Periodic Reporting for period 1 - DigiCare4You (An intersectoral innovative solution involving DIGItal tools, empowering families and integrating community CARE services for the prevention and management of type 2 diabetes and hypertension)
Période du rapport: 2021-04-01 au 2022-09-30
Type 2 diabetes (T2D) and hypertension (HTN) represent a major health, financial and psychological burden on individuals, their families and society and cause important challenges to public health systems. Although T2D and HTN can be prevented through lifestyle changes, their prevalence is increasing in Europe with overweight and obesity being major risk factors. Given the association between parents’ and children’s weight status, targeting families and promoting a supportive environment could have multiple benefits on lifestyle and health for both high-risk parents and their offspring.
Nowadays, there is a need to transform existing hospital- and disease-centred healthcare systems into people-centred integrated care models that focus on health promotion and disease prevention. Digitalization of healthcare could facilitate this transformation although technical innovations go hand in hand with organizational and policy innovations to achieve the anticipated impact. Last but not least, T2D and HTN are strongly associated with socioeconomic disadvantages, suggesting a health inequality dimension that needs to be considered when planning public health initiatives for their prevention and management.
Considering all the above, DigiCare4You Consortium jointly works with local stakeholders to strengthen primary health systems and deliver an intersectoral innovation, involving digital tools, for early screening, prevention and management of T2D and HTN in an effective, efficient and equitable way. DigiCare4You solution consists of a two-stage screening procedure to identify families at high risk for T2D and/or HTN, followed by an intervention combining the use of digital tools and activities supporting families’ well-being in schools and communities. DigiCare4You project will conduct an implementation study targeting more than 10,000 families in two middle-income countries (MICs, Albania & Bulgaria) and two high-income countries (HICs, Greece & Spain). Specifically DigiCare4You project aims to:
• Study and understand the local needs & contextual factors
• Adapt the innovative solution & develop the evaluation tools for its implementation
• Implement the innovative solution, using existing facilities, personnel and processes to foster a low-cost and sustainable approach & evaluate its process, impact, outcome, cost-effectiveness, scalability and transferability
• Apply regular monitoring to refine protocols and ensure adaptability, equity and effective uptake
• Develop a roadmap to help policy makers across Europe adopt Digicare4You solution and promote people-centred care and integrated health services
Nowadays, there is a need to transform existing hospital- and disease-centred healthcare systems into people-centred integrated care models that focus on health promotion and disease prevention. Digitalization of healthcare could facilitate this transformation although technical innovations go hand in hand with organizational and policy innovations to achieve the anticipated impact. Last but not least, T2D and HTN are strongly associated with socioeconomic disadvantages, suggesting a health inequality dimension that needs to be considered when planning public health initiatives for their prevention and management.
Considering all the above, DigiCare4You Consortium jointly works with local stakeholders to strengthen primary health systems and deliver an intersectoral innovation, involving digital tools, for early screening, prevention and management of T2D and HTN in an effective, efficient and equitable way. DigiCare4You solution consists of a two-stage screening procedure to identify families at high risk for T2D and/or HTN, followed by an intervention combining the use of digital tools and activities supporting families’ well-being in schools and communities. DigiCare4You project will conduct an implementation study targeting more than 10,000 families in two middle-income countries (MICs, Albania & Bulgaria) and two high-income countries (HICs, Greece & Spain). Specifically DigiCare4You project aims to:
• Study and understand the local needs & contextual factors
• Adapt the innovative solution & develop the evaluation tools for its implementation
• Implement the innovative solution, using existing facilities, personnel and processes to foster a low-cost and sustainable approach & evaluate its process, impact, outcome, cost-effectiveness, scalability and transferability
• Apply regular monitoring to refine protocols and ensure adaptability, equity and effective uptake
• Develop a roadmap to help policy makers across Europe adopt Digicare4You solution and promote people-centred care and integrated health services
During the 1st period of the project, the following tasks were completed:
• Two local Stakeholder Advisory Boards (SABs) (one with implementers and one with end-users) were established in each implementation country to contribute to the effective embedment of the DigiCare4You solution to the local systems
• A comprehensive review of the contextual factors related to the healthcare services in each country was conducted
• Two focus groups and two conjoint web surveys (one with implementers and one with end-users) were organized in each country to identify potential barriers and facilitators for the implementation of the DigiCare4You solution, as well as to explore the determinants of its acceptance and use
• Two systematic literature reviews were conducted to synthesise evidence on the clinical and cost-effectiveness of mHealth and community-based interventions for the prevention and management of T2D and HTN
• The strategies to guide the adaptation and implementation of the DigiCare4You solution in each country were identified
• The implementation plan and the standard operating procedures (SOPs) for the two-stage screening and the mHealth intervention were developed and adapted for each country
• The digital tools for the two-stage screening and the mHealth intervention were adapted, translated into the local languages and tested in each country in terms of usability and acceptance at the implementer and end-user level
• The material for the school intervention was adapted to the needs of each country and translated into the local languages
• The 1st version of the DigiCare4You Social Collaboration Platform, a web-based social community for the promotion of healthy and active lifestyle for all residents/families, was created
• The tools and the plan for the process, impact, outcome and cost-effectiveness evaluation of the DigiCare4You solution were developed
• The DigiCare4You Digital Platform and Secure Cloud-based Repository to be used for entering and storing all collected data, were developed, as well as the Visual Analytics component of the digital platform to provide a visualization of data relevant to the process and outcome evaluation
• The AI-empowered Virtual Assistant to guide the healthcare recipients in self-managing their condition was developed, as well as the main features of the Decision Support System to help the implementers monitor and evaluate the outcomes of the healthcare recipients and facilitate their decision-making
• The protocol of the DigiCare4You implementation study was developed, while approvals from Ethics Committees and/or regulatory authorities relevant to the research activities were obtained in each country
• A central training of the local research teams on the plan, SOPs and the digital tools for the screening and intervention, was conducted, followed by relevant trainings for the local implementers by the research teams in each country
• The plan for the communication and dissemination activities was formulated, dissemination material was developed, while the International SAB was established to support the development of a scalable DigiCare4You solution
• Two local Stakeholder Advisory Boards (SABs) (one with implementers and one with end-users) were established in each implementation country to contribute to the effective embedment of the DigiCare4You solution to the local systems
• A comprehensive review of the contextual factors related to the healthcare services in each country was conducted
• Two focus groups and two conjoint web surveys (one with implementers and one with end-users) were organized in each country to identify potential barriers and facilitators for the implementation of the DigiCare4You solution, as well as to explore the determinants of its acceptance and use
• Two systematic literature reviews were conducted to synthesise evidence on the clinical and cost-effectiveness of mHealth and community-based interventions for the prevention and management of T2D and HTN
• The strategies to guide the adaptation and implementation of the DigiCare4You solution in each country were identified
• The implementation plan and the standard operating procedures (SOPs) for the two-stage screening and the mHealth intervention were developed and adapted for each country
• The digital tools for the two-stage screening and the mHealth intervention were adapted, translated into the local languages and tested in each country in terms of usability and acceptance at the implementer and end-user level
• The material for the school intervention was adapted to the needs of each country and translated into the local languages
• The 1st version of the DigiCare4You Social Collaboration Platform, a web-based social community for the promotion of healthy and active lifestyle for all residents/families, was created
• The tools and the plan for the process, impact, outcome and cost-effectiveness evaluation of the DigiCare4You solution were developed
• The DigiCare4You Digital Platform and Secure Cloud-based Repository to be used for entering and storing all collected data, were developed, as well as the Visual Analytics component of the digital platform to provide a visualization of data relevant to the process and outcome evaluation
• The AI-empowered Virtual Assistant to guide the healthcare recipients in self-managing their condition was developed, as well as the main features of the Decision Support System to help the implementers monitor and evaluate the outcomes of the healthcare recipients and facilitate their decision-making
• The protocol of the DigiCare4You implementation study was developed, while approvals from Ethics Committees and/or regulatory authorities relevant to the research activities were obtained in each country
• A central training of the local research teams on the plan, SOPs and the digital tools for the screening and intervention, was conducted, followed by relevant trainings for the local implementers by the research teams in each country
• The plan for the communication and dissemination activities was formulated, dissemination material was developed, while the International SAB was established to support the development of a scalable DigiCare4You solution
During the 1st period, the following progress beyond the state of the art was made:
• Adaptation and digitalisation of a two-stage screening procedure for the early identification of individuals at risk of T2D: DigiCare4You built on the school and community-based population screening applied in the H2020 Feel4Diabetes-study and further adapted it, considering the contextual factors in each country. Digital tools were developed to identify parents/caregivers at risk of T2D.
• Customization of the mHealth applications to the needs of users and their carers: An in-depth situational analysis and needs assessment was conducted in each implementation country that guided the contextual and cultural adaptation of the mHealth applications, using the MetaClinic and MetaDieta digital health solutions as a basis.
• Engagement of key local stakeholders from the beginning of the project: Following a community-based participatory research approach, two SABs consisted of key local stakeholders (policy makers, implementers, school representatives and users) were established in each country and were actively involved in the adaptation of the DigiCare4You solution to the local needs and contextual factors.
• Focus on families and consideration of vulnerable groups: The DigiCare4You solution targets families instead of individuals; the screening procedure is combined with children’s growth assessment and the intervention was developed to support healthy and active living for the entire family. Moreover, the innovative solution will be implemented in both MICs and HICs across Europe and aims to improve access to healthcare for all families, including the most vulnerable.
• Adaptation and digitalisation of a two-stage screening procedure for the early identification of individuals at risk of T2D: DigiCare4You built on the school and community-based population screening applied in the H2020 Feel4Diabetes-study and further adapted it, considering the contextual factors in each country. Digital tools were developed to identify parents/caregivers at risk of T2D.
• Customization of the mHealth applications to the needs of users and their carers: An in-depth situational analysis and needs assessment was conducted in each implementation country that guided the contextual and cultural adaptation of the mHealth applications, using the MetaClinic and MetaDieta digital health solutions as a basis.
• Engagement of key local stakeholders from the beginning of the project: Following a community-based participatory research approach, two SABs consisted of key local stakeholders (policy makers, implementers, school representatives and users) were established in each country and were actively involved in the adaptation of the DigiCare4You solution to the local needs and contextual factors.
• Focus on families and consideration of vulnerable groups: The DigiCare4You solution targets families instead of individuals; the screening procedure is combined with children’s growth assessment and the intervention was developed to support healthy and active living for the entire family. Moreover, the innovative solution will be implemented in both MICs and HICs across Europe and aims to improve access to healthcare for all families, including the most vulnerable.