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|Issue 58||January 2013|
A Systematic Review: Mobile Applications and Internet-based Approaches for Supporting Non-Professional Caregivers
With an increasing number of Veterans who require care and assistance for traumatic brain injuries (TBI), physical impairments, or other chronic conditions there is a growing demand for spouses, parents, or other family members and friends to assume the role of caregiver. Electronic health applications and e-health tools are increasingly available and have the potential to facilitate caregiving outside of traditional healthcare settings, especially in the context of the rising use of smartphones and mobile technologies. Lessons learned from prior consumer health information technology (CHIT) interventions could help inform the development of health-related mobile applications.
CHIT applications are defined as electronic tools or technologies intended for use by consumers, patients, or family members that interact directly with users for the management of their health or healthcare, and in which data, information, or other recommendations are tailored and/or individualized. A CHIT tool may or may not link to a health professional or health system services. The VA is currently developing mobile applications that are intended for use by seriously injured post-9/11 Veterans and their family caregivers enrolled in the Comprehensive Assistance for Family Caregivers program. This report was requested on behalf of the VA offices that are developing these mobile tools.
Investigators with the VA Evidence-based Synthesis Program (ESP) Center in Portland, OR searched multiple databases and reviewed more than 2,600 articles and abstracts, with 57 meeting inclusion/exclusion criteria for this review. These articles were used to address the following questions:
Several studies described how technical barriers or lack of familiarity with technology could limit accessibility of the intervention. Despite the numerous potential technical barriers, few studies reported on the amount of technical assistance and training provided to users. Researchers speculated that older caregivers may be less likely to benefit from mobile applications because they are less likely to be users of handheld technology. Therefore, older caregivers may require training. They also may benefit from applications with special accommodations for poorer vision, decreased manual dexterity, and other limitations due to chronic illnesses. Accommodations for language preference may enhance the utility of mobile applications for immigrant caregivers. Of note, no studies found that security or privacy concerns were a barrier to use of the applications.
A larger trial involving asthma patients found that an intensive web-based intervention designed to improve parental and child knowledge of asthma reduced emergency room utilization. This intervention involved 44 animated lessons, with many covering real-life scenarios related to disease management and treatment adherence. Questions checked the user's comprehension.
Several studies also examined the role of online peer communication strategies. Parental users described benefits of peer support, such as lowering the sense of isolation. While peer communication improved parental coping in some instances, users also pointed out that the large volume of off-topic posts, as well as posts about losing seriously ill children were detracting features.
Two studies evaluated text messaging interventions. One small trial in liver transplant patients found that a text-message medication reminder system involving children and parents reduced rates of biopsy-proven rejection. Another very large trial found that a simple text-message intervention in which parents received up to five weekly text messages increased influenza vaccination rates in a low-income population.
A Cyberseminar session on this ESP Report will be held on Monday, February 25, 2013 at 12:00pm ET. To register, go to the HSR&D Cyberseminar web page.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers -- and to disseminate these reports throughout VA.
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This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.
See all reports online.