CFAS2019 poster FB final PEmp · What%is%Patient%Empowerment%(PEmp)?...
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! What is Patient Empowerment (PEmp)? A process through which patients gain a sense of control over their health and ability to manage their illness ! How can fertility patients benefit from PEmp? PEmp can help patients to feel informed, participate in decisions about their fertility care and better manage the psychological distress associated with infertility, which involves feelings of loneliness, uncertainty and loss of control. ! Why mHealth? Educational resources and online peer support have been shown to enhance PEmp mHealth provides easily accessible information that is simple & targeted to patients’ needs, as well as 24/7 connection with peers INTRODUCTION METHODS ! A pre:post design study evaluating a new mHealth App • Practical information about infertility, its treatment and associated psychosocial issues • A forum where users can share lived experiences and emotional support with peers. ! Participants: men and women undergoing fertility treatments in 4 clinics in Montreal and Toronto ! Google Analytics was used to track participant activity on the app during an 8Pweek period ! Measures: 1. Demographic characteristics and fertility history 2. Patient Empowerment using a 34Pitem adapted Patient Empowerment Questionnaire (van UdenPKraan et al. 2009) • Responses from 1 “completely disagree” to 5 “completely agree” • 7 subscale scores and a total score (0P170), with higher scores indicating greater PEmp 3. Perceived stress using the Perceived Stress Scale (PSS74) (Cohen et al. 1983) • Responses from 0 (“never”) to 4 (“very often”) • Total score between 0 and 16, higher = more perceived stress 4. Fertility:related quality of life using the 36Pitem FertiQoL (Boivin et al. 2011) • 4Ppoint LikertPtype scale • Final scores range from 0P100, higher = better QoL ! Sample characteristics (N = 152) ! Empowerment scores DISCUSSION ! Promoting PEmp is becoming increasingly recognized as an important aspect of patientPcentered care and patient wellPbeing. PEmp may help fertility patients cope with the stress of treatment and impaired quality of life. In fact, this study shows that those who felt more empowered were less stressed and had a better quality of life. ! People with lower initial PEmp were more engaged with the app, suggesting that Infotility may be a helpful resource to these patients as it provides tools to better understand infertility, navigate treatment, cope and feel supported. ! Although results regarding men are exploratory due to small sample size, this study demonstrate the potential of an mHealth forum to improve patient empowerment in men under stress. Stressed men may be especially empowered by mobile access to peers as it offers a safe and anonymous place to express feelings, and obtain validation, emotional support and knowledge. Fertility Patients’ Empowerment and Engagement with an mHealth App Félicia Brochu 12 , Peter Chan 23 , Carolyn Ells 124 , Nancy Feeley 124 , Kirk Lo 5 , Neal Mahutte 6 , Sophia Ouhilal 6 , Togas Tulandi 123 & Phyllis Zelkowitz 124 1 Jewish General Hospital, Montreal, Quebec, Canada; 2 McGill University, Montreal, Quebec, Canada; 3 McGill University Health Centre, Montreal, Quebec, Canada; 4 Lady Davis Institute, Montreal, Quebec, Canada; 5 Mount Sinai Hospital, Toronto, Ontario, Canada; 6 Montreal Fertility Centre, Montreal, Quebec, Canada; The objectives were to investigate in fertility patients: 1. How PEmp relates to quality of life and stress 2. How PEmp relates to engagement with an mHealth app 3. Whether PEmp changed during the study and in relation to use of an mHealth app RESULTS Women (N = 122) Men (N = 30) N % N % Language French 44 36.1% 4 13.3% English 78 63.9% 26 86.7% Annual household Income ≥ 100,000$ 73 60.3% 18 60.0% Highest educational degree CEGEP, technical or below 27 22.1% 11 36.7% University 42 34.4% 10 33.3% Graduate 53 43.4% 9 30.0% Immigrant 42 35.0% 11 36.7% Mean age: ♀ 35.23 (SD = 4.7) ♂ 37.07 (SD = 5.6) Average treatment duration ≥ 1 year for 58.2% of women and 50.0% of men Infertility diagnosis MalePfactor: 20.4% FemalePfactor: 34.9% MixedPfactor: 13.2% Unexplained: 19.7% Undergoing testing: 11.2% Empowerment subscale Women Men Being informed 2.28 (0.08) 2.48 (0.22) Feeling confident with my physician 2.71 (0.05) 2.71 (0.12) Acceptance of fertility problems 2.22 (0.08) 2.57 (0.16) Feeling confident about my treatment 2.91 (0.05) 2.91 (0.13) Optimism and control over the future 2.21 (0.06) 2.68 (0.14) SelfPesteem 2.75 (0.08) 3.06 (0.13) Social wellPbeing 2.78 (0.07) 3.13 (0.13) Total 86.76 (1.37) 93.42 (4.06) Because pairedPsamples tPtests revealed that PEmp scores did not differ between Time 1 and Time 2, only scores from Time 1 are shown below 8 weeks of app usage Time 1 1 st set of questionnaires Time 2 2 nd set of questionnaires Infotility In both women and men, PEmp scores were negatively related to perceived stress (r =P .511 and P.644, both p < .005) and positively related to quality of life (r = .593 and .612, both p < .005) at Time 1, suggesting that those with greater PEmp perceived less stress and reported a better quality of life. 1. How does PEmp relate to perceived stress and quality of life? 2. How does PEmp relate to subsequent engagement with the app? PEmp scores at Time 1 were explored in relation to 3 engagement indices (EI) developed to assess overall app usage, use of the informational content of the app, and use of the forum. These EIs were created by summing three logPtransformed and standardized indicators: the number of pages viewed, the number of sessions and the total time spent on pages. 3. Did PEmp change during the study in relation to engagement with the app? Women’s total PEmp was negatively related to the overall app EI (r = :.195, p < .05) and the information EI (r = :.222, p < .05), suggesting that women with lower PEmp at Time 1 had greater engagement with the app overall, and in particular with the informational section of the app. Men’s PEmp was not related to overall engagement with the app. However, a significant negative association was found between men’s PEmp and the forum EI (N = 11, r = :.759, p = .005), indicating that men who reported lower PEmp at Time 1 showed a greater subsequent engagement with the forum than those with higher levels of PEmp. Change in total PEmp was explored in relation to sociodemographic characteristics, fertility history, perceived stress and quality of life to identify subgroups whose levels of PEmp might have changed during the study in relation to engagement. Does engagement moderate change in PEmp? In women (N = 122), positive change in PEmp was associated with higher perceived stress at Time 1 (r = .176, p = .054) and seeking psychological counselling during treatment (t = P 3.151, p < .005), but not engagement with the app. In men (N = 30), change in PEmp during the study was associated with perceived stress at Time 1 (r = .470, p < .01) and engagement with the forum (r = .662, p < .05). A moderated multiple regression revealed a significant moderation effect of the forum EI on the relationship between stress and change in PEmp (N = 11, β = 5.876, SE = 2.701, t = 2.176, p < .05). Moderation model F = 5.053, p < .05, R 2 = .684 ! Simple slopes analysis indicated that men who were highly stressed at Time 1 and who engaged with the forum on the app reported a greater increase in PEmp post: intervention. Perceived stress Change in PEmp Forum EI β = 5.515 β = 1.239
Transcript of CFAS2019 poster FB final PEmp · What%is%Patient%Empowerment%(PEmp)?...
! What%is%Patient%Empowerment%(PEmp)?A"process"through"which"patients"gain"a"sense"of"control"""""""""""over"their"health"and"ability"to"manage"their"illness
! How%can%fertility%patients%benefit%from%PEmp?PEmp can"help"patients"to"feel"informed,"participate"in"decisions"about"their"fertility"care"and"better"manage"the"psychological"distress"associated"with"infertility,"which"involves"feelings"of"loneliness,"uncertainty"and"loss"of"control."
! Why%mHealth?Educational"resources"and"online"peer"support"have"been"shown"to"enhance"PEmpmHealth"provides"easily"accessible"information"that"is"simple"&"targeted"to"patients’"needs,"as"well"as"24/7"connection"with"peers"
INTRODUCTION
METHODS! A"pre:post%design%study%evaluating"a"new"mHealth"App
• Practical"information"about"infertility,"its"treatment"""and"associated"psychosocial"issues
• A"forum"where"users"can"share"lived"experiences"""""""and"emotional"support"with"peers.
! Participants:%men"and"women"undergoing"fertility"treatments"in"4"clinics"in"Montreal"and"Toronto"
! Google%Analyticswas"used"to"track"participant"activity"on"the"app"during"an"8Pweek"period
! Measures:
1. Demographic"characteristics"and"fertility"history
2. Patient%Empowerment%using"a"34Pitem"adapted"Patient'Empowerment'Questionnaire (van"UdenPKraan et"al."2009)• Responses"from"1"“completely"disagree”"to"5"“completely"agree”• 7"subscale"scores"and"a"total"score"(0P170),"with"higher"scores"
indicating"greater"PEmp
3. Perceived%stress%using"the"Perceived'Stress'Scale'(PSS74)(Cohen"et"al."1983)
• Responses"from"0"(“never”)"to"4"(“very"often”)• Total"score"between"0"and"16,"higher"="more"perceived"stress
4. Fertility:related%quality%of%life%using"the"36Pitem"FertiQoL(Boivin"et"al."2011)
• 4Ppoint"LikertPtype"scale• Final"scores"range"from"0P100,"higher"="better"QoL
! Sample%characteristics%(N =%152)
! Empowerment%scores
DISCUSSION! Promoting"PEmp is"becoming"increasingly"recognized"as"an"important"aspect"of"patientPcentered"care"and"patient"wellPbeing."PEmp may"help"fertility"patients"cope"with"the"
stress"of"treatment"and"impaired"quality"of"life."In"fact,"this"study"shows"that"those"who"felt"more"empowered"were"less"stressed"and"had"a"better"quality"of"life.
! People"with"lower"initial"PEmp were"more"engaged"with"the"app,"suggesting"that"Infotilitymay"be"a"helpful"resource"to"these"patients"as"it"provides"tools"to"better"understand"infertility,"navigate"treatment,"cope"and"feel"supported."
! Although"results"regarding"men"are"exploratory"due"to"small"sample"size,"this"study"demonstrate"the"potential"of"an"mHealth"forum"to"improve"patient"empowerment"in"men"under"stress."Stressed"men"may"be"especially"empowered"by"mobile"access"to"peers"as"it"offers"a"safe"and"anonymous"place"to"express"feelings,"and"obtain"validation,"emotional"support"and"knowledge."
Fertility%Patients’%Empowerment%and%Engagement%with%an%mHealth%AppFélicia'Brochu1'2,'Peter'Chan2'3,'Carolyn'Ells1'2'4,'Nancy'Feeley1'2'4,'Kirk'Lo5,'Neal'Mahutte6,'Sophia'Ouhilal6,'Togas'Tulandi1'2'3 &'Phyllis'Zelkowitz1'2'4
1Jewish"General"Hospital,"Montreal,"Quebec,"Canada;"2McGill"University,"Montreal,"Quebec,"Canada;"3McGill"University"Health"Centre,"Montreal,"Quebec,"Canada;"4Lady"Davis"Institute,"Montreal,"Quebec,"Canada;5Mount"Sinai"Hospital,"Toronto,"Ontario,"Canada;"6Montreal"Fertility"Centre,"Montreal,"Quebec,"Canada;"
The%objectives%were%to%investigate%in%fertility%patients:%1. How%PEmp relates%to%quality%of%life%and%stress2. How%PEmp relates%to%engagement%with%an%mHealth%app3. Whether%PEmp changed%during%the%study%and%in%
relation%to%use%of%an%mHealth%app
RESULTS
Women%(N =%122)
Men%(N =%30)
N % N %
LanguageFrench 44 36.1% 4 13.3%English 78 63.9% 26 86.7%Annual%household%Income≥ 100,000$ 73 60.3% 18 60.0%Highest%educational%degreeCEGEP,"technical"or"below
27 22.1% 11 36.7%
University 42 34.4% 10 33.3%Graduate 53 43.4% 9 30.0%Immigrant 42 35.0% 11 36.7%
Mean%age:%%♀ 35.23"(SD ="4.7)"""♂ 37.07"(SD ="5.6)Average%treatment%duration≥"1"year"for"58.2%"of"women"and"50.0%"of"men
Infertility%diagnosisMalePfactor:"20.4%" FemalePfactor:"34.9%MixedPfactor:"13.2%" Unexplained:"19.7%Undergoing testing:"11.2%
Empowerment%subscale Women MenBeing"informed 2.28"(0.08) 2.48"(0.22)Feeling"confident"with"my"physician 2.71"(0.05) 2.71"(0.12)Acceptance"of"fertility"problems 2.22"(0.08) 2.57"(0.16)Feeling"confident"about"my"treatment
2.91"(0.05) 2.91"(0.13)
Optimism"and"control"over"the"future
2.21"(0.06) 2.68"(0.14)
SelfPesteem 2.75"(0.08) 3.06"(0.13)Social"wellPbeing 2.78"(0.07) 3.13"(0.13)Total 86.76%(1.37) 93.42%(4.06)
Because"pairedPsamples"tPtests"revealed"that"PEmp scores"did"not"differ"between"Time"1"and"Time"2,"only"scores"from"Time"1"are"shown"below
8#weeksof#app#usage
Time%11st set"of"questionnaires
Time%22nd set"of"questionnaires
Infotility
In"both"women"and"men,"PEmp scores"were"negatively"related"to"perceived"stress"(r ="P.511"and"P.644,"both"p <".005)"and"positively"related"to"quality"of"life"(r =".593"and".612,"both"p <".005)"at"Time"1,"suggesting"that"those"with"greater"PEmp perceived"less"stress"
and"reported"a"better"quality"of"life.
1. How%does%PEmp relate%to%perceived%stress%and%quality%of%life?
2. How%does%PEmp relate%to%subsequent%engagement%with%the%app?PEmp scores"at"Time"1"were"explored"in"relation"to"3"engagement"indices"(EI)"developed"to"assess"overall"app"usage,"use"of"the"informational"content"of"the"app,"and"use"of"the"forum."These"EIs"were"created"by"summing"three"logPtransformed"and"standardized"indicators:"the"number"of"pages"viewed,"the"number"of"sessions"and"the"total"time"spent"on"pages."
3. Did%PEmp change%during%the%study%in%relation%to%engagement%with%the%app?
Women’s total%PEmp was%negatively%related%to%the%overall%app%EI%(r#=%:.195,%p#<%.05)%and%the%information%EI%(r#=%:.222,%p#<%.05),"suggesting"that"women"with"lower"PEmp at"Time"1"had"greater"engagement"with"the"app"overall,"and"in"particular"with"the"informational"section"of"the"app."
Men’s"PEmp was"not"related"to"overall"engagement"with"the"app."However,"a%significant%negative%association%was%found%between%men’s%PEmp and%the%forum%EI%(N#=%11,%r#=%:.759,%p#=%.005),"indicating"that"men"who"reported"lower"PEmp at"Time"1"showed"a"greater"subsequent"engagement"with"the"forum"than"those"with"higher"levels"of"PEmp."
Change"in"total"PEmp was"explored"in"relation"to"sociodemographic"characteristics,"fertility"history,"perceived"stress"and"quality"of"life"to"identify"subgroups"whose"levels"of"PEmp might"have"changed"during"the"study"in"relation"to"engagement.
Does#engagement#moderate#change#in#PEmp?
In"women%(N ="122),"positive"change"in"PEmp was"associated"with"higher"perceived"stress"at"Time"1"(r =".176,"p =".054)"and"seeking"psychological"counselling"during"treatment"(t ="P 3.151,"p <".005),"but"not"engagement"with"the"app.
In"men%(N ="30),"change"in"PEmp during"the"study"was"associated"with"perceived"stress"at"Time"1"(r =".470,"p <".01) and"engagement"with"the"forum"(r =".662,"p'<".05)."A"moderated"multiple"regression"revealed"a"significant"moderation"effect"of"the"forum"EI"on"the"relationship"between"stress"and"change"in"PEmp (N ="11,"β ="5.876,"SE ="2.701,"t ="2.176,"p <".05).
Moderation%modelF ="5.053,"p <".05,"R2"=".684
! Simple"slopes"analysis"indicated"that"men%who%were%highly%stressed%at%Time%1%and%who%engaged%with%the%forum%on%the%app%reported%a%greater%increase%in%PEmp post:intervention.%
Perceived"stress
Change"in"PEmp
Forum"EI
β ="5.515
β ="1.239
