Amaize, Aitalohi (UMD SPH Health Services Administration)
Barath, Deanna (UMD SPH Health Services Administration)
Bloodworth, Robin (UMD SPH Health Services Administration)
Chen, Jie (UMD SPH Health Services Administration)
Franzini, Luisa (UMD SPH Health Services Administration)
Kleinman, Dushanka (UMD SPH Epidemiology and Biostatistics)
Knudson, Alana (Walsh Center for Rural Health Analysis at NORC)
Oran, Rebecca (Walsh Center for Rural Health Analysis at NORC)
Simon-Rusinowitz, Lori (UMD SPH)
Background: Like many rural communities, the five-county Mid-Shore region of Maryland (comprised of Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties) faces unique health challenges, including higher rates of poverty and people living with chronic diseases. To help better meet regional health care needs and provide recommendations that could be applied to other Maryland rural areas, the Maryland Health Care Commission (MHCC) and the Department of Health established a workgroup (via Senate Bill 707 Freestanding Medical Facilities — Certificate of Need, Rates and Definition effective July 1, 2016) on rural health care delivery to oversee a study, hold public hearings and recommend policy options. At MHCC’s request, the UMD SPH and the Walsh Center for Rural Health Analysis at NORC partnered to conduct the study in parallel with the workgroup. The results of the study were published in November of 2017.
Goal: To highlight our mixed methods approach and present a summary of study findings and recommendations for restructuring and enhancing the health care delivery system on the Mid-Shore.
Objectives: To highlight our mixed methods approach and present a summary of study findings and recommendations for restructuring and enhancing the health care delivery system on the Mid-Shore.
Approach: The study consisted of the following: • 5 focus groups with Mid-Shore residents • Stakeholder interviews with community leaders • Analysis of claims and primary care physician workforce data • Review of literature and national rural health delivery models • Input from the Rural Health Care Delivery Workgroup, its advisory groups, and public hearings
Results: Four high-level recommendations to support better health and well-being of Mid-Shore residents and potentially other rural Maryland communities emerged: 1. Establish a Mid-Shore multi-sector Coalition 2. Create a rural community health demonstration program 3. Invest in fundamental programs that expand the health care workforce, elevate community-based health literacy and enable technology 4. Use strategic programs to position Maryland rural communities to benefit from Maryland’s health care reform initiatives.
Importance to public health: Maryland’s health care system is transforming from a volume-based to a value-based reimbursement and delivery system, and is well-positioned to respond to residents’ needs by focusing on improvement of the health and well-being of communities. Our study findings and past experience working with rural communities, indicate that community-driven solutions have the greatest potential for success.
Banis, George (UMD)
Beardslee, Luke (UMD)
Stine, Justin (UMD)
Ghodssi, Reza (UMD)
Background: Integrated capsule systems are widely gaining momentum for analysis or drug delivery in gastrointestinal (GI) regions where alternative techniques are expensive, invasive, or inadequate. Depending on the region, there are numerous physiological considerations that must be addressed for fluid sampling with minimal human intervention. Previous passive approaches to GI sampling lack a means of knowing whether a sample has been retrieved in real-time, while active approaches suffer due to cost and complex assembly.
Goal: This project aims to develop a wireless ingestible microsystem with specialized sensors for sampling secretions throughout the GI tract and monitoring enzymes in situ for indicating pathological conditions.
Objectives: In this work, a breadboard-level circuit representative of the electronics toward full integration within the capsule are used to monitor the removal of polymer material from gratings within a 3D printed capsule. The polymers protect sensors within the capsule, only exposing them when the device has reached the GI region of interest. Different Eudragit polymers are used to target different GI regions: E PO, S 100, and L 100 dissolve respectively at the stomach, ileum, and duodenum.
Approach: The circuit setup was first characterized and signal transmission protocols (serial or wireless) were compared. Sensors are inserted into 3D-printed capsules. Once inserted, the capsules are fastened using built-in threads and sealed with epoxy, then dip-coated into a 30 w/v% solution of each polymer in methanol, each for 1-5 coats with removal for 20 min intervals between each coating. Capsule coating thicknesses were analyzed over gratings and non-grating regions for uniformity. Capsules were then immersed in a control solution (pH 3 for S/L100 and pH 7 for E PO formulations) and progressively adjusted at 30 min intervals to different test pH sequences. After coating optimization was performed for each polymer, combined coatings were tested to determine ability to tailor sampling for more complex pH sequences.
Results: Gratings resulted in a slower increase with each coating due to polymer in-fill. We obtain the sensor output and corresponding change in capacitance over the course of pH adjustments for each polymer, indicating the expected length of time for chamber filling and sampling dynamics for each coating thickness. We also obtain representative sequences of L 100 and E PO formulations, as well as a combined coating of both polymers. As expected, the capacitance increase did not occur until the respective polymers dissolved at the appropriate pH, indicative that both single and combined coating strategies can be used to protect the sensing chambers until the characteristic pH-targeted regions are reached.
Importance to public health: This work is the first demonstration of a passive pH-dependent packaging strategy for ingestible capsule technology that offers information on the package integrity at any given time, while simultaneously providing a real-time active microelectronics-based system capable of wireless retrieval of sensor data for use in GI sampling and analysis.
Barath, Deanna (UMD SPH Health Services Administration)
Bloodworth, Robin (UMD SPH Health Services Administration)
Franzini, Luisa (UMD SPH Health Services Administration)
Background: Like many rural communities, the five-county Mid-Shore region of Maryland (comprised of Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties) faces unique health challenges, including higher rates of poverty and people living with chronic diseases
Goal: To understand the demand for health care by Mid-Shore residents in order to plan for a health care system that meets residents’ needs.
Objectives: • Where do residents of the Mid-Shore region go for health care? • Do residents in the region access care in the Mid-Shore region, in state or out of state? • For each county, do county residents access care in the county, the region, in state or out of state?
Approach: We used HSCRC hospital data, All Payer Claims Database, Medicare and Medicaid data to answer the questions above. We identify Mid Shore residents by zip codes, match to utilization databases, and identify visit location by provider zip code using the provider’s National Provider Identifier. All visits were assessed by type of visit: primary care, ER, inpatient.
Results: Mid-Shore residents have higher health care utilization relative to state averages. While most health care was accessed in the county of residence and in region, Medicare and Medicaid residents received more care locally compared to privately insured residents. Queen Anne’s residents are more likely to access care on the Western Shore, due to its proximity. Only about half of inpatient admissions are on the Mid-Shore, with less than 50 percent of privately insured residents staying in region. These patients have the transportation and other resources to access care based on reputation and specialized services offered by out-of-region hospitals.
Importance to public health: The findings reinforce the need to provide high-quality and accessible care on the Mid-Shore given that most residents access care locally for all their needs; and highlight the importance of maintaining and strengthening access to emergency room services on the Mid-Shore. The higher rates of inpatient admissions due to ambulatory sensitive conditions, across the region and particularly in Dorchester and Kent counties, indicate the need to reinforce ambulatory care locally. These results were shared with a Rural Health Workgroup and shared with the Legislature.
Benjenk, Ivy (UMD SPH HLSA)
Linman, Shawn (UMD SPH HLSA)
Chen, Jie (UMD SPH HLSA)
Background: Primary care practices are transforming the way that they provide care by increasing their medical home infrastructure. However, previous studies have shown variation in the implementation of these medical home functions across different practices types.
Goal: This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with severe psychological distress (SPD).
Objectives: Early work has also shown that adults with mental illness can significantly benefit from receiving their primary care through a medical home. The objective of this study is to examine the degree to which medical home functions have been implemented by primary care practices that care for adults with severe psychological distress (SPD), a proxy measure of mental illness. We also aim to examine whether adults with SPD are more or less likely to receive primary care from practices that have implemented the medical home functions as compared to adults without SPD.
Approach: Analysis of the 2015 Medical Expenditure Panel Survey (MEPS) Household Component and Medical Organizations Survey (MOS). This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care.
Results: Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with SPD (N=267, representing 3,658,230 Americans) were not any more or less likely to receive care from practices that have implemented the functions of a medical home that adults without SPD, including case management, electronic health records, flexible scheduling, and Patient Centered Medical Home (PCMH) certification. We did however find that adults with SPD were significantly more likely to be cared for in practices that provided individualized quality reports to their physicians (AOR=2.06, 95% CI 1.13-3.77).
Importance to public health: Although we found that adults with SPD receive care from different types of practices than adults without SPD, we did not find much difference between the two groups as related to the medical home functionality of their site of primary care. Due to their complex medical and psychosocial comorbidities, adults with mental illness have significant potential to benefit from primary care that is delivered through a medical home.
DuGoff, Eva H. (UMD SPH HLSA)
Benjenk, Ivy (UMD SPH HLSA)
Cushman, Jeremy T. (University of Rochester)
Jones, Courtney MC (University of Rochester)
Kind, Amy JH (University of Wisconsin)
Lohmeier, Michael (University of Wisconsin)
Shah, Manish N. (University of Wisconsin)
Background: Older adults are estimated to make over 20 million visits to the emergency department (ED) annually. Reducing unnecessary ED use is a priority, and designing appropriate interventions requires a nuanced understanding of what is driving health care utilization. Previous studies have established that sociodemographic and clinical health factors contribute to frequent ED use, but less is known about the importance of enabling resources as defined by the Aday-Andersen Health Behavior Model.
Goal: The purpose of our project is to identify enabling resources among older adult emergency department users.
Objectives: In light of a recent National Academy of Medicine report recommending population segmentation to better understand the specific needs in high-need subgroups, we examine the enabling resources among high-need segments of the ED population.
Approach: This is a retrospective cross-sectional study of patient-survey data collected as part of an on-going randomized trial. We defined high-need segments as individuals reporting one or more functional limitation with an activity of daily living and/or multimorbidity (3+ chronic conditions). For purposes of comparison, we use “relatively healthy” subjects who did not report a functional limitation or multimorbidity. 434 adults 60 and older living in Monroe County, New York or Dane County, Wisconsin who consented to participate in a randomized trial and were enrolled into the control group.
Results: One out of four older adults (24.9%) reported living with multimorbidity and a functional limitation; 32.5% reported living with multimorbidity and no functional limitations; and, 9% reported a functional limitation and fewer than three chronic conditions. Older adults with functional limitations and/or multimorbidity were more likely to report fair/poor health compared to relatively healthy older adults (p<0.001). We also found substantial differences in enabling resources by high-need segment. Older adults reporting a functional limitation with and without multimorbidity were more than three times as likely to report poor health literacy compared to relatively healthy older adults (p=0.015) and more than four times likely to report high levels of social isolation (p<0.001).
Importance to public health: Older adults with high needs have fewer enabling resources. These high-need older adults may require tailored interventions to reduce repeat ED visits, and future unnecessary ED visits.
Fernando, Nimasha (UMB SOM Epidemiology and Public Health)
Peprah, Yolanda (UMB SOP Pharmaceutical Health Services Research)
Chapin, Bambi (UMBC Sociology)
Onukwugha, Eberechukwu (UMB SOP Pharmaceutical Health Services Research)
Camelo Castillo, Wendy (UMB SOP Pharmaceutical Health Services Research)
Background: Federally Qualified Health Centers (FQHCs) are a valuable resource among individuals from underserved communities who face challenges accessing the health system. The vulnerability of these individuals is heightened if they have a chronic condition and experience multiple hospital-to-home transitions in care while attempting to continually manage their condition.
Goal: To investigate how health providers and community advocates from public service sites view FQHCs as possible resources for members of the Hispanic community with chronic conditions.
Objectives: Qualitative study. Six semi-structured audio-recorded interviews were conducted with providers (n=4) and patient advocates (n=2) regarding their perspectives of resources for individuals with chronic conditions from a Hispanic community in the Baltimore area during hospital-to-home transitions. Providers included a physician, nurse, interpreter, and community health program director. Interviews were recorded, transcribed, and translated verbatim (from Spanish, n=2).
Approach: Transcripts were systematically analyzed with Dedoose software to identify all responses where participants referred to an FQHC such as by describing a free clinic for the uninsured. Since participants were not directly asked about FQHCs, they were free to discuss these sites in any context they felt was relevant.
Results: All providers discussed FQHCs, but some described FQHCs as one resource to be utilized for a specific service or episode of care, while others only identified these centers as actors within the broader health system but not as resources for patients to utilize. No provider discussed FQHCs’ abilities to provide continuous chronic disease care. Although other elements of patients’ health networks and the health system were described as interconnected, FQHCs were referred to in isolation with no comment about their connection to the broader health system.
Importance to public health: Viewing FQHCs as disconnected from the larger health system may lead to providers and advocates missing opportunities to provide coordinated care for underserved patients with chronic conditions. By establishing partnerships and facilitating collaboration between FQHCs and other actors within patients’ health networks, the overall health system can be strengthened thereby improving access to continual care for underserved populations who may similarly utilize multiple health resources and sites for care.
Hegland, Thomas (UMD BSOS Economics)
Background: Medicaid is the primary payer for nursing home care in the United States and often struggles with ensuring its enrollees receive high quality nursing home care. Partially in an effort to address this quality problem, nearly half of state Medicaid programs have at some point between the 1990s and present offered payroll subsidies to nursing homes as part of their Medicaid payments. These subsidies can be very costly but also have the potential to efficiently induce increases in nursing home staffing levels, and so merit careful evaluation.
Goal: The goal of this project is to assess the efficacy of state Medicaid programs' nursing home payroll subsidies for improving nursing home staffing and care quality.
Objectives: 1. Estimate the causal effect of state Medicaid programs' nursing home payroll subsidies on nursing home staffing levels and care quality. 2. Determine the extent to which the effectiveness of subsidies varies across different subsidy designs and by nursing home market structure.
Approach: This research produces causal estimates of the effect of nursing home payroll subsidies on nursing home level outcomes by exploiting both variation in subsidy rates faced by individual nursing homes within subsidy states as well as variation across states which do and do not offer subsidies. In particular, difference-in-differences and synthetic control methods are employed. The data on nursing home staffing levels and resident outcomes used for these analyses is drawn from annual censuses of nursing homes conducted by state Medicaid agencies from 1996 through 2015. The information on state Medicaid programs’ nursing home reimbursement policies throughout this time period was collected by the researcher.
Results: Preliminary results drawing upon, in particular, evidence from the relatively unique subsidy regimes adopted by the states of Maine, Florida, and Texas point to substantially greater subsidy effects than previously reported in the literature, but with precise effects varying substantially by subsidy design.
Importance to public health: Better information about the relative efficacy of different Medicaid nursing home policies has the potential to improve both nursing home resident outcomes and Medicaid programs' cost efficiency, both important given the pressure created by the aging population’s increasing demand for nursing home care.
Huiszoon, Ryan (UMD)
Ramiah Rajasekaran, Pradeep (UMD)
Bentley, William (UMD)
Ghodssi, Reza (UMD)
Background: Bacterial biofilms present a significant challenge in healthcare, forming on a range of hydrated surfaces, particularly inserted and implanted medical devices where they serve as a source of recurring infection. Biofilms consist of bacteria encased primarily in polysaccharides and extracellular DNA, and this film affords the bacteria increased tolerance to antibiotics, rendering many treatments ineffective. Furthermore, these communities exacerbate the spread of antibiotic resistance by allowing horizontal gene transfer within the film. There are a lack of techniques to detect and eliminate these films on the geometrically complex surfaces where they form.
Goal: This work strives to develop a device-based approach to address the challenge of detecting and treating bacterial biofilms on complex device surfaces without reliance on excessive antibiotic use.
Objectives: In this work we explored the ability of a microfabricated electrode-based platform to function as an impedance sensor for biofilm detection and as a tool to apply the bioelectric effect for biofilm removal. By utilizing a flexible substrate, these functions can be achieved while the device conforms seamlessly with the 3D geometry of the vulnerable surface.
Approach: The device consisted of a flexible polyimide substrate with microfabricated electrodes arranged in an interdigitated pattern. The device is inserted into a cylindrical silicone tube, representative of urinary catheter’s geometry. Biofilms are grown over 24 hours and the change in the system impedance serves to detect the formation. After 24 hours of growth, the mature biofilms are treated with the bioelectric effect (BE). BE consists of the electric field induced by the impedance sensor and a low concentration dose of antibiotics. The electric field increases the susceptibility of the biofilm to antibiotics. After treatment, crystal violet staining will be used to correlate the change in biomass with the impedance sensing results and confirm the efficacy of the BE treatment.
Results: A 30% decrease in impedance corresponded to biofilm growth over 24 hours, along with a statistically significant increase in biomass. BE treatment led to a 12% increase in impedance, due to the removal of biofilm. The BE treatment also led to significant or nearly significant decreases in biomass compared to untreated, antibiotic only treated, or electric field only treated samples.
Importance to public health: Bacterial biofilms are significant public health issue, colonizing medical devices and surfaces, causing infections, and spreading antibiotic resistance. In addition, biofilms colonize water systems and food processing plants, introducing bacterial contaminants into food and drinking water.
Wang, Min Q. (UMD)
Ighani, Mehrnaz (UMD)
Background: Primary care physicians (PCPs) serve as the patients’ first point of entry into the health care system and the demand for them continues to grow which challenges the long-term viability of health care in rural areas. We provide an analysis of the active physician workforce in the five counties of the Maryland Mid-Shore region with a focus on PCPs and an overview of select demographic and practice characteristics.
Goal: To investigate the necessity and shortage of primary care physicians in 5 counties of Mid-Shore Maryland
Objectives: We provide an analysis of the active physician workforce in the five counties of the Maryland Mid-Shore region with a focus on PCPs and an overview of select demographic and practice characteristics.
Approach: Active primary care physicians (n=110) chosen were ˂75 years of age, held a specialty board in family medicine, general practice, internal medicine, pediatrics or OB/GYN general, had an active medical license, designated a practice in one of the counties, and provided patient care for ≥20 hours per week in 2014-2015. We excluded physicians working for the federal government and military.
Results: Of 110 PCPs available for 171,166 residents, 49 (45%) were family practitioners, 36 (33%) internists, 16 (15%) pediatricians, and 9 (8%) OB/GYNs. 20% were in solo practice, 27% practiced in a single specialty group practice, and 7% practiced as hospital staff as their primary practice. Slightly over half of the PCPs practiced in private non-proﬁt offices and slightly smaller than 1/3 practiced in private proﬁt offices. Ninety-five percent of PCPs participated in private insurance networks, while 86% participated in the Maryland Medical Assistance Program and 86% participated in the Medicare Program. The distribution of PCPs illustrated that Talbot, Kent, and Dorchester counties showed higher density of PCPs than Caroline and Queen Anne’s counties.
Importance to public health: The Mid-Shore region of Maryland suffers from primary care physician shortage and an uneven geographic distribution of PCPs. Policy decisions that increase the size of the primary care workforce without addressing distribution may not solve the PCP shortage issue.
Shim, Jae Kun
Background: Estimation of gait force asymmetry has valuable applications in clinical assessments. However, the gold standard for it (i.e. force platforms) are relatively expensive and limited to laboratory settings. The aim of this project was to investigate the feasibility of using an accelerometer mounted on the lower back for assessing gait asymmetry during gait.
Goal: Development of an accessible, cost-effective system for evaluation of gait force asymmetry under free-living conditions using accelerometers.
Objectives: The region near the L3 vertebrae was chosen for sensor placement of the sensor. We hypothesized that there will be a positive strong correlation between the asymmetry index measured from force platforms and the accelerometer.
Approach: A total of 25 young healthy participants completed three trials of walking and running under six conditions: normal walking as well as simulated asymmetry conditions. Their speed was controlled for by keeping them at +/-5% of their preferred walking/running trial as measured by speed gaits. Ground reaction forces and acceleration were measured simultaneously at 1000Hz. Left-right asymmetry was quantified using the peak magnitude of each signal during the corresponding stance leg. Pearson correlation coefficient was used to investigate the relationship between the two indices.
Results: The results showed a strong positive correlation between the force asymmetry index and the accelerometer index in running and walking ( r = 0.91 vs. r = 0.70, respectively).
Importance to public health: Estimation of force asymmetry in gait under free-living conditions can provide valuable clinical information about the effectiveness of rehabilitation or surgery procedures.
Marthey, Daniel (UMD SPH Health Services Administration)
Background: In children 6 to 19 years old dental caries are the most common chronic disease and four times more prevalent than asthma in teens (Centers for Disease Control and Prevention, 2016). Under the ACA, Children's dental services are required for Medicaid and CHIP but in the marketplaces dental coverage is not a required purchase.
Goal: The goal of this project was to understand how recent dental coverage policies impact children accessing dental services through each of the insurance types (Medicaid, CHIP, Private On/Off-Exchange).
Objectives: 1. Is there a difference in utilization rates of pediatric dental services between children accessing benefits via plan types including: Medicaid, CHIP, and private insurance on and off-exchange? 2. Between these plan types is there a difference in the rates of financial barriers to dental services experienced by children? We compare utilization and financial barriers to dental services between children (1-20 years) with dental coverage through Medicaid, CHIP and those with private coverage on and off-exchange using a nationally representative sample.
Approach: We use the National Health Interview Survey (NHIS) (2014-2016) to compare the odds of dental utilization and the odds of experiencing a financial barrier to dental services between children and adolescents aged 1-20 years by insurance type (Medicaid, CHIP, private on-exchange, private off-exchange). Using two logistic regression models we calculated differences between groups controlling for sex, race/ethnicity, household income, and health status and region.
Results: Findings suggest there is a significant difference in use of dental services between kids on Medicaid and exchange-based dental coverage (OR: .58, P: 0.00). Further we find that children in the CHIP program are much more likely to experience a dental visit compared with children on Medicaid (OR: 1.69, P: 0.00). Compared with the Medicaid cohort, children with private dental coverage off-exchange are less likely to experience a financial barrier (OR: .75, P: 0.00) and children with private insurance on-exchange are much more likely to experience a financial barrier (OR: 2.4, P: 0.00).
Importance to public health: These findings imply that children's dental health may be at risk if children are shifted from private off-exchange or Medicaid and CHIP programs into marketplace coverage.
Importance to public health:
Regmi, Rachana (MPH)
Importance to public health:
Singh, Usha (UMD/Westat)
Osafo-Darko, Benedicta (Westat)
Samson, Viola (Westat)
Jones, Chandria (Westat)
Brenda, Leath (Westat)
Background: Social determinants such as employment, housing, food and nutrition, education, transportation, recreation, and quality health care affect health. Imbalances in social determinants manifest as disparities and inequities in health. Discussants of a Westat Center on Health Disparities & Health Equity Research roundtable event highlighted innovative solutions and their applications for addressing health disparities. This roundtable highlighted creative approaches for sharing knowledge, applying technology innovations, and implementing sociological interventions as critical elements for promoting health equity.
Goal: The goal of this research is to use data from a Health Equity Roundtable discussion to identify and describe the benefits of recent technological and sociological interventions to improve health and wellness towards the goal of achieving health equity.
Objectives: • Identify innovations and interventions used to address population health needs to achieve health equity • Describe the importance of research and data in health policy and practice to address health disparities and promote health equity • Discuss how narrative inquiry, media, and information technology can be used in community-based participatory approach to explore health disparities
Approach: A Health Equity Roundtable featuring multidisciplinary professionals who engaged in an interactive dialogue about strategies for eliminating disparities and achieving health equity was held in November 2016. Content analysis was performed on the video recording of the roundtable discussion. The video was reviewed and data from the video was organized and coded, to identify key themes and strategies for achieving health equity.
Results: The Health Equity Roundtable participants discussed various strategies and interventions used to address population health needs to improve health equity. Interventions identified included the use of wearable technology to provide early identification of diseases, the application of telemedicine for addressing service needs across settings and geographic boundaries, and the use of video as an educational tool for addressing health disparities and promoting health equity. Additionally, participants emphasized the development of legislative and policy agendas to address prevention, health insurance coverage and workforce development.
Importance to public health: Emerging technological innovations and sociological interventions provide effective means for disease prevention, increase accessibility to quality healthcare, and develop healthcare policy that will address health disparities and promote health equity.
Zhang, Shannon (CHIDS)
Zappas, Anne (CHIDS)
Dugas, Michelle (CHIDS)
Gao, Gordon (CHIDS)
Background: Many chronic diseases today can be prevented with better lifestyle choices, but efforts to establish and maintain healthy habits often fail. Part of this could be attributed to a need for continuous care that is not provided in traditional models of health care (Block 2013; CAPP 2015). Treatment delivered via mobile technology (mHealth) may be able to help fill that gap, but there is inconsistency in the effectiveness of such interventions (Free et al. 2013).
Goal: The goal of this review is to summarize the various behavior change techniques (BCTs) used in randomized controlled trials of mHealth interventions to understand the variability in existing approaches and highlight areas for improvement.
Objectives: The first main objective of our literature review was to identify the top impact journals in the medical and medical informatics field and articles within these journals that test the effectiveness of mHealth interventions randomized controlled trial designs. Following this, our final objective is to summarize BCTs employed in intervention and comparator study arms.
Approach: In our mobile health literature review, we selected articles published in 2007-2017 in which the primary component of the intervention under evaluation involved a mobile technology component. Each study tested the effectiveness of mHealth interventions for improving health behavior or outcomes. We then coded the BCTs used in the mHealth intervention and comparator arms with a validated and well-established taxonomy (Michie, 2013).
Results: We identified 22 articles for the systematic literature review, 10 of which used text messaging interventions and 12 that used smartphone application interventions. A wide range of outcomes were studied from weight loss to medication adherence. A portion of the articles have already been coded for the behavioral change technique, but some are still being finalized.
Importance to public health: Our findings will help unpack the diversity in current approaches to mHealth, highlighting areas for standardization, refinement, and improvement of interventions. Evidence that BCTs are highly variable in their effectiveness would suggest that policymakers should be cautious when generalizing from one mHealth approach to another. Finally, greater precision in linking specific BCTs and effectiveness of mHealth will contribute to ensuring that people have access to the most effective treatment possible.