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Article: Improving self-care in patients with coexisting type 2 diabetes and hypertension by technological surrogate nursing: randomized controlled trial

TitleImproving self-care in patients with coexisting type 2 diabetes and hypertension by technological surrogate nursing: randomized controlled trial
Authors
Keywordstechnological surrogate nursing
eHealth
complex chronic disease
diabetes
hypertension
Issue Date2020
PublisherJournal of Medical Internet Research. The Journal's web site is located at http://www.jmir.org/
Citation
Journal of Medical Internet Research, 2020, v. 22 n. 3, p. article no. e16769 How to Cite?
AbstractBackground: Technological surrogate nursing (TSN) derives from the idea that nurse-caregiver substitutes can be created by technology to support chronic disease self-care. Objective: This paper begins by arguing that TSN is a useful and viable approach to chronic disease self-care. The analysis then focuses on the empirical research question of testing and demonstrating the effectiveness and safety of prototype TSN supplied to patients with the typical complex chronic disease of coexisting type 2 diabetes and hypertension. At the policy level, it is shown that the data allow for a calibration of TSN technology augmentation, which can be readily applied to health care management. Methods: A 24-week, parallel-group, randomized controlled trial (RCT) was designed and implemented among diabetic and hypertensive outpatients in two Hong Kong public hospitals. Participants were randomly assigned to an intervention group, supplied with a tablet-based TSN app prototype, or to a conventional self-managing control group. Primary indices—hemoglobin A1c, systolic blood pressure, and diastolic blood pressure—and secondary indices were measured at baseline and at 8, 12, 16, and 24 weeks after initiation, after which the data were applied to test TSN effectiveness and safety. Results: A total of 299 participating patients were randomized to the intervention group (n=151) or the control group (n=148). Statistically significant outcomes that directly indicated TSN effectiveness in terms of hemoglobin 1c were found in both groups but not with regard to systolic and diastolic blood pressure. These findings also offered indirect empirical support for TSN safety. Statistically significant comparative changes in these primary indices were not observed between the groups but were suggestive of an operational calibration of TSN technology augmentation. Statistically significant changes in secondary indices were obtained in one or both groups, but not between the groups. Conclusions: The RCT’s strong behavioral basis, as well as the importance of safety and effectiveness when complex chronic illness is proximately self-managed by layperson patients, prompted the formulation of the empirical joint hypothesis that TSN would improve patient self-care while satisfying the condition of patient self-safety. Statistical and decision analysis applied to the experimental outcomes offered support for this hypothesis. Policy relevance of the research is demonstrated by the derivation of a data-grounded operational calibration of TSN technology augmentation with ready application to health care management. Trial Registration: ClinicalTrials.gov NCT02799953; https://clinicaltrials.gov/ct2/show/NCT02799953
Persistent Identifierhttp://hdl.handle.net/10722/294071
ISSN
2020 Impact Factor: 5.428
2020 SCImago Journal Rankings: 1.446
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorOr, CK-
dc.contributor.authorLiu, K-
dc.contributor.authorSo, MKP-
dc.contributor.authorCheung, B-
dc.contributor.authorYam , LYC-
dc.contributor.authorTiwari , A-
dc.contributor.authorLau , YFE-
dc.contributor.authorLau, T-
dc.contributor.authorHui, PSG-
dc.contributor.authorCheng, HC-
dc.contributor.authorTan, J-
dc.contributor.authorCheung, MT-
dc.date.accessioned2020-11-23T08:25:55Z-
dc.date.available2020-11-23T08:25:55Z-
dc.date.issued2020-
dc.identifier.citationJournal of Medical Internet Research, 2020, v. 22 n. 3, p. article no. e16769-
dc.identifier.issn1438-8871-
dc.identifier.urihttp://hdl.handle.net/10722/294071-
dc.description.abstractBackground: Technological surrogate nursing (TSN) derives from the idea that nurse-caregiver substitutes can be created by technology to support chronic disease self-care. Objective: This paper begins by arguing that TSN is a useful and viable approach to chronic disease self-care. The analysis then focuses on the empirical research question of testing and demonstrating the effectiveness and safety of prototype TSN supplied to patients with the typical complex chronic disease of coexisting type 2 diabetes and hypertension. At the policy level, it is shown that the data allow for a calibration of TSN technology augmentation, which can be readily applied to health care management. Methods: A 24-week, parallel-group, randomized controlled trial (RCT) was designed and implemented among diabetic and hypertensive outpatients in two Hong Kong public hospitals. Participants were randomly assigned to an intervention group, supplied with a tablet-based TSN app prototype, or to a conventional self-managing control group. Primary indices—hemoglobin A1c, systolic blood pressure, and diastolic blood pressure—and secondary indices were measured at baseline and at 8, 12, 16, and 24 weeks after initiation, after which the data were applied to test TSN effectiveness and safety. Results: A total of 299 participating patients were randomized to the intervention group (n=151) or the control group (n=148). Statistically significant outcomes that directly indicated TSN effectiveness in terms of hemoglobin 1c were found in both groups but not with regard to systolic and diastolic blood pressure. These findings also offered indirect empirical support for TSN safety. Statistically significant comparative changes in these primary indices were not observed between the groups but were suggestive of an operational calibration of TSN technology augmentation. Statistically significant changes in secondary indices were obtained in one or both groups, but not between the groups. Conclusions: The RCT’s strong behavioral basis, as well as the importance of safety and effectiveness when complex chronic illness is proximately self-managed by layperson patients, prompted the formulation of the empirical joint hypothesis that TSN would improve patient self-care while satisfying the condition of patient self-safety. Statistical and decision analysis applied to the experimental outcomes offered support for this hypothesis. Policy relevance of the research is demonstrated by the derivation of a data-grounded operational calibration of TSN technology augmentation with ready application to health care management. Trial Registration: ClinicalTrials.gov NCT02799953; https://clinicaltrials.gov/ct2/show/NCT02799953-
dc.languageeng-
dc.publisherJournal of Medical Internet Research. The Journal's web site is located at http://www.jmir.org/-
dc.relation.ispartofJournal of Medical Internet Research-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjecttechnological surrogate nursing-
dc.subjecteHealth-
dc.subjectcomplex chronic disease-
dc.subjectdiabetes-
dc.subjecthypertension-
dc.titleImproving self-care in patients with coexisting type 2 diabetes and hypertension by technological surrogate nursing: randomized controlled trial-
dc.typeArticle-
dc.identifier.emailOr, CK: klor@hku.hk-
dc.identifier.authorityOr, CK=rp01369-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.2196/16769-
dc.identifier.pmid32217498-
dc.identifier.pmcidPMC7148548-
dc.identifier.scopuseid_2-s2.0-85082560913-
dc.identifier.hkuros318793-
dc.identifier.volume22-
dc.identifier.issue3-
dc.identifier.spagearticle no. e16769-
dc.identifier.epagearticle no. e16769-
dc.publisher.placeCanada-

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