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      Harnessing mobile health technology to support long-term chronic illness management: exploring family caregiver support needs in the outpatient setting

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          Abstract

          Objective

          Family caregiving is an important public health issue, particularly with the aging population. In recent years, mobile health (mHealth) technology has emerged as a potential low-cost, scalable platform to address caregiver support needs, and thereby alleviate the burden on caregivers. This study sought to examine the support needs of family caregivers in their lived experiences of outpatient care to inform the development of a future mHealth intervention.

          Materails and Methods

          We conducted 20 semi-structured interviews in 2 outpatient hematopoietic cell transplant (HCT) clinics at a large academic medical center in the Midwestern United States. A thematic analysis was performed to define emerging themes.

          Results

          Qualitative data analysis identified 5 primary themes that HCT caregivers faced: (I) lifestyle restrictions due to the patient’s immunocompromised state; (II) Unmet needs due to limitations in the current resources, including unfamiliar medical tasks without necessary trainings; and (III) caregivers’ adaptive strategies, including reformation of social relationships with family and friends. Based on these findings, we suggest 3 design considerations to guide the development of a future mHealth intervention.

          Conclusions

          The findings herein captured the family caregiver’s lived experiences during outpatient care. There was broad agreement that caregiving was challenging and stressful. Thus, effective and scalable interventions to support caregivers are needed. This study provided data to guide the content and design of a future mHealth intervention in the outpatient setting.

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          Most cited references58

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          Self-efficacy: Toward a unifying theory of behavioral change.

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            Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis.

            Do positive psychology interventions-that is, treatment methods or intentional activities aimed at cultivating positive feelings, positive behaviors, or positive cognitions-enhance well-being and ameliorate depressive symptoms? A meta-analysis of 51 such interventions with 4,266 individuals was conducted to address this question and to provide practical guidance to clinicians. The results revealed that positive psychology interventions do indeed significantly enhance well-being (mean r=.29) and decrease depressive symptoms (mean r=.31). In addition, several factors were found to impact the effectiveness of positive psychology interventions, including the depression status, self-selection, and age of participants, as well as the format and duration of the interventions. Accordingly, clinicians should be encouraged to incorporate positive psychology techniques into their clinical work, particularly for treating clients who are depressed, relatively older, or highly motivated to improve. Our findings also suggest that clinicians would do well to deliver positive psychology interventions as individual (versus group) therapy and for relatively longer periods of time. (c) 2009 Wiley Periodicals, Inc.
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              Positive psychology interventions: a meta-analysis of randomized controlled studies

              Background The use of positive psychological interventions may be considered as a complementary strategy in mental health promotion and treatment. The present article constitutes a meta-analytical study of the effectiveness of positive psychology interventions for the general public and for individuals with specific psychosocial problems. Methods We conducted a systematic literature search using PubMed, PsychInfo, the Cochrane register, and manual searches. Forty articles, describing 39 studies, totaling 6,139 participants, met the criteria for inclusion. The outcome measures used were subjective well-being, psychological well-being and depression. Positive psychology interventions included self-help interventions, group training and individual therapy. Results The standardized mean difference was 0.34 for subjective well-being, 0.20 for psychological well-being and 0.23 for depression indicating small effects for positive psychology interventions. At follow-up from three to six months, effect sizes are small, but still significant for subjective well-being and psychological well-being, indicating that effects are fairly sustainable. Heterogeneity was rather high, due to the wide diversity of the studies included. Several variables moderated the impact on depression: Interventions were more effective if they were of longer duration, if recruitment was conducted via referral or hospital, if interventions were delivered to people with certain psychosocial problems and on an individual basis, and if the study design was of low quality. Moreover, indications for publication bias were found, and the quality of the studies varied considerably. Conclusions The results of this meta-analysis show that positive psychology interventions can be effective in the enhancement of subjective well-being and psychological well-being, as well as in helping to reduce depressive symptoms. Additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions.
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                Author and article information

                Journal
                JAMIA Open
                JAMIA Open
                jamiaoa
                JAMIA Open
                Oxford University Press
                2574-2531
                December 2020
                05 December 2020
                05 December 2020
                : 3
                : 4
                : 593-601
                Affiliations
                [1 ] Department of Media and Information, College of Communication Arts and Sciences, Michigan State University , East Lansing, Michigan, USA
                [2 ] Department of Biostatistics, School of Public Health, University of Michigan , Ann Arbor, Michigan, USA
                [3 ] School of Information, University of Michigan , Ann Arbor, Michigan, USA
                [4 ] Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan , Ann Arbor, Michigan, USA
                [5 ] Department of Anesthesiology, University of Michigan , Ann Arbor, Michigan, USA
                [6 ] Michigan Institute for Clinical and Health Research, University of Michigan , Ann Arbor, Michigan, USA
                [7 ] Stamps School of Arts and Design, University of Michigan , Ann Arbor, Michigan, USA
                [8 ] School of Nursing, University of Michigan , Ann Arbor, Michigan, USA
                Author notes
                Corresponding Author: Sung Won Choi, MD MS, University of Michigan, Blood and Marrow Transplantation Program, 1500 E. Medical Center Dr., D4118 MPB, Ann Arbor, MI 48109-5718, USA; sungchoi@ 123456med.umich.edu
                Author information
                http://orcid.org/0000-0001-6755-0179
                http://orcid.org/0000-0001-6625-3092
                http://orcid.org/0000-0002-6321-3834
                Article
                ooaa053
                10.1093/jamiaopen/ooaa053
                7969961
                33758797
                efe06db1-dd85-4897-9963-c105ade9961b
                © The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 02 March 2020
                : 18 August 2020
                : 24 September 2020
                Page count
                Pages: 9
                Funding
                Funded by: American Society of Hematology Bridge Grant and National Institutes of Health / National Heart, Lung, and Blood Institute;
                Award ID: 1R01HL146354
                Funded by: Edith S. Briskin and Shirley K Schlafer Foundation;
                Categories
                Research and Applications
                AcademicSubjects/SCI01530
                AcademicSubjects/MED00010
                AcademicSubjects/SCI01060

                family caregiver,hematopoietic cell transplantation,bone marrow transplantation,mhealth

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