CAMBRIDGE, MA, United States
CAMBRIDGE, MA, United States

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Weitzman P.F.,Environment And Health Group, Inc. | Caballero A.E.,Harvard University | Millan-Ferro A.,Harvard University | Becker A.E.,Harvard University | And 2 more authors.
Diabetes Educator | Year: 2013

Purpose: The purpose of this study was to examine how attitudes and practices related to bodily aesthetic ideals and selfcare might inform the engagement of Latinas with type 2 diabetes (T2DM). Methods: Focus groups were used to collect qualitative data concerning bodily aesthetic ideals and diabetes management, including help-seeking experiences, from Latina women with T2DM (n = 29) receiving care through Latino Diabetes Initiative at the Joslin Diabetes Center. Focus groups were conducted in Spanish, audiotaped, transcribed, and content analyzed. Results: Four main themes emerged: (1) a preference among participants for a larger than average body size, although perceptions of attractiveness were more closely linked to grooming than body size; bodily dissatisfaction centered on diabetes-induced skin changes, virilization, and fatigue rather than weight; (2) diabetic complications, especially foot pain, as a major obstacle to exercise; (3) fatalistic attitudes regarding the inevitability of diabetes and reversal of its complications; and (4) social burdens, isolation, and financial stressors as contributing to disease exacerbation. Conclusions: Interventions that emphasize reduced body size may be less effective with Latinas who have T2DM than those that emphasize the benefits of exercise and weight loss for skin health, energy levels, and reduced virilization. © 2013 The Author(s).


Chen H.,Environment And Health Group, Inc. | Maxwell H.,Environment And Health Group, Inc. | Xing L.,Environment And Health Group, Inc. | Levkoff S.E.,Environment And Health Group, Inc.
Gerontechnology | Year: 2014

Purpose: Improving access to health services based on health information technology (HIT) is a challenge for digitally disadvantaged elderly groups, who are often from low socioeconomic and educational backgrounds. In recent projects we tried different strategies to deliver HIT-based psycho- educational programs to families that have obvious health needs, but are disadvantaged in their access to HIT. The purpose of this presentation is to describe what was and was not effective in these case examples and to evaluate these efforts with respect to the emerging field of technology acceptance research. Method: In two different studies, we provided online education and support to older adults and family caregivers and then qualitatively evaluated the degree to which participants engaged in the online programs. Results: In our first study, we provided online education and support to Chinese dementia caregivers living in an older Shanghai community where industrialization and commercialization are relatively underdeveloped. Families targeted for the intervention typically did not have computers at home (n=88) and were not able to participate in the program. After trying various options, the final successful solution was to organize an offline group learning by gathering family caregivers with peer volunteers at a nearby community senior center and then conducting the learning session using the online program via a large screen in a conference room. The second project provided online telemonitoring support to older adults living in rural Arkansas and suffering from congestive heart failure. The majority did not have computers and could not participate in the program as designed. Of those who did have computers (n=57), about 50% participated. The most promising solution, which is currently being tested, is to provide the telemonitoring program through mobile phones to transmit monitoring data (e.g., blood pressure, weight) to the clinical center, with which prospective participants are already familiar. Discussion: The experience from these empirical trials suggests that to successfully engage digitally disadvantaged people, the most promising design for HIT programs is a design based on technological modes that are currently available and familiar to the target users. This position is consistent with the Accelerating Diffusion of Proven Technologies (ADOPT) perspective, which emphasizes the importance of integrating an HIT program with the local social, clinical, and financial environments1. Despite barriers such as poverty, digital illiteracy, and residence in rural areas, many improvements can be made for digitally disadvantaged groups by using HIT innovations.


Wang A.,Hefei University of Technology | An N.,Hefei University of Technology | Lu X.,Environment And Health Group, Inc. | Chen H.,Environment And Health Group, Inc. | And 5 more authors.
Journal of Medical Internet Research | Year: 2014

Background: There are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. Objective: The objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the "Health & Fitness" category of the iTunes App Store. Methods: We constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. Results: After applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). Conclusions: The findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the "Health and Fitness" category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily.


Grant
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 372.46K | Year: 2012

DESCRIPTION (provided by applicant): Abstract Environment and Health Group (EHG), Inc. in collaboration with our partners: New England Association of HIV over 50, the Massachusetts Statewide Consumer Advisory Board (SWCAB) on HIV/AIDS, the Department of Computer Science and Engineering at the University of South Carolina, and Fenway Health Center proposes to develop an innovative, low-cost, tailored, cell phone text message intervention. Currently over 500,000 African Americans are living with HIV/AIDS. Inaddition, according to the Centers for Disease Control and Prevention, by 2015, people over 50 years of age will account for half of all HIV/AIDS cases in the United States. EHG's proposed intervention will seek to address the lack of evidenced-based interventions for those African Americans, who are over 50, and HIV positive. The program will combine pill reminders (ART and other chronic illness medications) with motivational messages for African Americans, 50 years and older, with HIV. This intervention will address two major barriers to ART adherence among HIV positive older adults: 1) neurocognitive abilities (memory and executive function), 2) affect (attitude and outlook). As well as the cultural barrier of distrust of health care professionals felt bymany oldr African Americans. The project is based on EHG's own work in the field of HIV/AIDS and on a need assessment conducted in 2011 that revealed that: 1) text messages and motivational messages were desirable in supporting ART compliance, and 2) textmessaging was preferred over computer-based interventions as a means of ART support. In Phase 2, we will conduct a randomized control trial of the cell phone intervention. This second phase of the study will include local pharmacies as partners.PUBLIC HEALTH RELEVANCE: Project Narrative Currently, over 1 million Americans are infected with HIV/AIDS, and African Americans account for more than half of these infections. A key problem in the fight against HIV/AIDS is the lack of low-cost, evidenced-based interventions for those struggling with the disease. In this Phase I study, we will develop, and test, a novel method to promote adherence to ART and co-occurring chronic illness treatments among HIV positive, African Americans, who are over 50.


Grant
Agency: Department of Health and Human Services | Branch: National Institutes of Health | Program: SBIR | Phase: Phase II | Award Amount: 397.89K | Year: 2016

DESCRIPTION provided by applicant Environment and Health Group EHG Inc in collaboration with a number of Boston MA and Columbia SC based organizations seeks to enhance test and commercialize an individually tailored culturally sensitive positive psychology and behavioral economics based mobile health intervention to promote ART adherence increase ART self efficacy and reduce feelings of stress burden among HIV positive African Americans age and older African Americans represent a growing portion of people living with HIV CDC by those age will account for half of all cases of HIV AIDS in the U S NIDA Poor ART adherence contributes to disparities in HIV AIDS outcomes among older African Americans The proposed project is based on EHGandapos s previous research with HIV age years and older African American adults That research revealed personalized pill reminder text messages with positive psychology based motivational and educational messages are effective at addressing two major barriers to ART adherence in this group memory deficits resulting from the combined effects of HIV cognitive aging and increased allostatic load and low motivation due to lack of ART self efficacy and negative affect Findings showed significant improvement in ART adherence scores and marginally significant improvement in ART self efficacy scores While affect scores did not change qualitative findings showed the intervention helped reduce feelings of stress burden Supporting ART adherence is key to reducing health disparities among HIV African Americans Doing so for those age and older who are most vulnerable to cumulative age accelerating effects of HIV infection and allostatic load is urgent which is why we are lowering the age cut off from to in Phase II To date no ART adherence support intervention has been developed for this highly vulnerable group The Phase II project will enhance the existing mobile intervention by offering a two way communication capability through which participants can i indicate andquot pill takenandquot in response to pill reminders and ii receive a positive visual icon as behavioral economics based reinforcement for andquot pill takenandquot responses live real time pharmacist counseling and medication support and the addition of opt in smoking cessation educational and motivational texts Overall aims are to expand mhealth intervention to incorporate new Phase II features evaluate effectiveness in an RCT of HIV African Americans age and older and prepare marketing and commercialization plans Our long term goal is to increase ART adherence thus decreasing health disparities among HIV African Americans age PUBLIC HEALTH RELEVANCE According to the CDC there are approximately African Americans in the age group of and older who are living with an HIV diagnosis Unfortunately many African Americans will die earlier from HIV AIDS than their white non Hispanic counterparts due in large part to lack of adherence to Antiretroviral therapy ART The proposed mhealth intervention seeks to increase ART adherence among HIV African Americans who are over the age of thus improving health outcomes and reducing disparities in this group


Grant
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 339.41K | Year: 2011

DESCRIPTION (provided by applicant): Falls are associated with substantial harm to the elderly, as well as high societal costs. The overall goal of the Phase I SBIR application is to deploy and validate a vibration and motion sensor-based monitoring system that both a) reliably detects falls and b) provides the data necessary to develop a model to predict and, thus prevent, falls in older adults. We have a fully developed prototype of an entirely passive fall detection system (FDS) that is ready for deployment. The specific aims for this Phase I application are as follows: 1) Develop algorithms to model the three most common types of falls by analyzing retrospectively collected data from the FDS datasets; 2): Validate algorithms by collecting and analyzing prospective (real time) FDS data and comparing with the incident nurse reports (current gold standard); 3) Identify gait signatures that proceeded recorded fall; and 4) Obtain resident/family members/staff perspectives on the FDS. The proposed SBIR Phase I application is particularly timely, given the Health Care Reform Bill that contains several provisions relevant to aging-services technologies, including the use of aging services technologies and new models of funding for long- term care services andsupports. While commercially available remote monitoring systems are currently in use, none have been evaluated in non-company sponsored prospective randomized trials. The proposed Phase I application will provide the technical foundation to support a Phase II randomized trial to evaluate the cost- effectiveness of the proposed FDS. These data are needed to move this technology from a promising to an evidence-based practice, to justify coverage by the Center for Medicare and Medicaid Services (CMS) andcommercial payers. Currently, remote health management represents 1.4 percent of the market for home health monitoring in the U.S., but is expected to double from 1.8 billion in 2007 to 3.6 billion in 2012. This Phase I application is a collaboration among Environment and Health Group, Inc. and our partners at the University of South Carolina, Palmetto Health (PH), and the South Carolina Regional Authority, which is legislatively mandated to focus on the commercialization of new knowledge-based discoveries that derive from the University, and whose program SCLaunch, provides matching funds for awarded SBIR grants. PUBLIC HEALTH RELEVANCE: This project will result in a fall detection system (FDS) based on 2 passive sensors (floor vibration and motion) and their accompanying data handling systems. The proposed product has substantial benefits over existing fall detection systems, as it does not require the person to wear or activate an alarm for assistance, is entirely hidden from view, and poses no threats to privacy. Given the anticipated shortages in the number of health care workers available to care for an increasingly number of frail older adults, such a monitoring system has enormous potential for uptake by nursing homes, assisted living facilities, and other environments where older adults reside.


Grant
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 292.49K | Year: 2011

DESCRIPTION (provided by applicant): The growing prevalence of dementia, the health and mental health consequences for family caregivers, the lack of ethno-cultural and linguistic training programs for ethnic minority family caregivers, and the increasingpenetration of the internet in ethnic minority communities underscore the need for an online training program for ethnic minority dementia caregivers. In response to the National Institute on Aging PA-06-049, we propose to develop and test the feasibilityand preliminary effectiveness of an online self-directed, skill training intervention for Chinese and Hispanic adults providing care to individuals with Alzheimer's disease and related dementia. The overall goal of this project is to use internet-based technology to develop a self-directed training intervention that is designed to enhance caregiver management skills to improve self-efficacy, which we hypothesize will lead to reduced caregiver burden and emotional distress; and increase caregiver self-care skills, which we hypothesize will result in enhanced overall health and quality of life. Specifically, Phase I will develop a prototype for two internet-based SDL training programs, one for Chinese caregivers, and the other for Hispanic caregivers, to improve caregiving management skills and self care skills. An iterative formative evaluation will be performed to inform the process of designing the intervention components in order to ensure the usability, content validity, motivational design, and ethno-cultural and linguistic competency of the intervention. A randomized controlled trial will be conducted to assess preliminary effectiveness of the training intervention with regard to its impact on both caregivers and care recipients. The findings of this Phase I application will be used to develop a Phase II SBIR, in which we will conduct a large-scale randomized trial of the full scale SDL intervention. Phase 1 study results will provide the effect size necessary to determine the sample size needed for the Phase 2 application. Evidence of the effectiveness of the SDL training program will be a valuable contribution to the developing evidence-base of online caregiver training programs for ethnic minority caregivers. Successful accomplishment of the Phase II application will result in an innovative, online caregiver training service model with high commercialization potential. First, the use of the proposed technology will facilitate the delivery of competence-based training services, which can be offered eitherstanding alone or in combination with other support-based services available for dementia caregivers. Second, the proposed training model can be applied not only for ethnic minority caregivers with dementia, but also for caregivers caring for older adultswith other chronic conditions. PUBLIC HEALTH RELEVANCE: The proposed Phase I effort focuses on developing a self-directed skill training intervention program for ethnic Chinese and Hispanic dementia caregivers. This is highly relevant to the nation's public health not only because there is a persistent lack of ethno-cultural and linguistically competent education, support, and assistance programs for these ethnic minority groups, but also because Hispanic and Asian Americans are two fastest growing groups of the nation, increasing by 43% in the past decade, according to the Census Bureau report released in early 2011.


Grant
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase II | Award Amount: 224.70K | Year: 2010

DESCRIPTION (provided by applicant): This is an application in response to NOT-OD-10-034 through the NIH Basic Behavior and Social Sciences (b-BSSR) Opportunity Network (OppNet). The parent grant (2 R44 AG026815), E-Technology for Chinese Dementia Caregivers, supports a Phase II SBIR randomized trial that tests a web-based education and social support intervention for Chinese-speaking dementia caregivers. The proposed OppNet research fits within the first b-BSSR funding category, that of research on behavioral and social processes, and more specifically, on the influence of sociocultural processes on cognitive and emotional responses of Chinese dementia caregivers. The proposed research will expand significantly the scope of the funded parent SBIR project by allowing an in-depth examination of basic sociocultural processes and mechanisms that influence caregiver outcomes. This supplement will enable us to incorporate additional cultural variables that will allow us to conduct sophisticated analyses using structural equation methods to model the direct and indirect pathways of the relationships between cultural values (e.g., familism, reciprocity, and tolerance) and other culturally situated variables (e.g., coping styles, social support, and self-efficacy/control) on caregiver outcomes. While there has been significant research documenting differences in the nature and effects of dementia caregiving for specific cultural groups, there is little understanding of the factors that influence these differences. The proposed application will allow us to analytically distinguish elements of caregiving from those mediated by the representations and experiences of specific cultural groups, from those cultural values that may moderate caregiver outcomes. Such an analysis is necessary to elucidate the complex and multidimensional influences of cultural values and culturally-situated variables in the socioculural stress and coping model. The proposed supplemental study will (a) verify cultural and content validity of measures used to assess outcome, mediator, and moderator variables in a qualitative study, and (b) incorporate findings from the qualitative study into the current Phase II outcome assessment, analyzing the influence of cultural variables on mechanisms and processes (mediator and moderator variables) that affect caregiver outcomes. PUBLIC HEALTH RELEVANCE: The proposed SBIR examines the influence of cultural variables on stress and coping mechanisms and processes for ethnic Chinese caregivers, relying on a sociocultural model of stress and coping


Grant
Agency: Department of Health and Human Services | Branch: | Program: SBIR | Phase: Phase I | Award Amount: 289.80K | Year: 2010

DESCRIPTION (provided by applicant): The nation's aging population experiences high rates of chronic disease that are associated with excess morbidity and mortality, and concomitant high medical costs. Care for older adults with chronic disease is typically fragmented, and lacking continuity over time and across settings. Neither older adults with chronic disease, nor their informal family caregivers, typically have the knowledge or self-management skills necessary to manage these conditions. The mismanagement of chronic disease has important implications for both the individual and society, resulting in poor health outcomes, as well as avoidable health care costs. This Phase I application will establish the feasibility, acceptability, and short-term effectiveness of a unique Coordinated Telehealth Care Program that integrates strategies for home telehealth/remote patient monitoring and care coordination for rural, older patients with a diagnosis of congestive heart failure (CHF). The focus on CHF is because it is one of the most prevalent and costly chronic diseases in the Medicare population. Specific study aims are to: 1) develop a low cost, effective remote patient monitoring system that uses low cost PCs and web 2.0 technology to monitor symptoms and enhance self-management skills of the older adult and his/her caregiver; 2) develop and implement the Coordinated Telehealth Care Program that incorporates this low cost remote patient monitoring system for older, rural Arkansans with a diagnosis of CHF; 3) evaluate the program in a randomized controlled pilot study using the RE-AIM conceptual model; and, 4) develop and submit a Phase II application, based on Phase I evaluation results. The results from the Phase I study, specifically, the differences in outcomes between treatment and usual care groups in the endpoints (e.g., number of re- hospitalizations) will be used to predict sample size needed for the Phase II application. Environment and Health Group is collaborating with the Reynolds Institute Center on Aging (RICOA) and the Reynolds Department of Geriatrics at the University of Arkansas Medical School, one the largest academic geriatric medicine programs in the country, and with Medullan Inc., a Cambridge, MA-based health software development company. Geriatric clinical investigators from the RICOA have collaborated on this proposal, ensuring that the home telehealth/remote patient monitoring and care coordination program addresses issues unique to the geriatric patient with CHF. RICOA investigators will implement the program among rural, older Arkansans, while Medullan will develop the needed software. The goal of the Phase II SBIR will be to develop, implement, and evaluate, in a robust randomized trial, a home telehealth/remote patient monitoring care coordination program for older persons with a diagnosis of CHF in rural areas. The subsequent Phase II application, will lead to an innovative service delivery model not only for older patients with CHF, but for older adults with multiple co-morbidities and geriatric syndromes, with the potential to be replicated and marketed in rural areas across the country. PUBLIC HEALTH RELEVANCE: The management of chronic disease is an enormous public health challenge with the rapid aging of the United States population. The management of chronic diseases such as heart disease and diabetes presents special problems in rural areas because of the shortage of health care providers, their lack of training in geriatrics, and the long distances patients have to travel to access care. The proposed project will develop and evaluate an innovative approach to care coordination and telehealth in rural patients with congestive heart failure. The proposed project is designed to improve patient health and reduce costs by using innovative low cost technology to promote better care coordination.


Grant
Agency: Department of Health and Human Services | Branch: National Institutes of Health | Program: SBIR | Phase: Phase II | Award Amount: 981.99K | Year: 2015

DESCRIPTION provided by applicant The objective of this Phase II application is to develop an online self directed learning SDL intervention program that seeks to improve caregiving and self care skills among ethnic Chinese dementia caregivers The benefits of such a product may include improved psychological health in caregivers and a reduction in behavioral disturbances among elderly care recipients with dementia While online dementia caregiver interventions are advantageous in reaching broad audiences they face significant challenges in engaging the target audience and keeping them engaged throughout the intervention program The proposed online SDL skill training intervention addresses these challenges with a comprehensive engagement design to ensure retention and effective learning in the training program All Phase I Study Aims have been successfully completed The prototype provides preliminary evidence that an SDL training intervention is able to successfully engage ethnic Chinese caregivers of elders with dementia improving perceived self efficacy to manage caregiving tasks while reducing negative emotions in the caregiver Phase II Specific Aims The Phase II study will further develop the prototype into a fully functioning online SDL skill training intervention for ethnic Chinese dementia caregivers and evaluate it in a randomized control trial In Specific Aim we will develop additional multi lingual training video clips to complete the training program and make them available for Cantonese Mandarin and or English speaking caregivers from different Chinese cultural backgrounds In Specific Aim we will develop software that enables and integrates all engagement design functionalities In Specific Aim we will conduct a randomized controlled trial to evaluate the effectiveness of the SDL training intervention based on a comprehensive engagement design intervention arm compared to one that does not rely on a comprehensive engagement design control arm Primary Hypotheses The intervention arm will result in significantly better caregiver health outcomes reduced perceived stress and depressive symptoms and care recipient outcomes reduced behavioral disturbances compared to the control arm Secondary Hypotheses The effects of the intervention on the primary outcomes are mediated through increased adherence e g amount of total exposure to the intervention program increased self efficacy in handling caregiving tasks and reduced expressed emotion Evidence of the effectiveness of the SDL intervention will contribute to the larger information and communication technology field increasing our understanding and basic knowledge of effective engagement in the rapidly growing field of online health interventions The comprehensive engagement approach developed through this SBIR could be transferred to other ethnic minority groups facing dementia caregiving challenges as well as other populations facing challenges related to the management of other chronic conditions PUBLIC HEALTH RELEVANCE The proposed Phase II effort focuses on developing a self directed skill training intervention program for ethnic Chinese dementia caregivers This is highly relevant to the nationandapos s public health not only because there is a persistent lack of ethno cultura and linguistically competent education support and training programs for this large and growing population but also because the proposed approach for enhancing engagement in online interventions can potentially be transferred to other ethnic minority groups facing dementia caregiving challenges as well as challenges related to the management of other chronic conditions thus having broader public health implications

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