A non-randomised feasibility study of a mHealth follow-up program in bariatric surgery.

BACKGROUND: Behavioural support via mobile health (mHealth) is emerging. This study aimed to assess the feasibility, acceptability, cost, and potential effect on weight of a mHealth follow-up program in bariatric surgery. METHODS: This was a non-randomised feasibility study describing intervention development and proof in the concept of a mHealth follow-up program in bariatric surgery. The study compares a prospective cohort with a historical control group and was conducted in a tertiary bariatric surgery service in Australia. The intervention group included individuals who had bariatric surgery (2019-2021) and owned a smart device, and the historical control group received usual postoperative care (2018). The intervention involved usual care plus codesigned biweekly text messages, monthly email newsletters, and online resources/videos over a 6-month period. The primary outcome measures included feasibility (via recruitment and retention rate), acceptability (via mixed methods), marginal costs, and weight 12 months postoperatively. Quantitative analysis was performed, including descriptive statistics and inferential and regression analysis. Multivariate linear regression and mixed-effects models were undertaken to test the potential intervention effect. Qualitative analysis was performed using inductive content analysis. RESULTS: The study included 176 participants (n = 129 historical control, n = 47 intervention group; mean age 56 years). Of the 50 eligible patients, 48 consented to participate (96% recruitment rate). One participant opted out of the mHealth program entirely without disclosing their reason (98% retention rate). The survey response rate was low (n = 16/47, 34%). Participants agreed/strongly agreed that text messages supported new behaviours (n = 13/15, 87%); however, few agreed/strongly agreed that the messages motivated goal setting and self-monitoring (n = 8/15, 53%), dietary change (n = 6/15, 40%), or physical activity (n = 5/15, 33%). Interviews generated four main themes (n = 12): 'motivators and expectations', 'preferences and relevance', 'reinforced information", and 'wanting social support'. The intervention reinforced information, email newsletters were lengthy/challenging to read, and text messages were favoured, yet tailoring was recommended. The intervention cost AUD 11.04 per person. The mean 12-month weight was 86 ± 16 kg and 90 ± 16 kg (intervention and historical control) with no statistically significant difference. Intervention recipients enrolled at 3 months postoperatively demonstrated a statistically significant difference in 12-month weight (p = 0.014). CONCLUSION: Although this study observed high rates of recruitment and retention, findings should be considered with caution as mHealth may have been embraced more by the intervention cohort as a result of the 2019 coronavirus pandemic. Of the various digital strategies developed and tested, the text message approach was the most acceptable; however, future intervention iterations could be strengthened through tailoring information when possible. The use of email newsletters and online resources/videos requires further testing of effectiveness to determine their value for continued use in bariatric surgery services.

A mixed-method study to inform the development and implementation of eHealth in a bariatric surgery service in an Australian public hospital.

AIM: This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. METHODS: This mixed-method study (survey and semi-structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. RESULTS: This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two-thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. CONCLUSION: This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial.

Implementation and evaluation of a university–hospital partnership program for Type 2 diabetes.

Objective The aims of this study were to determine whether a university-hospital partnership program for Type 2 diabetes (T2D) would: be well attended; reduce the number of patients on the diabetes out-patient waiting list who have been waiting longer than the recommended; increase discharge from the hospital clinic; increase university health clinic (UHC) occasions of service; be sustainable; and be acceptable to participants. Method A prospective observational study was conducted between 2016 and 2019. Participants with T2D were referred to a UHC, initially from a hospital diabetes wait list. The final program consisted of 10 weeks: before and after individual assessments, as well as 8 weeks of exercise and education facilitated by health professionals and students. Participant demographic characteristics and data on attendance, discharge and follow-up requirements, the percentage of patients waiting longer than the recommended for a new hospital out-patient appointment, university activity and patient satisfaction were collected. Results In all, 130 participants commenced the program, 80% completed at least six of eight group sessions and 80% attended the final assessment. The percentage of people waiting longer than recommended decreased from 63% to 16%. The hospital discharged 87% and 59% of participants from the dietitian and endocrinologist respectively. The UHC recorded 2056 occasions of service and 2056 student experiences including dietetics, exercise physiology, psychology, nursing, optometry, social work and podiatry students relating to the program. Satisfaction was high, as measured by the Short Assessment of Patient Satisfaction, with a mean score of 23.9 from a possible score of 28.0 (n = 93). Conclusion The partnership resulted in a new model of care for patients with T2D and increased learning experiences for students. What is known about the topic? Diabetes is the fastest growing disease in Australia, placing unsustainable demands on the health system. Access to patient-centred care and self-management education is essential to optimise glycaemic control, prevent or delay complications and maintain quality of life. The increasing demand of diabetes on the health system affects access to timely care, with unacceptably long wait times reported, resulting in an increase in morbidity and mortality and poor patient satisfaction. A potential solution is the use of clinical students to contribute to service delivery. Student-assisted and student-led health clinics have increased access to care across the globe for many years. What does the paper add? Although group education has the potential to reduce the burden on clinical service delivery, it was unclear whether a partnership program using students and university and hospital resources would be acceptable to people with T2D and whether this model delivered at a UHC would be sustainable and of benefit to both the health service and university. The results of the evaluation suggest that a university-hospital partnership program is well accepted by participants, well attended, reduces the number of patients waiting for a hospital appointment longer than the acceptable waiting times, increases UHC activity and provides interdisciplinary student experiences. As such, this paper provides evidence that this model of care offers a potential solution to increasing demands for health services for diabetes and student clinical experience. What are the implications for practitioners? Partnerships between UHCs and hospitals offer a sustainable solution to increasing demand for diabetes services and student training requirements. The description of the development, implementation and evaluation processes can be used by practitioners and educators as a framework for the translation of similar models of care to meet demands in other areas where demand for health services exceeds capacity.

Evaluation of patient experience post structured education for diabetes self management (Dose Adjustment For Normal Eating-OzDAFNE).

AIMS: To examine OzDAFNE participant feedback to determine if OzDAFNE results in positive participant reported outcomes and experiences, improves quality of life; and to identify areas for improvement. METHODS: Quantitative and qualitative evaluations of participants' experience were undertaken prior to, and at the end of, every OzDAFNE program from 2010 to 2019. Evaluations included Likert scale and open-ended questions. Responses were analysed descriptively, for response rates and to identify themes. Mean difference in Problem Area in Diabetes (PAID) score was calculated from pre-course to 12 months. RESULTS: 189 participants attended OzDAFNE. 93% rated the overall quality of OzDAFNE as "Excellent". Confidence in managing diabetes increased from 25% pre-OzDAFNE to 96% at completion. Major themes identified as most useful and relevant were carbohydrate counting (89/189), insulin adjustment (87/189) and exercise (46/189). At 12 months (n = 44), 97% were "mostly"/ "always" using OzDAFNE principles; 72% reported their diabetes control was "a lot better" than pre-OzDAFNE due to increased knowledge and implementation of principles. The value of the shared patient experience was reported at all time points. By 12 months, mean PAID score decreased significantly (p < 0.001). CONCLUSIONS: The OzDAFNE patient experience was very positive, with high satisfaction reported. Increased confidence and knowledge and ongoing implementation of principles resulted in improved diabetes management. OzDAFNE offers a patient-centred approach that is valued by participants.

Exploring the highs and lows of very low carbohydrate high fat diets on weight loss and diabetes- and cardiovascular disease-related risk markers: A systematic review.

AIM: Very low carbohydrate high fat diets (VLCHF) are increasingly popular for weight loss and diabetes management, but the risk implications of long-term adherence to a high-fat-diet remain unclear, especially in high-risk populations. This review aimed to examine adherence, weight loss, diabetes- and cardiovascular disease (CVD)-related risk markers in adults consuming VLCHF diets. METHODS: Online databases were searched for randomised controlled trials ≥3 months duration that met a pre-defined macronutrient prescription: VLCHF ≤25%E carbohydrate, >35%E fat; low fat (LF) ≥45%E carbohydrate, ≤30%E fat; and reported energy, saturated fat (SFA), weight, blood glucose, cholesterol and blood pressure (BP). Studies were excluded if the macronutrient prescription was not targeted (n = 32); not met (n = 17) or not reported (n = 13). RESULTS: Eight studies included: 1217 commenced; 922 completed overweight and obese adults. Diets were isocaloric moderately energy-restricted, closely monitored with ongoing support from dietitians, physicians, and/or nurses. Four studies reported non-adherence beyond 3 months (n = 3) and 6 months (n = 1) despite interventions of 12, 15 and 24 months. VLCHF diets were high in fat and SFA (fat 49%-56%E; SFA 11%-21%E) compared to LF diets (fat 13%-29%E; SFA 5%-11%E). All groups achieved significant weight loss and improvements in BP and blood glucose. LDL-C reduction favoured LF, P < .05; increased HDL-C and reduced triglyceride levels favoured VLCHF, P < .05. CONCLUSIONS: VLCHF and LF diets with moderate energy restriction demonstrate similar weight loss and improvements to BP to 3 months. However, adherence is likely poor without intensive support from health professionals. Dietary SFA should be monitored to ensure recommended intakes, but longer-term studies with high adherence are required to confirm the level of CVD-risk and potential harms.

Designing, implementing and sustaining IPE within an authentic clinical environment: the impact on student learning.

Interprofessional education (IPE), as preparation for interprofessional practice (IPP), is essential for quality, coordinated, outcome-focussed patient care. To develop capacity for IPP in future healthcare practitioners, IPE needs to be developed within curriculum and applied within authentic settings. The study aims were threefold: (a) determine if an established type 2 Diabetes Mellitus (T2DM) exercise and healthy lifestyle program could be replicated and delivered at a satellite health precinct; (b) report on changes in students' attitudes to IPP in response to involvement in the program; (c) explore the perceptions of students in response to participation in the program whilst on placement. This paper reports on the quantitative changes in perceptions of IPE as measured by the SPICE-R2 instrument and a qualitative analysis of the student reflection of participating in IPP. Thirty-five students, from 4 health professions, participated in the study. The quantitative outcomes showed significant improvement in the perceptions of IPE (p <.01), including significant improvements understanding of roles and responsibilities, teamwork, and patient outcomes (p <.01). The qualitative analysis included a subset of 18 students who participated across two focus groups, highlighting four key themes: (a) health students reported varied initial experience with, and understanding of IPE; (b) the IPE program enabled students to see the value of teamwork for patient care; (c) IPE enhanced role clarity amongst the students, and (d) the IPE program provided an authentic learning experience, best suited to final year students. Our findings reinforced the value of a partnership between higher education and health services to deliver IPP care and learning, student valuing of the importance of IPE as part of authentic learning, and need for a scaffolded approach toward IPE is needed across health curriculums, and clinical placement to ensure all students can develop IPE capabilities that will enable them to work together to deliver the best healthcare to clients.