yield useful information . Data synthesis Given the heterogeneity of the included studies , meta‐ analysis and /or qualitative synthesis was not possible . A narrative summary of the study findings is presented . Results ICPs can be effective in ensuring that patients receive relevant clinical interventions and /or assessment s in a timely manner , although these improvements may reflect better documentation rather than actual changes in practice . ICPs can be effective in improving the documentation of rehabilitation goals , documentation of communication with patients , carers ( diagnosis , prognosis and follow‐up arrangements ) and documentation of notification of primary care physicians of discharge . However , this can create additional burdens of work for staff . Early studies of  ICP‐managed care in the acute stroke context have demonstrated reduced length of stay without any associated adverse effects on discharge destination , morbidity or mortality . These effects do not reach statistical significance , however , and may reflect wider changes in service provision and a general trend towards reduced length of hospital stay . While later studies in the acute and rehabilitation context s do not reveal any significant reduction in length of stay , they do report greater documented use of certain clinical interventions and assessment s , suggesting that ICPs can be effective in mobilising hospital re sources around the patient . ICPs implemented in the context of acute stroke care can be effective in reducing the occurrence of urinary tract infections , although we do not know whether this can be attributed to improved service integration . ICP management in stroke rehabilitation may not be flexible enough to meet diverse patient needs and can result in insufficient attention to higher‐level functioning and carer needs influencing perceptions of quality of life . ICP management may assist in clarifying role boundaries and a shared underst and ing of the work , but this can result in some members of the disciplinary team perceiving that their contribution is not appropriately reflected in the documentation . There is some evidence that ICPs may be effective in changing professional behaviours in the desired direction where there is scope for improvement , but in situations in which multidisciplinary working is effective , their positive effects may be limited . Furthermore , it is far from clear what the active ingredients of ICPs actually are . Kwan et al. suggest that it was the process of ICP development that had most impact on behaviours rather than the use of the artefact per se.20 None of the studies assessed the balance of costs and benefits of ICP use . Therefore , we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits . Conclusions Implication s for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care . This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of re sources around the patient without incurring additional increases in length of stay . ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable . Their value in the context of rehabilitation setting s in which recovery pathways are more variable is less clear . There is some evidence that ICPs may be effective in bringing about behavioural changes in context s where deficiencies in service provision have been identified . Their value in context s where inter‐professional working is well established is less clear . While earlier before and after studies show a reduction in length of stay in ICP‐managed care , this may reflect wider healthcare trends , and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced . There is some evidence to suggest that ICPs bring about improvements in documentation , but we do not know how far documented practice reflects actual practice . It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use . As none of the studies review ed included an economic evaluation , moreover , it remains unclear whether the benefits of ICPs Background If eHealth interventions are not used ( properly ) , their potential benefits can not be fulfilled . User perceptions of eHealth are an important determinant of its successful implementation . This study examined how patients with chronic obstructive pulmonary disease ( COPD ) and their physiotherapists ( PHTs ) value an eHealth self-management intervention following a period of use . Objective The study aim ed to evaluate the perceptions of COPD patients and their PHTs as eHealth users . Methods In this study , an eHealth self-management intervention ( website and mobile phone app ) aim ed at stimulating physical activity ( PA ) in COPD patients was evaluated by its users ( patients and PHTs ) . As participants in a r and omized controlled trial ( RCT ) , they were asked how they valued the eHealth intervention after 6 months ’ use . Interview requests were made to 33 PHTs from 26 participating practice s , and a question naire was sent to 76 patients . The question naire was analyzed in Excel ( Microsoft ) . The interviews with the PHTs and text messages ( short message service , SMS ) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows ( VERBI GmbH ) . Results A total of 60 patients with COPD filled out the question naire , and 24 PHTs were interviewed . The mobile phone app was used 89.0 % ( 160.2/180 days ) ( st and ard deviation [ SD ] 18.5 ) of the time by patients ; 53 % ( 13/24 ) of PHTs reported low or no use . Patients scored the ease of use of the app 5.09 ( SD 1.14 ) ( on a 7-point scale ) . They found the presentation of the PA information in the app to be clear , insightful , and stimulating . All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients . Patients mostly sent informative , neutral messages concerning the PA goal , and PHTs sent mostly motivating , positive messages concerning the PA goal . Messages were not perceived as supportive in reaching the PA goal according to the patients . Perceived usefulness of the intervention for the PHTs was the objective measurement of PA , the ability to see PA patterns over time , and the ability to use the intervention as a tool to give their patients insight into their PA . For patients , it was that the intervention supported them in increasing their PA and that it made them feel fitter . Barriers to use of the intervention according to the PHTs were time constraints and financial reasons . Seventy-nine percent ( 19/24 ) of the PHTs and 58 % ( 35/60 ) of the patients mentioned they would be interested in using the intervention in the future . Conclusions PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention . This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future Background Patients with cardiovascular diseases managed by a person-centered care ( PCC ) approach  have been observed to have better treatment outcomes and satisfaction than with traditional care . eHealth may facilitate the often slow transition to more person-centered health care by increasing patients ’ beliefs in their own capacities ( self-efficacy ) to manage their care trajectory . eHealth is being increasingly used , but most studies continue to focus on health care professionals ’ logic of care . Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases . Objective The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome ( ACS ) . Methods This was a sub study of a r and omized controlled trial investigating the effects of PCC in patients hospitalized with ACS . In total , 199 patients with ACS aged < 75 years were r and omly assigned to a PCC intervention ( n=94 ) or st and ard treatment ( control group , n=105 ) and were followed up for 6 months . Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool , or both , for at least 2 months after hospital discharge . The primary end point was a composite score of changes in general self-efficacy , return to work or prior activity level , and rehospitalization or death 6 months after discharge . Results Of the 94 patients in the intervention arm , 37 ( 39 % ) used the eHealth tool at least once after the index hospitalization . Most of these ( 24/37 , 65 % ) used the mobile app and not the Web-based app as the primary source of daily self-rating input . Patients used the eHealth tool a mean of 38 times during the first 8 weeks ( range 1–118 , SD 33 ) and 64 times over a 6-month period ( range 1–597 , SD 104 ) . Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group ( odds ratio 4.0 , 95 % CI 1.5–10.5 ; P=.005 ) . This improvement was driven by a significant increase in general self-efficacy compared with the control group ( P=.011 ) . Patients in the PCC group who did not use the eHealth tool ( n=57 ) showed a nonsignificant composite score improvement compared with those in the control group ( n=105 ) ( odds ratio 2.0 , 95 % CI 0.8–5.2 ; P=.14 ) . Conclusions We found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care . Trial Registration Swedish registry , Research web.org , ID NR 65 791 The purpose of this study was to examine the psychometric properties ( test-retest and interrater reliability , criterion concurrent validity ) of 3 verbal pain- assessment tools ( Faces Pain Scale , Numerical Rating Scale , Present Pain Intensity Scale )  and a behavioural pain- assessment scale for use with an elderly population . The study used a repeated- measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-r and om stratified sample of 130 elderly long-term-care residents . The findings support the test-retest and interrater reliability of the  behavioural pain- assessment tool  across all levels of cognitive impairment , whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment ; however , the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools . The findings are discussed in relation to their clinical and research implication Background Massive duplication of effort occurs when research ers all over the world undertake extensive search es for r and omized controlled trials when preparing systematic review s , when developing evidence -based guidelines and when applying for research funding for eczema treatments . Such duplication wastes valuable re sources . Search ing for r and omized controlled trials of eczema is a laborious task involving scrutiny of thous and s of individual references from diverse electronic data bases in order to obtain a few papers of interest . Clinicians and patients who wish to find out more about a particular treatment are at risk of missing the relevant evidence if they are not trained in electronic bibliographic search ing . Systematic review s can not be relied upon to comprehensively inform current optimal eczema treatments due to incomplete coverage and because many may be out of date .An international , publically available and comprehensive re source which brings together all r and omized controlled trials on eczema treatment using a highly sensitive search has the potential to release more filtered knowledge about patient care to those who need it most and to significantly shorten the duration and costs of many clinical eczema research and guideline projects . DescriptionThe G lobal R e source of E czemA T rials brings together information on all r and omized controlled trials of eczema treatments published from the beginning of 2000 up to the end of 2010 and will be up date d every month . We search ed the Cochrane Central Register of Controlled Trials in The Cochrane Library and the Cochrane Skin Group Specialised Register , MEDLINE , EMBASE , LILACS , AMED and CINHAL data bases . We included 268 RCTs ( 24th March 2011 ) covering over 70 different treatment interventions .The structure of the Global Re source of Eczema Trials allows the user as much , or as little , specificity when retrieving information on trials as they wish , in an easy to use format . For each trial , the data base gives the citation for the published report and also provides enough information to enable a user to decide whether the trial is worth further scrutiny . Conclusions The Global Re source of Eczema Trials has been created to facilitate knowledge mobilization into healthcare and to reduce wastage of research time through unnecessary duplication . The collective time saved by research groups around the world can now be used to make strides in optimising the treatment of eczema , in order to further benefit people with eczema . The data base can be accessed free of charge at http://www.great data BACKGROUND There are over two billion telephones in use worldwide . Yet , for millions of Americans with intellectual disabilities ( ID ) , access to the benefits of cellphone technology is limited because of deficits in literacy , numerical comprehension , the proliferation of features and shrinking size of cellphone hardware and user interfaces . Developments in smart phone technology and PDA-based cellphones provide an opportunity to make the social and safety benefits of cellphones more independently accessible to this population . METHOD This project involved employment of universal design and other specialised software development methods to create a multimedia cellphone interface prototype which was compared with a typical mainstream cellphone in a usability evaluation for individuals with ID . Participants completed a structured set of incoming/outgoing phone tasks using both the experimental and control conditions . Usability measurements included the amount of assistance needed and errors made in completing the cellphone use sequence . RESULTS A total of 22 individuals with ID participated in the research by engaging in a series of incoming and outgoing cellphone calls using both the multimedia cellphone prototype system and a mainstream Nokia 6360 cellphone . Test subjects required significantly less help ( P = 0.001 ) and made significantly fewer errors ( P < 0.001 ) when completing eight calls using the specialised multimedia phone system as compared with the mainstream phone . CONCLUSIONS The statistical evidence of both usability results provide promising evidence of the feasibility of implementing universal design and other specialised software development method ologies for increasing independent access to the benefits of cellphone technologies for students and adults with ID . Issues related to design ing cognitively accessible interfaces , study limitations and future directions are discussed OBJECTIVE To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia . DESIGN In a cross-sectional descriptive study nursing home ( NH ) residents  were videotaped at rest and during a structured movement procedure . Following one training session and one practice session , two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools . SETTING Fourteen NHs in Western Washington State participating in a r and omized controlled trial of an intervention to enhance pain assessment and management .  PARTICIPANTS Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment . MEASURES  Checklist of Nonverbal Pain Indicators ( CNPI ) and the Pain Assessment in Advanced Dementia ( PAINAD ) , demographic and pain-related data ( Minimum Data Set ) , nursing assistant reports of participants ' usual pain intensity , and Pittsburgh Agitation Scale . RESULTS Internal consistency for both tools was good except for the CNPI at rest for one rater . Inter-rater reliability for pain presence was fair ( K = 0.25 for CNPI with movement ; K = 0.31 for PAINAD at rest ) to moderate ( K = 0.43 for CNPI at rest ; K = 0.54 for PAINAD with movement ) . There were significant differences in mean CNPI and PAINAD scores at rest and during movement , providing support for construct validity . However , both tools demonstrated marked floor effects , particularly when participants were at rest . CONCLUSIONS Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD , findings from the current study indicate that these measures warrant further study with clinical users , should be used cautiously both in research and clinical setting s and only as part of a comprehensive approach to pain assessment Background Although numerous evidence -based and feasible interventions are available to treat pain from childhood vaccine injections , evidence indicates that children are not benefitting from this knowledge . Unrelieved vaccination pain puts children at risk for significant long-term harms including the development of needle fears and subsequent health care avoidance behaviours . Parents report that while they want to mitigate vaccination pain in their children , they lack knowledge about how to do so . An evidence -based clinical practice guideline for managing vaccination pain was recently developed in order to address this knowledge-to-care gap . Educational tools ( pamphlet and video ) for parents were included to facilitate knowledge transfer at the point of care . The objectives of this study were to evaluate usability and effectiveness in terms of knowledge acquisition from the pamphlet and video in parents of newly born infants . Methods Mixed methods design . Following heuristic usability evaluation of the pamphlet and video , parents of newborn infants review ed revised versions of both tools and participated in individual and group interviews and individual knowledge testing . The knowledge test comprised of 10 true/false questions about the effectiveness of various pain management interventions , and was administered at three time points : at baseline , after review of the pamphlet , and after review of the video . Results Three overarching themes were identified from the interviews regarding usability of these educational tools : receptivity to learning , accessibility to information , and validity of information . Parents ’  performance on the knowledge test improved ( p≤0.001 ) from the baseline phase to after review of the pamphlet , and again from the pamphlet review phase to after review of the video . Conclusions Using a robust testing process , we demonstrated usability and conceptual knowledge acquisition from a parent-directed educational pamphlet and video about management of vaccination pain . Future studies are planned to determine the impact of these educational tools when introduced in clinical setting s on parent behaviors during infant vaccinations PURPOSE This report up date s the Cancer Care Ontario Program in Evidence -Based Care guideline for the management of  depression in adult patients with cancer . This guideline covers pharmacologic , psychological , and collaborative care interventions , with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer . METHODS Recommendations were developed by synthesizing information from extant guidelines and review s and search ing for r and omized controlled trials from the date of data base inception ( 1964 for MEDLINE and 1974 for EMBASE ) to January 2015 . Quality assessment of guidelines and systematic review s were conducted by using the Appraisal of Guidelines for Research and Evaluation II ( AGREE II ) , Assessment of Multiple Systematic Review s ( AMSTAR ) , and Cochrane Risk of Bias tools . Final recommendations were developed through a st and ardized Program in Evidence -Based Care multidisciplinary expert and knowledge user review process . RESULTS Two high- quality relevant clinical practice guidelines , eight pharmacologic trials , nine psychological trials , and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed . Eight specific recommendations were made to establish a st and ard of care for the management of depression in patients with cancer . The recommendations and practical management tools were review ed as being well organized and helpful , although systemic barriers to implementation were identified . CONCLUSION This up date d guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and /or pharmacologic interventions , without evidence for the superiority of any specific treatment over another . New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression AIM To present an overview of the main components of r and omised controlled trials and identify issues for consideration during their design and management . BACKGROUND R and omised controlled trials ( RCTs ) are considered to be the gold st and ard for determining causality and can provide high quality evidence to inform nursing practice . DATA SOURCES A search of online data bases and websites was undertaken to identify relevant contemporary literature to inform the discussion . DISCUSSION / CONCLUSION Conducting a robust r and omised controlled trial can present research ers with numerous challenges and practical considerations . The importance of taking account of the Consort guidelines during their design , conduct and reporting is emphasised . IMPLICATION S FOR RESEARCH / PRACTICE Evidence from well conducted RCTs contributes to the development of effective nursing interventions . To avoid bias and ensure valid results , the design , conduct and reporting of RCTs should follow the Consort guidelines . Service users should be involved in the design and management of RCTs Background The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘ point of care ’ management by multidisciplinary health teams in hospital setting s. While high- quality , expert-developed clinical pathways have many potential benefits , their impact has been limited by variable implementation strategies and suboptimal research design s. Best strategies for implementing pathways into hospital setting s remain unknown . This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways . Design / methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways : asthma and gastroenteritis . Using a balanced incomplete block design , we will r and omize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway , thus conducting two cluster r and omized controlled trials to evaluate this implementation intervention . A minimization procedure will be used to r and omize sites . Intervention sites will receive a tailored strategy to support full clinical pathway implementation . We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes . The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients . Primary clinical outcomes for each clinical pathway include the following : Asthma — the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge ; and Gastroenteritis — the proportion of relevant patients appropriately treated with oral rehydration therapy . Data sources include chart audits , administrative data bases , environmental scans , and qualitative interviews . We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits . Discussion This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation , and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways . Trial registration Clinical Trials.gov : Background The Research -Based Education and Quality Improvement ( ReBEQI ) European partnership aims to establish a framework and provide practical tools for the selection , implementation , and evaluation of quality improvement ( QI ) interventions . We describe the development and preliminary evaluation of the software tool NorthStar , a major product of the ReBEQI project . Methods We focused the content of NorthStar on the design and evaluation of QI interventions . A lead individual from the ReBEQI group drafted each section , and at least two other group members review ed it . The content is based on published literature , as well as material developed by the ReBEQI group . We developed the software in both a Microsoft Windows HTML help system version and a web-based version . In a preliminary evaluation , we surveyed 33 potential users about the acceptability and perceived utility of NorthStar . Results NorthStar consists of 18 sections covering the design and evaluation of QI interventions . The major focus of the intervention design sections is on how to identify determinants of practice ( factors affecting practice patterns ) , while the major focus of the intervention evaluation sections is on how to design a cluster r and omised trial . The two versions of the software can be transferred by email or CD , and are available for download from the internet . The software offers easy navigation and various functions to access the content . Potential users ( 55 % response rate ) reported above-moderate levels of confidence in carrying out QI research related tasks if using NorthStar , particularly when developing a protocol for a cluster r and omised trial Conclusion NorthStar is an integrated , accessible , practical , and acceptable tool to assist developers and evaluators of QI interventions Background Numerous mobile applications have been developed to support diabetes-self-management . However , the majority of these applications lack a theoretical foundation and the involvement of people with diabetes during development . The aim of this study was to develop and test a mobile application ( app ) supporting diabetes self-management among people with newly diagnosed type 2 diabetes using design thinking . Methods The app was developed and tested in 2015 using a design -based research approach involving target users ( individuals newly diagnosed with type 2 diabetes ) , research scientists , healthcare professionals , design ers , and app developers . The research approach comprised three major phases : inspiration , ideation , and implementation . The first phase included observations of diabetes education and 12 in-depth interviews with users regarding challenges and needs related to living with diabetes . The ideation phrase consisted of four interactive workshops with users focusing on app needs , in which ideas were developed and prioritized . Finally , 14 users tested the app over 4 weeks ; they were interviewed about usability and perceptions about the app as a support tool . Results A multifunctional app was useful for people with newly diagnosed type 2 diabetes . The final app comprised five major functions : overview of diabetes activities after diagnosis , recording of health data , reflection games and goal setting , knowledge games and recording of psychological data such as sleep , fatigue , and well-being . Users found the app to be a valuable tool for support , particularly for raising their awareness about their psychological health and for informing and guiding them through the healthcare system after diagnosis . Conclusions The design thinking processes used in the development and implementation of the mobile health app were crucial to creating value for users . More attention should be paid to the training of professionals who introduce health apps . Trial registration : Danish Data Protection Agency : 2012 - 58 - 0004 . Registered 6 February 2016
Conclusion : Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste .
Abstract Introduction : Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties , efficacy , and effectiveness .
Although considerable re sources are spent on developing and evaluating these tools with the aim of increasing access to care , current evidence suggests they are not made available to end users , reducing their impact and creating potential research waste .