Background:Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective:A focus group with 7 participants was conducted to examine the app's usability and collect feedback for future iterations. Methods:Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results:Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions:These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client's preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes' program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals.

Social determinants of health, the effects of colonialism, and systemic injustices result in some groups being at disproportionately higher risk for developing type 2 diabetes (T2D). Many T2D prevention programs have not been designed to provide equitable and inclusive care to everyone. This paper presents an example of the steps taken in an evidence-based community T2D prevention program, Small Steps for Big Changes (SSBC), to improve equitable access and inclusivity based on input from a stakeholder advisory group and the ConNECT Framework. To improve reach to those most at risk for T2D, SSBC has changed both eligibility criteria and program delivery. To ensure that all testing is done in an inclusive manner, changes have been made to measurements, and to training for those delivering the program. This paper also provides actionable recommendations for other researchers to incorporate into their own health programs to promote inclusivity and ensure that they reach those most at risk of T2D.

Background People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies.

Despite the surge in popularity of virtual health care services as a means of delivering health care through technology, the integration of research evidence into practice remains a challenge. Rapid reviews, a type of time-efficient evidence synthesis, offer a potential solution to bridge the gap between knowledge and action. This paper aims to highlight the experiences of the Fraser Health Authority’s Virtual Health team in conducting rapid reviews. This paper discusses the experiences of the Virtual Health team in conducting 15 rapid reviews over the course of 1.5 years and the benefit of involving diverse stakeholders including researchers, project and clinical leads, and students for the creation of user-friendly knowledge products to summarize results. The Virtual Health team found rapid reviews to be a valuable tool for evidence-informed decision-making in virtual health care. Involving stakeholders and focusing on implementation considerations are crucial for maximizing the impact of rapid reviews. Health care decision makers are encouraged to consider implementing rapid review processes to improve the translation of research evidence into practice, ultimately enhancing patient outcomes and promoting a culture of evidence-informed care.

Objective:To explore clinical practice patterns of physical therapists (PTs) who treat people with Achilles tendinopathy (AT), and identify perceived barriers and facilitators for prescribing and engaging with therapeutic exercise among PTs and people with AT.Methods:Two cross-sectional surveys were electronically distributed between November 2021 and May 2022; one survey was designed for PTs while the second was for people with AT. Survey respondents answered questions regarding their physical therapy training and current practice (PTs), injury history and management (people with AT), and perceived barriers and facilitators (PTs and people with AT).Results:341 PTs and 74 people with AT completed the surveys. In alignment with clinical practice guidelines, more than 94% of PTs surveyed (97% of whom had some form of advanced musculoskeletal training) prioritise patient education and therapeutic exercise. Patient compliance, patient knowledge, and the slow nature of recovery were barriers to prescribing therapeutic exercise reported by PTs, while time, physical resources, and a perceived lack of short-term treatment effectiveness were barriers for people with AT.Conclusions:Consistent with clinical practice guidelines, PTs with advanced training reported prioritising therapeutic exercise and education for managing AT. However, both PTs and people with AT identified many barriers to prescribing or engaging with therapeutic exercise. By addressing misconceptions about the time burden and ineffectiveness of exercise, and by overcoming access issues to exercise space and equipment, PTs may be able to improve intervention adherence and subsequently outcomes for people with AT.

mHealth technologies are being continually used to supplement diabetes prevention programs. Given the thousands of mHealth apps on the market and lack of an evidence base, there has been a call for more thorough development and evaluation of apps targeting diabetes prevention behaviors. This paper presents a case study on the development of an mHealth app to support participants in the Small Steps for Big Changes diabetes prevention program, using the Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research (FASTER). The design process followed the 5 stages within the development phase of FASTER ( Empathize, Define, Ideate, Prototype, and Test ) and broadly consisted of a needs assessment, literature review, end-user feedback and heuristic evaluation. Additionally, the app behavior change scale was consulted to ensure that the resulting app included evidence-based techniques to maximize its potential of behavior change. This systematic process resulted in the development of an app consisting of evidence-based behavior change techniques likely to elicit behavior change. This paper is the first to use the FASTER to develop a diabetes prevention app (or app of any type) and confirms the usability and usefulness of the framework within the complex area of preventative medicine. The systematic development of the Small Steps for Big Changes app will be followed by thorough validation coupled with usability and effectiveness evaluations in the next two phases of the FASTER.

In this paper, we explore what is needed to generate quality research to guide evidence-informed digital health policy and call the Canadian community of patients, clinicians, policy (decision) makers and researchers to action in setting digital health research priorities for supporting underserved communities. Using specific examples, we describe how evidence is produced and implemented to guide digital health policy. We study how research environments must change to reflect and include the communities for whom the policy is intended. Our goal is to guide how future evidence reaches policy makers to help them shape healthcare services and how these services are delivered to underserved communities in Canada. Understanding the pathways through which evidence can make a difference to equitable and sustainable digital health policy is vital for guiding the types of research that attract priority resources.

OBJECTIVES:Previous reviews have highlighted the efficacy of lifestyle diabetes prevention programs (DPPs) in decreasing type 2 diabetes (T2D) risk, but the participating populations were predominantly White. This is concerning, as ethnically diverse populations are disproportionately affected by T2D. The objective of this scoping review was to 1) summarize existing tailored DPPs and 2) provide recommendations for future program implementation to improve access and reach for diverse populations. METHODS:This work represents a subanalysis of a larger scoping review synthesizing DPPs. Several databases were searched for studies relating to T2D risk and lifestyle programs. Study characteristics were systematically extracted using the Template for Intervention Description and Replication checklist. RESULTS:Of 25,110 screened publications, 351 (220 programs) were included in the larger review. Only 29% (64 programs) of the 220 programs were identified as specifically serving ethnically diverse populations and were included in this subanalysis. An updated search was run that identified an additional 10 publications (10 programs). Over a third (35%) of programs reported strategies used to tailor their intervention to the target population; of those that reported, 62% tailored the content of the intervention to be culturally appropriate and relevant as well as accommodate the geographic and cultural context. CONCLUSIONS:Based on recruitment, tailoring, and provision strategies used in DPPs targeting specific underresourced populations, this review provides recommendations on how future program developers can increase access and reach, improving individual- and population-level health outcomes via T2D reduction in those at highest risk.

Abstract Background The integration of virtual solutions in healthcare has shown promise in improving access and reducing strain on hospital services. To maximize impact, healthcare authorities should understand what populations to prioritize in virtual healthcare service deployment as well as the research evidence for virtual care services for those populations. This study aims to support the Fraser Health (FH) Authority in prioritizing the implementation of virtual health, focusing on patient populations that would benefit most. “Patient profiles” were created by analyzing admission, readmission rates, and length of stay based on chronic conditions across FH sites. Using the Pabon Lasso Model for visualization, chronic conditions were categorized into zones to identify those with the greatest acute load. Rapid umbrella reviews were conducted for heart failure, COPD, and diabetes to identify evidence-based virtual care solutions for these high-utilization populations. The resulting knowledge products offered user-friendly, high-level overviews of the evidence for decision-making. Results Heart failure, COPD, diabetes, schizophrenia, and anxiety disorders were identified as top chronic conditions with highest acute loads. Rapid umbrella reviews indicated potential benefits of the following virtual care interventions for heart failure, COPD, and diabetes: remote patient monitoring (RPM), eLearning, virtual support (via phone calls or video conferencing), tele-rehabilitation, and text messaging. Conclusion Integration of virtual care services has the potential to revolutionize healthcare but requires careful planning and consideration of barriers. Patient profiles and rapid umbrella reviews offer a comprehensive approach to inform prioritization and implementation. RPM, eLearning, virtual support, tele-rehab, and text messaging showed promise for specific chronic conditions.

AimDiabetes prevention programs targeting dietary and physical activity behavior change have been shown to decrease the incidence of type 2 diabetes; however, more thorough reporting of intervention characteristics is needed to expedite the translation of such programs into different communities. This scoping review aims to synthesize how diabetes prevention programs are being reported and implemented.MethodsA scoping review following the Arkey and O’Malley methods was conducted following the PRISMA guidelines. Medline, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched for studies relating to diabetes prevention, and diet/exercise interventions. Only studies delivering a diet/exercise intervention among adults identified as “at risk” for developing type 2 diabetes were included. The Template for Intervention Description and Replication (TIDieR) was used to guide data extraction, and each DPP was scored on a scale from 0 to 2 for how thoroughly it reported each of the items (0 = did not report; 2 = reported in full; total score /26).ResultsOf the 25,110 publications screened, 351 publications (based on 220 programs) met the inclusion criteria and were included for data extraction. No studies comprehensively reported on all TIDieR domains (mean TIDieR score = 15.7/26; range 7 to 25). Reporting was particularly poor among domains related to ‘modifications’, ‘tailoring’, and ‘how well (planned/actual)’. "How well (planned)" assesses the intended delivery of an intervention, detailing the initial strategies and components as per the original design, while "how well (actual)" evaluates the extent to which the intervention was executed as planned during the study, including any deviations or modifications made in practice.ConclusionsWhile there is evidence to suggest that diabetes prevention programs are efficacious, more thorough reporting of program content and delivery is needed to improve the ability for effective programs to be implemented or translated into different communities.

Background Virtual patient-to-provider messaging systems such as text messaging have the potential to improve healthcare access; however, little research has used theory to understand the barriers and facilitators impacting uptake of these systems by patients and healthcare providers. This review uses the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore barriers and facilitators of patient-to-provider messaging. Methods A rapid umbrella review method was followed. Medline and CINAHL were searched for review articles that examined patient-to-provider implementation barriers and facilitators by patients or healthcare providers. Two coders extracted implementation barriers and facilitators, and one coder mapped these barriers and facilitators on to the COM-B and TDF. Results Fifty-nine unique barriers and facilitators were extracted. Regarding healthcare provider oriented barriers and facilitators, the most frequently identified COM-B components included Reflective Motivation (identified in 42% of provider barriers and facilitators), Psychological Capability (19%) and Physical Opportunity (19%) and TDF domains included Beliefs about Consequences (identified in 28% of provider barriers and facilitators), Environmental Context and Resources (19%), and Social Influences (17%). Regarding patient oriented barriers and facilitators, the most frequently identified COM-B components included Reflective Motivation (identified in 55% of patient barriers and facilitators), Psychological Capability (16%), and Physical Opportunity (16%) and TDF domains included Beliefs about Consequences (identified in 30% of patient barriers and facilitators), Environmental Context and Resources (16%), and Beliefs about Capabilities (11%). Conclusions Both patients and healthcare providers experience barriers to implementing patient-to-provider messaging systems. By conducting a COM-B and TDF-based analysis of the implementation barriers and facilitators, this review highlights several theoretical domains for researchers, healthcare systems, and policy-makers to focus on when designing interventions that can effectively target these issues and enhance the impact and reach of virtual messaging systems in the future.

BACKGROUND The remote, dispersed, and multicultural population of Canada presents unique challenges for health care services. Currently, virtual care solutions are being offered as an innovative solution to improve access to care. OBJECTIVE Given the inequities in health care access faced by immigrant, refugee, and Indigenous Canadians, this review aimed to summarize information obtained from original research regarding these people’s experiences with virtual care services in Canada. METHODS We conducted a rapid review following published recommendations. MEDLINE and CINAHL were searched for studies relating to virtual care and Canadian immigrants, refugees, or Indigenous peoples. Peer-reviewed articles of any type were included so long as they included information on the experiences of virtual care service delivery in Canada among the abovementioned groups. RESULTS This review demonstrates an extreme paucity of evidence examining the experiences of immigrant, refugee, and Indigenous groups with virtual care in Canada. Of the 694 publications screened, 8 were included in this review. A total of 2 studies focused on immigrants and refugees in Canada, with the remaining studies focusing on Indigenous communities. Results demonstrate that virtual care is generally accepted within these communities; however, cultural appropriateness or safety and inequitable access to wireless services in certain communities were among the most cited barriers. CONCLUSIONS Little evidence exists outlining immigrants’, refugees’, and Indigenous peoples’ perspectives on the landscape of virtual care in Canada. The development of virtual care programming should take into consideration the barriers, facilitators, and recommendations outlined in this review to improve equitable access. Further, developers should consult with local community members to ensure the appropriateness of services for immigrant, refugee, and Indigenous communities in Canada.

Background. Occupational Therapists, among other healthcare decision makers, often need to make decisions within limited timeframes and cannot wait for the completion of large rigorous systematic reviews and meta-analyses. Rapid reviews are one method to increase the integration of research evidence into clinical decision making. Rapid reviews streamline the systematic review process to allow for the timely synthesis of evidence; however, there does not exist a single agreed upon guide for the methodology and reporting of rapid reviews. Purpose. This paper proposes a rapid review methodology that is customized to a professional organization practice which can feasibly be used by practice networks such as those of the Canadian Association for Occupational Therapy to conduct reviews. Implications. Practice networks provide a sustainable mechanism to integrate research evidence and foster communication amongst practitioners. This guide for conducting and reporting rapid reviews can be used across Occupational Therapy practice networks and similar groups to support the consistent and timely synthesis of evidence necessary to improve evidence-informed clinical decision making.

Purpose: Hypokinetic dysarthria associated with Parkinson's disease (PD) is characterized by dysprosody, yet the literature is mixed with respect to how dysprosody affects the ability to mark lexical stress, possibly due to differences in speech tasks used to assess lexical stress. The purpose of this study was to compare how people with and without PD modulate acoustic dimensions of lexical stress—fundamental frequency, intensity, and duration—to mark lexical stress across three different speech tasks. Method: Twelve individuals with mild-to-moderate idiopathic PD and 12 age- and sex-matched older adult controls completed three speech tasks: picture description, word production in isolation, and word production in lists. Outcome measures were the fundamental frequency, intensity, and duration of the vocalic segments of two trochees (initial stress) and two iambs (final stress) spoken in all three tasks. Results: There were very few group differences. Both groups marked trochees by modulating intensity and fundamental frequency and iambs by modulating duration. Task had a significant impact on the stress patterns used by both groups. Stress patterns were most differentiated in words produced in isolation and least differentiated in lists of words. Conclusions: People with PD did not demonstrate impairments in the production of lexical stress, suggesting that dysprosody associated with PD does not impact all types of prosody in the same way. However, there were reduced distinctions in stress marking that were more apparent in trochees than iambs. In addition, the task used to assess prosody has a significant effect on all acoustic measures. Future research should focus on the use of connected speech tasks to obtain more generalizable measures of prosody in PD.

The study investigated word recognition during neural activation in monolinguals and bilinguals. We specifically examined word retrieval and blood-oxygenation changes in the prefrontal cortex during a code-mixed word recognition task. Participants completed a gating task incorporating monolingual sentences and Spanish-English code-mixed sentences while using functional near-infrared spectroscopy (fNIRS) to measure blood-oxygenation changes. Word recognition contained four phonotactic conditions: (1) voiceless initial consonants, (2) voiced initial consonants, (3) CV-tense words, and (4) CV-lax words. Bilingual speakers had word-recognition capabilities similar to monolingual speakers even when identifying English words. Word recognition outcomes suggested that prefrontal cortex functioning is similar for early age of acquisition (AOA) bilinguals and monolinguals when identifying words in both code-mixed and monolingual sentences. Monolingual speakers experienced difficulty with English-voiced consonant sounds; while bilingual speakers experienced difficulties with English-lax vowels. Results suggest that localization of speech perception may be similar for both monolingual and bilingual populations, yet levels of activation differed. Our findings suggest that this parity is due to early age of acquisition (AoA) bilinguals finding a balance of language capabilities (i.e., native-like proficiency) and that in some instances the bilingual speakers processed language in the same areas dedicated to first language processing.

OBJECTIVE:This scoping review describes resistance-based therapeutic exercise intervention characteristics for Achilles tendinopathy (AT) treatment (e.g., therapeutic dose, underlying mechanisms targeted by exercise) and assesses participant reporting characteristics.METHODS:Seven electronic databases were searched; studies delivering a resistance exercise-focused treatment for individuals with AT were included. The Template for Intervention Description and Replication (TIDieR) and the ICON 2019 'Recommended standards for reporting participant characteristics in tendinopathy research' checklists framed data extraction, and study quality was assessed using the Mixed Methods Appraisal Tool 2018 version.RESULTS:68 publications (describing 59 studies and 72 exercise programs) were included. Results demonstrate that therapeutic exercise interventions for AT are well reported according to the TIDieR checklist, and participant characteristics are well reported according to the ICON checklist. Various underlying therapeutic mechanisms were proposed, with the most common being increasing tendon strength, increasing calf muscle strength, and enhancing collagen synthesis.CONCLUSIONS:While evidence suggests that resistance-based therapeutic exercise interventions are effective in treating AT, more reporting on program fidelity, adherence, and compliance is needed. By summarizing currently published AT exercise programs and reporting key intervention characteristics in a single location, this review can assist clinicians in developing individualized resistance training programs for people with AT.

Background With hundreds of pain management apps on the Canadian marketplace, it can be challenging for patients and clinicians to select effective and evidence-based mobile health (mHealth) apps that address pain from a biopsychosocial perspective.Aims The aim of this study is to identify pain management apps within the Canadian app marketplaces to aid clinicians in recommending apps.Methods The iOS and Android marketplaces were systematically searched to identify pain management apps that included at least one core component of cognitive behavioral therapy (CBT) or mindfulness- and acceptance-based therapies. Selected apps were assessed using a researcher developed psychological components checklist, and the Mobile App Rating Scale (MARS). These two measures provided a robust assessment of the apps' technical abilities and psychological principles being implemented.Results Five hundred eight pain management apps were identified, yet only 12 included a psychological component and were available for evaluation. On average, apps contained 8.10 out of 18 psychological components (SD = 2.77) with a MARS quality rating of 4.02 out of 5 (SD = 0.32). The most common psychological components were grounded in CBT, including psychoeducation, sleep hygiene, behavioral activation, coping skills training, and social support. Among the least commonly included components were goal setting, values, and culture/diversity. Two-thirds of the apps involved health care practitioners in their development, but independent scientific review of apps was scarce.Conclusion The highest scoring apps (Curable, Pathways, Vivify) are highlighted for health care practitioners who may wish to recommend mHealth technologies to their patients for pain management. Future directions for research and app development are discussed.

With thousands of mobile health (mHealth) solutions on the market, patients and health care providers struggle to identify which solution to use and prescribe. The lack of evidence-based mHealth solutions may be because of limited research on intervention development and the continued use of traditional research methods for mHealth evaluation. The Multiphase Optimization Strategy (MOST) is a framework that aids in developing interventions that produce the best-expected outcomes (ie, effectiveness), given constraints imposed on affordability, scalability, and efficiency (also known as achieving intervention EASE). The preparation phase of the MOST highlights the importance of formative intervention development-a stage often overlooked and rarely published. The aim of the preparation phase of the MOST is to identify candidate intervention components, create a conceptual model, and define the optimization objective. Although the MOST sets these 3 targets, no guidance is provided on how to conduct quality research within the preparation phase and what specific steps can be taken to identify potential intervention components, develop the conceptual model, and achieve intervention EASE with the implementation context in mind. To advance the applicability of the MOST within the field of implementation science, this study provides an account of the methods used to develop an mHealth intervention using the MOST. Specifically, we provide an example of how to achieve the goals of the preparation phase by outlining the formative development of an mHealth-prompting intervention within a diabetes prevention program. In addition, recommendations are proposed for future researchers to consider when conducting formative research on mHealth interventions with implementation in mind. Given its considerable reach, mHealth has the potential to positively affect public health by decreasing implementation costs and improving accessibility. The MOST is well-suited for the efficient development and optimization of mHealth interventions. By using an implementation-focused lens and outlining the steps in developing an mHealth intervention using the preparation phase of the MOST, this study may guide future intervention developers toward maximizing the impact of mHealth outside academia.