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      Protocol for a randomised blocked design study using telephone and text-messaging to support cardiac patients with diabetes: a cross cultural international collaborative project

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          Abstract

          Background

          The prevalence of type 2 diabetes is rising internationally. Patients with diabetes have a higher risk of cardiovascular events accounting for substantial premature morbidity and mortality, and health care expenditure. Given healthcare workforce limitations, there is a need to improve interventions that promote positive self-management behaviours that enable patients to manage their chronic conditions effectively, across different cultural contexts. Previous studies have evaluated the feasibility of including telephone and Short Message Service (SMS) follow up in chronic disease self-management programs, but only for single diseases or in one specific population. Therefore, the aim of this study is to evaluate the feasibility and short-term efficacy of incorporating telephone and text messaging to support the care of patients with diabetes and cardiac disease, in Australia and in Taiwan.

          Methods/design

          A randomised controlled trial design will be used to evaluate a self-management program for people with diabetes and cardiac disease that incorporates the use of simple remote-access communication technologies. A sample size of 180 participants from Australia and Taiwan will be recruited and randomised in a one-to-one ratio to receive either the intervention in addition to usual care (intervention) or usual care alone (control). The intervention will consist of in-hospital education as well as follow up utilising personal telephone calls and SMS reminders. Primary short term outcomes of interest include self-care behaviours and self-efficacy assessed at baseline and four weeks.

          Discussion

          If the results of this investigation substantiate the feasibility and efficacy of the telephone and SMS intervention for promoting self management among patients with diabetes and cardiac disease in Australia and Taiwan, it will support the external validity of the intervention. It is anticipated that empirical data from this investigation will provide valuable information to inform future international collaborations, while providing a platform for further enhancements of the program, which has potential to benefit patients internationally.

          Trial registration

          ACTRN 12611001196932.

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          Most cited references13

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          Cardiovascular disease and risk factors in Asia: a selected review.

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            Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data.

            Participation in cardiac rehabilitation (CR) benefits patients with coronary heart disease (CHD), yet worldwide only some 15–30% of those eligible attend. To improve understanding of the reasons for poor participation we undertook a systematic review and meta-synthesis of the qualitative literature. Qualitative studies identifying patient barriers and enablers to attendance at CR were identified by searching multiple electronic databases, reference lists, relevant conference lists, grey literature, and keyword searching of the Internet (1990–2010). Studies were selected if they included patients with CHD and reviewed experience or understanding about CR. Meta-synthesis was used to review the papers and to synthesize the data. From 1165 papers, 34 unique studies were included after screening. These included 1213 patients from eight countries. Study methodology included interviews (n = 25), focus groups (n = 5), and mixed-methods (n = 4). Key reasons for not attending CR were physical barriers, such as lack of transport, or financial cost, and personal barriers, such as embarrassment about participation, or misunderstanding the reasons for onset of CHD or the purpose of CR. There is a vast amount of qualitative research which investigates patients’ reasons for non-attendance at CR. Key issues include system-level and patient-level barriers, which are potentially modifiable. Future research would best be directed at investigating strategies to overcome these barriers.
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              A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions.

              We reviewed the literature on the use of text messaging for clinical and healthy behaviour interventions. Electronic databases were searched in December 2009 using keywords related to text messaging and health interventions. The final review included 24 articles. Of those, seven covered medication adherence, eight discussed clinical management and nine reported on health-related behaviour modification. Sixteen were randomized controlled trials (RCT), five were non-controlled pre-post comparison studies and three were feasibility pilots not reporting a behavioural outcome. The frequency of messaging ranged from multiple messages daily to one message per month. Among the 16 RCTs, 10 reported significant improvement with interventions and six reported differences suggesting positive trends. Text messaging received good acceptance and showed early efficacy in most studies. However, the evidence base is compromised by methodological limitations and is not yet conclusive.
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                Author and article information

                Contributors
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2013
                9 October 2013
                : 13
                : 402
                Affiliations
                [1 ]School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia
                [2 ]Institute of Health and Biomedical Innovation Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia
                [3 ]Department of Nursing, Tzu Chi College of Technology; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
                [4 ]Taiwanese Centre for Evidence-based Health Care, Hualien, Taiwan
                [5 ]Mater Medical Research Institute, Mater Health Services, Brisbane, Australia
                [6 ]School of Medicine, University of Queensland, Herston QLD 4029, Australia
                [7 ]Department of Cardiology, Royal Brisbane and Women’s Hospital, Butterfield Street, Brisbane QLD 4029, Australia
                [8 ]Mater Health Services, Raymond Terrace, South Brisbane QLD 4101, Australia
                [9 ]School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo QLD 4014, Australia
                [10 ]Centre for Functioning and Health Research, Metro South Health, Corner of Ipswich Road and Cornwall Street, Woolloongabba QLD 4102, Australia
                [11 ]School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia
                Article
                1472-6963-13-402
                10.1186/1472-6963-13-402
                3852414
                24106997
                3f2d8fd2-7c64-4ec4-844d-e02f66ae147d
                Copyright © 2013 Wu et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 July 2012
                : 7 October 2013
                Categories
                Study Protocol

                Health & Social care
                cardiac,diabetes,international collaboration,protocol,randomised controlled trials,self-management,telephone,text-messaging

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