Development and Evaluation of an Interactive Mobile Health Intervention to Support Patients with Active Tuberculosis

项目摘要 结核病（TB）仍然是一个紧迫的全球健康问题，也是世界范围内死亡的主要原因， 每年有150万例死亡是可以预防的。许多不良后果与治疗不当有关 坚持导致长期的传染性，发病率和经济困难，以及日益增长的耐药性 TB.为了提高依从性，直接观察治疗（DOT）一直是长期推荐的策略。 然而，由于DOT是劳动密集型的，依赖于运输，并且通常对患者不方便， 普遍实施仍然具有挑战性，新的支持性治疗监督策略 needed.移动的医疗技术，包括 应用程序，增加 能够容纳 多个工具（例如，自动提醒，症状跟踪），除其他外，有很大的希望提供 支持性治疗监督，加强患者对自身护理的参与，并改善监测， 沟通和个性化定制。到目前为止，很少有结核病相关的应用程序直接针对患者， 包括支持患者参与自我管理护理的功能 .拟议的研究将 使用快速迭代方法转换和扩展TextTB，将创新的依从性监控纳入 一个经过移动的优化的应用程序，与最终用户和利益相关者一起完善和增强，并评估可行性、可用性 以及在治疗成功率历史较低的情况下的初始疗效， 自我管理。培训和研究建立在博士前和博士后工作的基础上， 领导一个由积极接受结核病治疗的患者和结核病专家组成的团队开发了一种基于短信的TextTB， 干预这项干预措施旨在支持通过自我管理接受结核病治疗的患者， 医疗保健团队可以更快地对没有依从性或依从性有问题的患者做出反应。虽然成功 作为试点，确定了需要改进的地方，例如提高警报自动化程度，扩大教育 信息，结合治疗过程的可视化，并改善患者定制。响应式设计 APP可以解决这些问题。候选人的长期职业目标是成为一名独立的研究人员 并领导制定适合世界新兴经济体的尖端干预措施， 促进自我管理健康和预防疾病。职业发展计划结合了教学 课程与实际指导的研究经验，以实现以下培训目标：1）获得 健康信息学高级培训，2）发展以患者为中心的迭代开发专业知识 技术，3）实现有效进行临床试验的能力，以设计和评估信息 技术，以改善病人的结果，和4）获得熟练的科学写作和语法。的 候选人已经制定了一个明确的研究轨迹，以病人为导向的干预研究，这符合 NINR的方案优先事项是促进自我管理，促进健康和预防疾病， 推进护理科学，改善世界公民的健康和福祉。

PROJECT SUMMARY Tuberculosis (TB) remains an urgent global health problem and a leading cause of death worldwide with most of the 1.5 million annual deaths being preventable. Much of the adverse outcomes are related to poor treatment adherence resulting in prolonged infectivity, morbidity and economic hardship, and the growing drug resistant TB. To improve adherence, directly observed therapy (DOT) has been a long standing recommended strategy. However, because DOT is labor intensive, transportation dependent, and often inconvenient to patients it continues to be challenging to implement universally and new supportive treatment supervision strategies are needed. Mobile health technologies, including apps, with increased sophistication capable of accommodating multiple tools (e.g., automated reminders, symptom tracking), among others, hold great promise to provide supportive treatment supervision, heighten patient involvement in their own care and improve monitoring, communication, and individual tailoring. To date, few TB related apps have directly targeted patients and none included functions to support patient engagement in self-management of their care . The proposed research will use rapid iterative methodology to convert and expand TextTB to include innovative adherence monitoring into a mobile optimized app, refine and enhance with end-users and stakeholders and assess feasibility, usability and initial efficacy in a setting with historically low treatment success rates where treatment delivery is commonly by self-administration. The training and research builds upon pre- and post-doctoral work where the candidate led a team of patients in active TB treatment and TB experts to develop TextTB, a text messaging-based intervention. This intervention aimed to support patients receiving TB treatment by self-administration and healthcare teams to more quickly respond to patients with non- or problematic adherence. Although successful as a pilot, needed improvements were identified, such as increasing automation of alerts, expanding educational messages, incorporating visualization of treatment course, and improving patient tailoring. Responsive design apps could address these issues. The candidate's long-term career goal is to become an independent researcher and lead in the development of cutting-edge interventions, suitable for the emerging economies of the world, that facilitate self-management of health and prevent disease. The career development plan integrates didactic coursework with practical mentored research experience to achieve the following training goals: 1) obtain advanced training in health informatics, 2) develop expertise in iterative development of patient-centered technologies, 3) achieve capacity to effectively conduct clinical trials to design and evaluate information technology to improve patient outcomes, and 4) obtain proficiency with scientific writing and grantsmanship. The candidate has developed a clear research trajectory for patient-oriented intervention research, which meets NINR's programmatic priorities to promote self-management, to promote health and prevent disease, and to advance nursing science to improve the health and well-being of the world's citizens.