The role of digital health interventions to improve health literacy in surgical patients: a narrative review in arthroplasty

Davaris, Myles T.; Bunzli, Samantha; Trieu, Jason; Dowsey, Michelle M.; Choong, Peter F. M.

doi:10.1111/ans.17931

Cited by 9 publications

(6 citation statements)

References 44 publications

(239 reference statements)

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“…As of 2022, it is safe to say, that while the numbers of scientific reports on this topic are promising, the disease is often neglected as a serious health condition, for example, it was not considered relevant to a high degree in the face of multiple COVID-19 restrictions and service cuts in 2019 and for extended periods thereafter, even though COVID-19 was observed to impact aging adults in particular, along with those who are obese and often suffer from osteoarthritis, quite markedly and significantly [1]. As a result, predicting that the multiple COVID pandemic restrictions would largely protect against this infectious disease, but failing to consider the fact that these public health strategies could worsen chronic health conditions such as osteoarthritis and its burden and costs at all disease stages quite adversely, which was indeed apparent on later reflection, this oversight has clearly placed many older adults at risk for excess osteoarthritis disability, as well as a probable heightened COVID-19 infection risk [10] and possible increases in pain, muscle weakness, wasting, and frailty [10]. In addition to the multiple needs of the community dwelling older adult under such circumstances, those suffering from osteoarthritis may have had concerns about what to do as a whole, and were expected to be digitally literate, and receive information via remote mechanisms that may have provoked confusion, or fear of undertaking recommended steps because they did not understand the instructions provided [11].…”

Section: Resultsmentioning

confidence: 99%

Osteoarthritis Literacy and Equity Issues: A Post COVID-19 Analysis and Update

Marks

2022

JARH

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Background Osteoarthritis, the most common joint disease and one affecting a large number of older adults is not always amenable to the use of passive interventions such as surgery or pharmacologic interventions, but even then, to maximize any desirable intervention approaches, a trustworthy and supportive partnership with the sufferer is strongly indicated. Complicating this process are emerging equity and persistent health literacy issues, as well as post COVID-19 service associated ramifications and persistent disease risks. Aim This mini review was designed to examine what current data reveal as regards the presentation of osteoarthritis and its pathology among the older adult as of the current post COVID-19 pandemic period in 2022, and how health literacy and equity issues are likely implicated in some degree with the disease presentation and its outcomes and will be likely to continue, unless remediated. Methods Peer reviewed published articles on this topic were sought from multiple data bases using the key words- osteoarthritis, health equity, health literacy, prevention, and intervention. Results As in prior years, osteoarthritis continues to induce considerable physical disability and consistently impedes the attainment of a high life quality for many older adults. Although not studied to any degree, attention to health equity and literacy issues appear to pose additional osteoarthritis intervention challenges, especially among the long COVID affected older adults and those with low income and educational levels. Conclusions Many behaviourally oriented and necessary osteoarthritis management approaches and interventions may fail to reduce the functional disability and pain experienced by older people with any form of osteoarthritis to any meaningful degree if a) the provider does not tailor their recommendations in light of possible prevailing health literacy, economic, and educational challenges; b) the patient does not understand how their health behaviours impact joint disease as well as COVID-19 risk status, and are not empowered to undertake these.

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Section: Resultsmentioning

confidence: 99%

Osteoarthritis Literacy and Equity Issues: A Post COVID-19 Analysis and Update

Marks

2022

JARH

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“…Ensuring the VKS is appropriate for individuals with low health literacy is more of a priority because low musculoskeletal health literacy is associated with worse outcomes post-TKR, 7 and digital interventions have the potential to improve health literacy. 23 The other two participants who perceived the VKS as less acceptable related this to the digital delivery format, which they found anxietyprovoking and/or too difficult to use. This demonstrates that digital interventions are unlikely to meet all patients' needs, even when their development involves extensive patient input and prioritises accessibility/ inclusion.…”

Section: Discussionmentioning

confidence: 98%

“…Arguably, this does not present a major concern for the potential value of the VKS as this individual had already obtained and acted on relevant health information, suggesting he had high health literacy. Ensuring the VKS is appropriate for individuals with low health literacy is more of a priority because low musculoskeletal health literacy is associated with worse outcomes post‐TKR, 7 and digital interventions have the potential to improve health literacy 23 …”

Section: Discussionmentioning

confidence: 99%

“…Rigorously developing digital interventions is essential to mitigate these drawbacks. Despite this, a recent review of educational joint replacement digital interventions reported none had been developed using a validated framework or co‐designed with the intended users 23 . Other reviews have raised concerns about the quality of TKR apps and YouTube videos, and the readability of online TKR educational resources 24–26 …”

Section: Introductionmentioning

confidence: 99%

“…Despite this, a recent review of educational joint replacement digital interventions reported none had been developed using a validated framework or codesigned with the intended users. 23 Other reviews have raised concerns about the quality of TKR apps and YouTube videos, and the readability of online TKR educational resources. [24][25][26] To help address the above issues, this project aimed to develop a novel UK-based pre-operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS).…”

Section: Introductionmentioning

confidence: 99%

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Supporting patients to prepare for total knee replacement: Evidence‐, theory‐ and person‐based development of a ‘Virtual Knee School’ digital intervention

Anderson,

McHugh,

Comer

et al. 2023

Health Expectations

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IntroductionDigital delivery of pre‐operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre‐ and post‐operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks.ObjectiveTo develop a pre‐operative TKR education and prehabilitation digital intervention, the ‘Virtual Knee School’ (VKS).MethodsThe VKS was developed using an evidence‐, theory‐ and person‐based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think‐aloud interviews with nine patients who were awaiting/had undergone TKR. Meta‐inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773).ResultsMost participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta‐inferences were generated and recommend: Comprehensive pre‐operative TKR education and prehabilitation support should be rapidly accessible in digital and non‐digital formats. Pre‐operative TKR digital interventions should employ computer‐ and self‐tailoring to account for patients' individual needs and preferences.ConclusionsIntegrating evidence, theory and stakeholders' perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre‐operative TKR care.Patient or Public ContributionPatient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototype and helped disseminate the project findings.

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