Mobile Health and Vascular Health-Diabetes

Question: Discuss about the Essay for Mobile Health and Vascular Health-Diabetes? Answer: Introduction Background of the study Mobile health solutions are growing at a rapid rate and they have become an integral part of healthcare landscape. There are more than a hundred thousand mobile applications today and they effectively create value in different ways. While talking about cardiovascular diseases, it has seen that such diseases affects woman having diabetes mellitus. Among patients with diabetes, cardiovascular disease prevention is vital but underutilized. There are numerous research works were executed that demonstrated the fact that Mobile health strategies are emerging communication tools for improving self management and health behaviours. However, the feasibility of m-health for enhancing health behaviours in indigent population is a good topic to research on. Parashar conducted a study and found that among indigent African-American womenhaving diabetes, the use and development of mobile health application is feasible and results in increased patient satisfaction and positive reinforcement to healt hy behaviours (1). Use of technology in any filed is now become essential. However, whether the people are aware about mhealth still remain questionable. Under such circumstances, this study was prepared where the researcher tried to explore the awareness aspect related to the mobile health service in specific diabetics. Importance of mobile health Although mobile health devices are a special opportunity to capture the health data of patients remotely, it is not clear whether patients have the tendency to use multiple devices simultaneously and whether the use affects adherence. A study was conducted to research on this topic (2). It was concluded that use of mobile technologies have the possibility to transform care delivery within individuals over time. However, devices may need to be tailored to meet the specific patient needs. The fast proliferation of mobile devices gives many opportunities for health care professionals for exchanging health information electronically. A study was conducted for understanding the willingness to exchange different types of information related to health by mobile devices. A sample of 3,165 patients was taken for analyzing data (7). Ordinal logistic regression analysis was taken up. Respondents were not willing to exchange their mobile devices information that is complex or sensitive. Age, trust and socioeconomic factors are associated with engagement in mobile health information exchange. For tailoring and developing mobile technologies for clinician-patient communication, there is a need to consider demographic groups and information type (8). Mobile-cellular subscriptions have seen increase in the last few years. The accessibility to messages sent by SMS over mobile networks has universal accessibility and mobile phones that are not sophisticated do not have these facilities (9). There has been much research made on p for improving health services and changing behaviours of vulnerable population. A study was taken up for identifying the major factors that have the influence on effectiveness of evidence-based SMS messages designed to reduce health inequities. Focus group discussions were taken up for 45 participants and grounded theory was utilized in research to reveal that there lies six mediators of meaning of SMS messages (5). These are lack of clarity and/or practicality of content, negative or non-affirming framing of advocacies, disconnect with the reality of the social determinants of health and the diversity of cultures within a population,oppressive or authoritarian content, incongruity with cultural and traditio nal practices and fear- or stress-inducing content (5). The conclusion of the study was that the quality of text messages has an impact on the effectiveness of a mobile health intervention. There is an urgent need of interventions for incorporating and evaluating the quality of SMS and examining the mediators of meaning within each population group. There must an improvement made in transparency of the process as well as the quality of the outcomes. Vascular diseases It has seen that vascular disease is one of the major concerns in UK in modern times. A significant number of deaths occurred due to such specific aspects. Research has shown that such vascular disease has resulted due to stroke, diabetes or angina. While, analyzing the facts behind such issues, research has shown that instant medical help could reduce the severe affects of such vascular diseases. Over the period, a large number of research works has been executed to understand the importance of instant healthcare services while dealing with vascular health diseases. Many of the research works has indicated that use of mobile health can be a better option for such vascular diseases. Relationship between mobile health Vascular Health-Diabetes Mobile health or mHealth is the wide use of mobile services for supporting medical and public health. Despite the majority of the mHealth in families with low-middle income economies focuses on communicable disease, there is a great potential for improving vascular disease management. These are in relation to diet, smoking, and exercise. Other important benefits of mHealth in vascular disease are the monitoring of the patients, treatment reminders and allocating recourses. There is wide research exploring the feasibility and acceptability of the mHealth among the public (10). The government sectors of different countries are emphasizing on the primary healthcare services so that the people can get access to healthcare through mobile phones. The main aim of using mobile health services in relation to diabetes and vascular disease is to promote good health practices and provide rich information on the basic determinants of health and existing services in health care (11). The ultimate goal is to have better patient outcomes. The implications for healthcare delivery system through mHealth are supportive supervision, delivery system improvements, enabling working modalities and enhancement of knowledge (12). The interactive voice responses, text messaging and short message servicing can improve lifestyle behaviors that are related to diabetes and vascular diseases. The risk factors for diabetes and vascular diseases are best described in literature. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity (13). Interactive voice response and short message service-based interventions for diabetes disease management have shown benefits with respect to blood glucose management, hospital readmissions, and diabetic glycemic control (14). Emerging evidence suggests that mHealth interventions improve cardiovascular-related lifestyle behaviours and disease manageme nt. mHealth programs developed worldwide are based on evidence-based behavioural theories and incorporate advances in artificial intelligence for bringing changes in the fulfilment of the ever-changing patients needs (15). Purpose of the Study This project aims to look at the role of health apps in vascular health promotion and diabetes promotion. It also has the aim of assessing the feasibility and acceptance of community pharmacists in the use of mobile health apps for professional development and health promotion in the community. Aims and Objectives To identify if smart-phone users are aware of available health apps; To identify the patients opinions on barriers and facilitators on using mHealth applications; To seek diabetic patients opinions on whether or not the current diabetes applications available meet their aspirations and the reasons for this; Methodology This section of the study has demonstrated the research method that the researcher has applied while executing this research work. It has seen that the purpose of the study was to understand the role of mobile health application as a tool for diabetics patients. Since, the study involves understanding use of mobile application in healthcare service promotion; awareness became one of the major aspects (21). Therefore, the researcher has utilized mixed research approach for this study. The research design is mixed research design that involves collecting, integrating and analyzing quantitative and qualitative data when there is a need to provide better understanding of the research topic. This research design was taken up for utilizing the advantage of both quantitative and qualitative data (16). Quantitative data are the close-ended information that consists of statistically analyzing scores collected on the available information. Qualitative data are open-ended information that is gathered by interviews, observations and focus groups. By having both qualitative and quantitative research data helps in gaining depth and breadth of understanding the research topic (17). Quantitative approach: The present research had mixed research approach with a quantitative research followed by a qualitative research. The quantitative data collection is carried out for: (1) Researching on the public perception of both Telehealth and mobile health by determining the level of public awareness, the perception of usefulness of mobile applications, which types of health applications people commonly used, existing concerns and barriers, and a possible correlation between disease status and the use of mobile apps (2) Finding the degree of utilisation of health apps by members of the public and pharmacists in order to identify if there is a potential for preventing vascular disease development via the use of health apps for health promotion (22). (3) Assessing the feasibility and acceptance of community pharmacists in the use of mobile health apps for professional development and health promotion in the community Qualitative approach: The qualitative data collection and analysis is undertaken for assessing the relation of diabetes and mhealth. The advantage of having mixed research methodology is that there is a possibility of traiangulation. This refers to the use of different means for examining the same phenomena. In context of the present research objective, triangulation will help in identifying the aspects of the phenomena of mhealth and vascular diseases and diabetes in a more accurate manner and by approaching it from different points by different techniques and methods (23). Proper triangulation needs careful analysis if the information given by each method and their strengths and weaknesses. With the help of a mixed research method, researcher can generate a grounded theory. A broad range of research questions can be answered by mixed research and this is the main aspect of the present research taken up (18). Stronger evidence can be received from the research for a conclusion by corroboration and conver gence of findings. The researcher is able to add understanding and insights that may be missed when only a single method is used. The generalizability of the results also increases with the utilization of mixed research (20). Qualitative and quantitative research when used together deliver more complete knowledge required for informing practice and theory (19). In mixed research method, design is used based on both perspectives and research problems become the research questions based on prior experience. Interpretation of the results is continual and can influence stages in the research process. Sample of the study: As the central aim of this study is to understand the awareness of mobile health facilities as well as how such mobile health service reduced the severe effects of vascular diseases, specifically, diabetics, the researcher has considered both general people as well as pharmacists as the target population. In specific, the researcher has selected 210 people as the sample of this study. All such samples were considered for the quantitative study purpose. At the same time 10 healthcare professional were selected for interview purpose. It has also noted that among these 210 people, 120 were general people and rests were pharmacists. Data collection and analysis technique In order to collect quantitative data, the researcher has used closed ended questionnaire. The questionnaire involved two sections. The first section supports the researcher to collect demographic data, when the second section of the study has dealt with data related to mobile health service for diabetic patients. On the other hand, to collect qualitative data, the researcher has conducted 10 face-to-face interview sessions, where the healthcare professionals gave their views about this mobile health application and its effectiveness in case of diabetics patients. Since, the study involves both qualitative as well as quantitative study; the researcher has performed the quantitative study at the first stage. To perform this quantitative study, the researcher has used Microsoft excel for shorting as well as analysing the data. Here, the descriptive statistics, mainly the frequency percentage was used. At the same time, the researcher has used column and pie charts to display the results. On the other hand, the qualitative study has been performed subsequent to quantitative study (24). Here, the researcher mainly utilized thematic approach to understand whether the current diabetes applications available meet their aspirations and the reasons for this. Ethics approval It has seen that the researcher has submitted all research article related documents such as research proposal, respondents consent form, questionnaire, etc at the university, prior to start working on the research article. Based on ethics approval, the researcher has performed the rest of the research work. Results and Analysis In this section, the researcher has presented the results of data collected using questionnaire as well as face to face interviews. The first section of this chapter explored the quantitative analysis and subsequent section dealt with qualitative study. Finally, a detailed discussion also been performed in this section. Quantitative study Part A: Common Question [1] Do you live locally? As mentioned in the above section, the researcher has gathered data from 210 samples. Among these sample, 88.10% people (n = 185) has mentioned that they are local people. However, 11.90% respondents have mentioned that they are from outsides. The table 3.1 and figure 3.1 has demonstrated this data. No of response Percentage Yes 185 88.10% No 25 11.90% Since a majority of the respondents are from local area, it can be said that the results has explored the effectiveness of mobile health service for diabetic patients in NHS area. [2] Do you own a smartphone? When the above section has dealt with location of the respondents, the table 3.2 and figure 3.2 has shown the proportion of people who have smart phone. Though smart phone has become one of the essential part of daily life, the research has shown that almost 10% (n = 20) of the selected samples do not have smart phones. So, it can be said that almost 91% (n = 190) of the selected sample have used smart phone and therefore they may have heard about healthcare applications. No of response percentage Yes 190 90.48% No 20 9.52% [3] Would you consider getting one if you knew there are applications for health management? Here, the respondents were asked whether they would use the software if they previously knew that there exists any software for heath management. According to the below mentioned table, it can be said that almost 88.10% said yes whereas 20.83% said no. Part B: Questionnaire for public [1] Are you aware of the availability of health apps (applications) for smartphones? Now, the respondents were asked whether they are aware about the availability of healthcare application on smart phone. When 66.67% (n = 80) respondents has mentioned yes, a significant proportion (n = 40) has denied. This mean, a large group of people have no idea about availability of healthcare applications on smart phone though have smart phones. This directly indicates that the awareness about the mobile health service is still not up to the mark. Since on the objectives of the study was to assess the awareness about mobile health applications among smart phone users, there is requiring initiatives to enhance the awareness among general people. No of response percentage Yes 80 66.67% No 40 33.33% [2] Do you have any of the following medical conditions? (Tick as many as appropriate) No of response Percentage Diabetes 45 37.50% High blood pressure 15 12.50% High cholesterol 30 25.00% None of the above 30 25.00% The above table has shown that out of 120 people, 45 people have raised that they have diabetes. Similarly, 30 people have mentioned that they have high cholesterol as well as 30 people mentioned that they have no such issue. [3]Would you be interested in an app that would allow you to input information on a regular basis in order to help you monitor your medical condition? [For example entering your glucose levels or blood pressure measurements] Though a large number of samples have smart phone, while asking them whether they prefer to get a smart phone if they know that there are applications of health management, 70.83% (n = 85) have responded positively. This indicates that there is a significant chances of success related to use of mobile application for better healthcare service delivery. No of response Percentage Yes 85 70.83% No 35 29.17% [4] Would you be interested in an app that would send the information entered to a doctor or nurse who would then contact you if required? [For example, if blood pressure readings are very high or low the pharmacist, doctor or nurse would contact you and advise you on what to do] In response to this question, it has seen that 62.50% population has mentioned that they are interested, when 45 disagreed with this. No of response Percentage Yes 75 62.50% No 45 37.50% [5] Which healthcare professional would you prefer to be the one monitoring the information sent? In response to the question, half of the respondents have mentioned that they prefer doctor to monitor their health related information. Following which, they prefer nurse and then local pharmacist. No of response Percentage Nurse 45 37.5% Local Pharmacist 25 20.8333% Doctor 50 41.6667% [6] Are you taking any medication on a regular basis? The maximum number of respondents has mentioned that they have taken medication on regular basis. It means they are aware that medication will help to enhance the health life. No of response Percentage Yes 85 70.83% No 35 29.17% [7] If yes, would you be interested in an app that helps to remind you to take your medication? Though a large number of samples have smart phone, while asking them whether they prefer to get a reminder from the app, 87.50% (n = 105) have responded positively. This indicates that there is a significant chances of success related to use of mobile application for better healthcare service delivery. No of response Percentage Yes 105 87.50% No 15 12.50% [8] What types of apps do you download? In response to the question it has seen that on an average people download apps related to games and books. No of response Percentage Games 25 21% Education 25 21% Books 30 25% News 15 13% Social media 10 8% Health 5 4% Business 10 8% [9] What was the last time you downloaded the app? From the response to this question, it has become clear that the respondents are well aware about the usefulness of mobile application as they have downloaded any app on frequent basis. No of response Percentage Last week 30 25% Last month 30 25% Within 6 months 20 17% Within a year 15 13% More than a year ago 25 21% Part C: Questionnaire for pharmacist [1] Are you aware of the CPPE (Centre for Pharmacy Postgraduate Education) guide to health apps for pharmacists? Though a large number of samples have smart phone, while asking the pharmacist whether they are aware about CPPE, 83.33% (n = 75) have responded positively. This indicates that there is a significant chances of success of introduction of health apps. No of response Percentage Yes 75 83.33% No 15 16.67% [2] Which healthcare professional does the public prefer to be the one monitoring the information sent? In response to the question, half of the respondents have mentioned that they prefer doctor to monitor their health related information. Following which, they prefer nurse and then local pharmacist. No of response Percentage Nurse 30 33% Local Pharmacist 40 44% Doctor 20 22% [3] Do you read the CPEE guide? Now, the respondents were asked whether they are following CPEE guidelines or not. When 94.44% (n = 85) respondents has mentioned yes, a small proportion (n = 5) has denied. This mean, a large group of people have clear idea about the usefulness of CPEE guidelines. No of response Percentage Yes 85 94.44% No 5 5.56% [4] How do you rate the usefulness of the guide for your practice? Finally, the pharmacist were asked whether the CPEE guidelines are useful for health care professionals or not, around 44% respondents have mentioned that it is very useful. At the same time, the maximum people agreed with the fact that this is useful. No of response Percentage Very useful 40 44% Useful 30 33% Somehow useful 10 11% Not Useful 10 11% [5] What health services does your pharmacy provide? Finally, they were asked what kind of service they can deliver using this app. In response to this question, it has seen that there are average response for each of the below mentioned aspects. No of response Percentage Blood pressure measurement 25 28% Blood glucose measurement 15 17% Smoking cessation 10 11% BMI calculation 20 22% NHS health checkups 15 17% Cholesterol measurement 5 6% Qualitative Study This section of study has dealt with data gathered from face to face interview with health care professionals. The 10 health care professionals were interviewed based on four different aspects related to objective two and three. While considering the first theme, There is a lack of awareness of diabetes mobile health applications, it has seen that a mixed review was there. According to them, if 100 people were considered then almost 60 percent people were unaware about such mobile health applications. The quantitative study has also demonstrated equivalent results. So, the next concern was to understand what the reasons behind it are. According to them, it has seen that lack of use, time, inconvenience, limitation of functionalities mainly creates such issues. Therefore, from this point of view, it can be argued that in order to enhance the awareness of mobile health among general people, first of all, the usability, functionalities needs to be reviewed. The second them of this study was, Time is the main barrier to using diabetes mobile application. In response to this aspect, almost 80 percent people thinks time barrier was there which prevent the applicability of diabetics mobile applications. Many times, the complexity in terms of time management, priority setting, etc aspects of diabetics mobile applications takes time. Therefore, general people easily get de-motivated after using some time. According to them, the application needs to be designed in a simpler way. The third theme is all about alternative design of diabetics mobile applications. As mentioned in the above paragraph, people normally asked for simple app rather much more complex one. According to them, diabetics patient needs to follow proper time management strategy. So, one of the use of such application would be the remainders. Research has seen that diabetics patient needs to consume insulin at specific time. So, setting remainder for the night time insulin may be one of the options. Again, they have also said that blood glucose monitoring is another important aspect of diabetic patients. Therefore, it can also be said that remainder for monitoring blood glucose level on a frequent interval may be another alternative. Finally, the fourth theme has demonstrated that use of social networking through diabetic mobile applications might augment the chances of controlling such important vascular diseases. According to them, if the patients can get access through their diabetic mobile applications, it would help them to help each other. It has seen that one diabetic patient can understand better about another diabetic patients conditions than normal people. Therefore, they can easily provide advice through using these apps. In context of the data analysis, there is a necessity to highlight the key quotations that form the basis of the qualitative study. One patient was found to be stating that I would say that is what I feel. I can go and see anybody I like and they can tell me, but at the end of the day I need to inject, I need to watch what I eat its up to me so, its me. The elicited themes was that People can offer advice, but I have to make the decisions. On asked about who they rely specifically on and why, the participant said that Me, myself. I-I try to, I read-I read and if theres anything interesting I look into it and I do ask Drs and you know what I mean. Yeah. The participants was also found quoting that ) I dont well personally I dont feel its right to erm, rely on anybody else because something which erm, obviously its not something which people can easily empathise with.... The main point reflected from the analysis si that patients rely on themselves most to manage their condition. This implies that patients can be better managed by mHealth services that are the proper means of handling diabetes. The study revealed some points that were most important towards the use of mHealth in diabetes. The first point was that diabetes has a substantial impact on the patient care. Participants were from varying ages and thus the study recognised the effect of diabetes on their lives. Diabetes seemed to have an effect on occupation as well in education, social interactions and even psychological wellbeing. The literature search highlighted key long-term benefits of diabetes-structured education and its role in reducing the cost of diabetes care in the long term. It also pointed out that education leads to improved self-care as well as the fact that such educational courses aid with managing diabetes. The second point identified was that acceptability of mHealth by the common public is a matter of concern even though there are immense potential for mHealth to play a role in disease management. The mobile health market is already into progress and is gaining popularity due to the number of mobile applications available. Despite such progress, this study identified that awareness of such applications is limited. The third aspect is the role of pharmacist in diabetes care. Even though the pharmacists are recognized as significant role players in diabetes care, only few of them may be playing direct role in diabetes care by advising on medicines and dispensing. Therefore, it can be said that education is essential for diabetic patients. The above analysis has indicated one thing that the use of mobile application for diabetic patients is crucial. What is required is to amend the applicability, functionalities so that it can provide desire results. However, the healthcare professionals have raised concern about the longibility of such diabetic mobile applications. Many times due to misuse, the legibility of such applications get reduced. So, from that point of view, it can be said that design of manual is another important aspects here. Overall, proper education support is required while using such diabetic mobile applications. Therefore, incorporation of user manuals is essential aspect here. Discussion and Conclusion The main objective of the dissertation has been the acceptability of mHealth among the public and the pharmacists, who play a vital role in the health care delivery system. The results of the study conclude that there is a widespread use of mobile applications for health related purpose. Pharmacist use mHealth as a proper tool for health application that is used for cost effective and efficient health promotion in the community. Many pharmacists take up the use of mobile applications as the best means for creating public awareness. They rely on the fact that credible health information can be obtained from the applications that are used for health promotion and continuous health monitoring. The study also reveals that there does not lies much difference in the use of smart phones and applications between pharmacists who practice in the high class societies and those who practice in middle-class societies. Awareness creation and education are the two most important factors of increase of use of health applications for vascular diseases and diabetes. The study also revealed that there is no statistically significant difference in the possession of smartphones and download of apps between pharmacists practicing in middle-class-to-affluent areas and those in middle-class-to-deprived areas. Education and awareness creation activities to increase health apps use for health promotion and CPD are needed in all areas to improve acceptance. Many of the pharmacists may not be knowing about the availability of the diabetes tracker on the mobile phones. However, most of the pharmacists have the readiness to use the applications available for health related purposes, including diabet es and vascular diseases and the pharmacists recommend to the patients to use such mobile phone applications. This is the major step towards assisting diabetic and vascular disease patients for leading a healthy life and preventing the growth of the diseases. Such mobile applications help people at risk of developing diabetes and cardiovascular disease to take part in healthy lifestyle and habits and prevent onset of the diseases. There has been an immense rise in the use of mobile phone applications for health by the common people. There has been an increased rise in the adherence of mhealth application by the population at large due to the advantages they give and the better patient outcomes received. The population has the understanding that intervention by mHealth is effective in having diabetes and vascular disease outcomes. There is an optimized use of mobile applications for the advantages of recording of patient data, visual aids, reminders, and remote collaboration with the healthcare professionals. The conclusion is that there lies clear advantage of using mHealth by pharmacists and common population who have left the traditional means of healthcare and opted for the modern and more useful healthcare services. Moreover, the incorporation of perceptions of common population is paramount for the application of mHealth to the highest level. Patients and healthcare professionals are an integral part of such progress. References Ryu S. 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