Inflammatory bowel disease (IBD) is a chronic illness that is comprised of two major disorders: Crohn's disease and ulcerative colitis. Adults with IBD have adopted telehealth and mobile health (mHealth) interventions to improve their selfmanagement skills and symptom-monitoring. This systematic review aimed to evaluate the efficacy of telehealth and mHealth interventions and explore the benefits and challenges of these interventions in patients with IBD. This review used a convergent segregated approach to synthesize and integrate research findings, a methodology recommended by the Joanna Briggs Institute for mixed-methods systematic reviews. Databases searched included PubMed, CINAHL, Embase, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. The search followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, which yielded sixteen quantitative and two qualitative articles. A narrative synthesis was performed to present the findings of quantitative and qualitative studies. Evidence from quantitative and qualitative studies was then integrated for a combined presentation. The results of quantitative analysis supported the efficacy of telehealth and mHealth interventions to improve patients' quality of life, medication adherence, disease activity, medication monitoring, disease-related knowledge and cost savings. While some participants in qualitative studies reported certain challenges of telehealth and mHealth interventions, most of the participants conferred the benefits of the interventions, including improved disease-related knowledge, communication between patients and providers, sense of reassurance, and appointment options. The evidence from quantitative and qualitative synthesis partially supported each other. 1 | INTRODUCTION Inflammatory bowel disease (IBD) is a chronic illness of the gastrointestinal (GI) tract that mainly encompasses two major disorders: Crohn's disease (CD) and ulcerative colitis (UC; Lee, Kwon, & Cho, 2018). Active inflammation of the GI tract is the key factor behind IBD (Stein & Shaker, 2015). The clinical presentation of IBD includes abdominal pain, diarrhea, bowel urgency, rectal bleeding, weight loss, nutritional deficiencies, and many other extraintestinal manifestations (Stein & Shaker, 2015). Additionally, other symptoms, such as anxiety, depression, sleep disturbances, and fatigue, are highly prevalent in adults with IBD (Conley et al., 2017). This symptom burden, coupled with the remitting-relapsing nature of the disease and many other factors, including low social and family support, female gender,
Purpose and Objectives This article describes the implementation and evaluation of a chronic disease mini-grant initiative, coordinated by a state health department in collaboration with multiple stakeholders. Braided funding from federal and state sources was used to build and implement the initiative. Intervention Approach Mini-grants, facilitated by five different facilitating organizations, were funded to promote implementation of policy, systems, and environmental (PSE) changes at the local level. Grant recipients represented a variety of sectors, including education, government, and nonprofit organizations. Evaluation Methods Primary (surveys) and secondary (final reports) data documented achievement of PSE changes. Results A total of $196,369 was dispersed to 65 organizations; 126 PSE changes in the areas of physical activity, nutrition, and tobacco were reported. Challenges in implementing and evaluating mini-grants were identified, including the heterogeneity of the sectors/settings involved and associated variability of proposed activities, time lines, measurement, and evaluation activities. COVID-19 (coronavirus disease 2019) also disrupted the plans for many projects. Implications for Public Health The success of this initiative can be attributed to four main elements: (1) the use of intermediary organizations to facilitate the mini-grants; (2) a participatory evaluation process, combined with early and ongoing communication among all stakeholders; (3) a braided funding strategy; and (4) a multisector approach that engaged both traditional and nontraditional public health organizations. The processes and outcomes, including challenges, can inform other state health departments’ efforts in braiding funding and engaging intermediary organizations to expand the reach of PSE changes at the local level.
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