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

项目总结 结核病(TB)仍然是一个紧迫的全球健康问题，也是全世界大多数人死亡的主要原因 每年有150万人死亡是可以预防的。许多不良后果与糟糕的治疗有关。 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 结核病。为了提高依从性，直接观察治疗(DOT)一直是一种长期推荐的策略。 然而，由于DOT是劳动密集型的，依赖于运输，而且往往给患者带来不便呢 普遍实施仍然具有挑战性，新的支持性治疗监督战略是 需要的。移动医疗技术，包括 应用程序，增加了 能够容纳的复杂程度 多种工具(例如，自动提醒、症状跟踪)以及其他工具很有希望提供 支持性治疗监督，提高患者对自己护理的参与度，改善监测， 沟通，以及个人剪裁。到目前为止，与结核病相关的应用程序很少直接针对患者，没有 包括支持患者参与其护理自我管理的功能 。拟议的研究将 使用快速迭代方法转换和扩展TextTB，以将创新的遵从性监控包括到 移动优化的应用程序，与最终用户和利益相关者一起改进和增强，并评估可行性、可用性 在治疗成功率历史最低的情况下的初步疗效，其中治疗交付通常 通过自我管理。培训和研究建立在博士后和博士后工作的基础上，候选人 领导一组正在接受积极结核病治疗的患者和结核病专家开发了TextTB，一种基于短信的 干预。这项干预措施旨在支持接受结核病治疗的患者通过自我管理和 医疗团队能够更快地对依从性不佳或有问题的患者做出反应。虽然成功 作为试点，确定了需要的改进，例如增加警报的自动化，扩大教育 信息，纳入治疗过程的可视化，并改进患者定制。响应性设计 应用程序可以解决这些问题。候选人的长期职业目标是成为一名独立研究员 并带头开发适合世界新兴经济体的尖端干预措施， 促进自我管理健康，预防疾病。职业发展计划结合了说教 具有实际指导研究经验的课程工作，以实现以下培训目标：1)获得 健康信息学方面的高级培训，2)开发以患者为中心的迭代开发的专业知识 技术，3)具备有效进行临床试验以设计和评估信息的能力 技术，以改善患者的预后，以及4)通过科学写作和勇气获得熟练的技能。这个 候选人为以患者为中心的干预研究制定了明确的研究轨迹，满足了 NINR促进自我管理、促进健康和预防疾病以及 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.