The Impact of Patient Online Access to Computerized Medical Records and Services on Type 2 Diabetes: Systematic Review.

BACKGROUND: Online access to computerized medical records has the potential to improve convenience, satisfaction, and care for patients, and to facilitate more efficient organization and delivery of care. OBJECTIVE: The objective of this review is to explore the use and impact of having online access to computerized medical records and services for patients with type 2 diabetes mellitus in primary care. METHODS: Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016. No limitations were placed on study design, though we applied detailed inclusion and exclusion criteria to each study. Thematic analysis was used to synthesize the evidence. The Mixed Methods Appraisal Toolkit was used to appraise study quality. RESULTS: A search identified 917 studies, of which 28 were included. Five themes were identified: (1) disparities in uptake by age, gender, ethnicity, educational attainment, and number of comorbidities, with young men in full-time employment using these services most; (2) improved health outcomes: glycemic control was improved, but blood pressure results were mixed; (3) self-management support from improved self-care and shared management occurred especially soon after diagnosis and when complications emerged. There was a generally positive effect on physician-patient relationships; (4) accessibility: patients valued more convenient access when online access to computerized medical records and services work; and (5) technical challenges, barriers to use, and system features that impacted patient and physician use. The Mixed Methods Appraisal Toolkit rated 3 studies as 100%, 19 studies as 75%, 4 studies as 50%, and 1 study scored only 25%. CONCLUSIONS: Patients valued online access to computerized medical records and services, although in its current state of development it may increase disparities. Online access to computerized medical records appears to be safe and is associated with improved glycemic control, but there was a lack of rigorous evidence in terms of positive health outcomes for other complications, such as blood pressure. Patients remain concerned about how these systems work, the rules, and timeliness of using these systems.

Impact of Information Technology-Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis.

BACKGROUND: Information technology-based interventions are increasingly being used to manage health care. However, there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes. OBJECTIVE: The objective of this study was to conduct a systematic review and meta-analysis of clinical trials, assessing the impact of information technology on changes in the levels of hemoglobin A1c (HbA1c) and mapping the interventions with chronic care model (CCM) elements. METHODS: Electronic databases PubMed and EMBASE were searched to identify relevant studies that were published up until July 2016, a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools. The study search and selection were performed by independent reviewers. Of the 1082 articles retrieved, 32 trials (focusing on a total of 40,454 patients) were included. A random-effects model was applied to estimate the pooled results. RESULTS: Information technology-based interventions were associated with a statistically significant reduction in HbA1c levels (mean difference -0.33%, 95% CI -0.40 to -0.26, P<.001). Studies focusing on electronic self-management systems demonstrated the largest reduction in HbA1c (0.50%), followed by those with electronic medical records (0.17%), an electronic decision support system (0.15%), and a diabetes registry (0.05%). In addition, the more CCM-incorporated the information technology-based interventions were, the more improvements there were in HbA1c levels. CONCLUSIONS: Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes. No clinically relevant impact was observed on low-density lipoprotein levels and blood pressure, but there was evidence that the cost of care was lower.

Adoption of Health Mobile Apps during the COVID-19 Lockdown: A Health Belief Model Approach.

This study aimed to investigate the adoption of the Sehha, Mawid, and Tetamman mobile health applications during the COVID-19 pandemic in Saudi Arabia. The present study investigated factors influencing app use intention based on the Health Belief Model (HBM) approach. This study was conducted using a sample of 176 participants from the Riyadh and Makkah regions during the lockdown in May 2020. This study uses structural equation modeling for data collected using SmartPLS 3.3.9 (GmbH, Oststeinbek, Germany) to examine the effect of constructs on the model. The most important predictor was the perceived benefits of the mobile health apps, followed by self-efficacy. The perceived barriers and cues to action have no significant effect on behavioral intention. The perceived benefits and self-efficacy as keys can provide an overview to the government and to health organizations for taking into account the most important factors of the adoption of mobile health apps, meaning that the developer must adjust to the characteristics of the community of people that need applications that provide many benefits and have an impact.

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COVID-19 Mobile Apps in Saudi Arabia: Systematic Identification, Evaluation, and Features Assessment.

Background: The coronavirus disease 2019 (COVID-19) pandemic is the greatest global health threat in our century at the moment, and the use of mobile health apps has been one digital healthcare strategy adopted for coping with this outbreak. Objective: This study aims to identify and explore the mobile applications that are currently being utilized for dealing with COVID-19 in Saudi Arabia. Methods: The applications were selected based on the (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) PRISMA guidelines, then the functionalities were extracted based on the COVID-19 application mind map. Finally, the quality of the apps was assessed using the Mobile Application Rating Scale (MARS) for overall quality, satisfaction, engagement, functionality, aesthetics, and information. Results: The search identified six applications that were currently being used for COVID-19 which provided the following functionalities: self-assessment, self-isolation, permit for car mobility, prevention guidelines, COVID-19 lab results, call support, identifying nearby facilities, reporting suspected cases, and booking clinic appointments and the COVID-19 test. The findings showed that while most of these features were provided by multiple apps, on the MARS, the overall scores ranged from 3.26 to 3.69 with the apps scoring lower in the areas of satisfaction and engagement and higher in functionalities. Conclusion: Further steps are needed to unify all these functions in one health app to enhance the users' experience.

Determinants of Willingness to pay for Employment-Based Health Insurance Among Governmental School Workers in Saudi Arabia.

School workers constitute the bulk of public workers in Saudi Arabia. Most of these workers seek public health care services through the Ministry of Health, which is characterised by an overloaded service. Consequently, the government is planning to introduce employment-based health insurance. However, government employees' willingness to pay (WTP) for health insurance was not investigated. This study explores the feasibility and acceptability of employment-based health insurance by examining public school workers' WTP. Methods: six hundred and twenty-second number participants from Riyadh city were interviewed from September to October 2020 using an online structured questionnaire. The contingent valuation method with a payment card was used to assess WTP among the participants. This study also determined the association between the willingness to participate and WTP for health insurance respondents' demographic and socio-economic characteristics. Chi-square and multiple linear regression analyses were used to analyse the data. The majority (76%) with an average monthly mean of 77.9 Saudi Riyal (SAR) ($20.7) per capita. Male, had higher educated, and those diagnosed with chronic disease were more likely to report a willingness to participate and/or pay for health insurance (P > .005). This study demonstrates that WTP for employment-based health insurance depends on workers' characteristics. The results of this study may be of use to policymakers to help with a set insurance premium, priority setting and fund allocation.

Translation and Validation of the Arabic Version of the Capability Assessment for Diet and Activity (CADA) Questionnaire in Saudi University Employed Women.

BACKGROUND: The Capability Assessment for Diet and Activity (CADA) is a questionnaire that was developed in English and designed to measure the practical barriers and opportunities for diet and physical activity. OBJECTIVE: This study aimed to translate, culturally adapt, and validate the CADA questionnaire for the Arabic context in a sample of Saudi women employed at a university. METHODS: The CADA was translated into Arabic using the forward and backward translation process. The Arabic version was then validated with a sample of 125 female Saudi participants. In order to evaluate the psychometric properties of the Arabic version, Spearman's rank correlation coefficient was assessed, and a principal component analysis was performed. RESULTS: The translated CADA had good psychometric quality. The content validity analysis revealed a representativeness score of 99.3% and a degree of clarity of 98.6%, indicating excellent compatibility. The principal component analysis showed a single-factor structure. CONCLUSIONS: The Arabic version of the CADA questionnaire is now available to assess opportunities to achieve a healthy diet and physical activity level as part of health behavior management, which can lead to more effective interventions for improving people's health in Arabic-speaking countries.

Perceptions of health care professionals towards clinical practice guidelines: The case of Diabetes Mellitus in Saudi Arabia.

BACKGROUND: Clinical practice guidelines are developed by healthcare policy makers and disseminated to practitioners in order to minimize practice variations and to improve the quality of care. Problems arise when there is a sole reliance on passive dissemination strategies such as mailing or publishing the guidelines, as these approaches do not usually lead to the adoption. OBJECTIVE: This study aims to explore the perspectives of the health care professionals toward the Saudi National Diabetes Guidelines in terms of awareness, adherence and their preferred dissemination and implementation strategies of the guideline. METHOD: A cross-sectional survey was conducted among physicians and nurses working in twenty primary health care centers in the city of Riyadh between February and March 2019. RESULTS: Nearly half of the total 179 respondents reported that they were unaware of the guidelines (49.1%), and 92% of the remaining 91 participants who were aware of the guideline reported that they had first heard about it through their official mail. The mean scores ranked according to the most preferred methods for disseminating and implementing the diabetes guidelines were as follows: via reminder systems 4.35±0.74, financial incentives 4.33±0.65, and audit and feedback 4.27±0.58. On the other hand, the least favorable strategies were traditional education 3.79±0.96 and the distribution of the guideline by mail 3.13±0.95. CONCLUSION: The level of awareness of the diabetes guidelines among the primary health care professionals was suboptimal. This was more likely due to the Ministry of Health's reliance on passive implementation strategies. In order to have the guidelines translated into clinical practice, active and targeted implementation strategies such as reminder systems, audit and feedback must be considered by the Saudi health policy makers.

Trends in the prevalence of type 2 diabetes mellitus and obesity in the Arabian Gulf States: systematic review and meta-analysis.

We report trends in type 2 diabetes mellitus and obesity in adults residing in the Arabian Gulf States. Among the Saudi population, the prevalence of diabetes increased from 10.6% in 1989 to 32.1% in 2009. Prevalence of the disease increased faster among Saudi men than women, with growth rates of 0.8% and 0.6% per year, respectively.